Group Work

with Sexually
Abused Children
 Group Work
with Sexually
Abused Children
A Practitioner's Guide

Lynn Grotsky • Carel Camerer • Lynn Damiano

/ ^ V S a g e Publications, Inc.
V^ty International Educational and Professional Publisher
Thousand Oaks • London • New Delhi
Copyright © 2000 by Sage Publications, Inc.

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or
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Library of Congress Cataloging-in-Publication Data

Grotsky, Lynn.
Group work with sexually abused children : A practitioner's guide / by
Lynn Grotsky, Carel Camerer, Lynn Damiano.
p. cm. — (Interpersonal violence)
Includes bibliographical references.
ISBN 0-7619-2079-X (pbk: acid-free paper)
I. Title. II. Series. III. Camerer, Carel. IV. Damiano, Lynn.
1. Sexually abused children—Rehabilitation. 2. Group psychotherapy for
children—Problems, exercises, etc.
RJ507.S49 G76 2000
618.92'858360651—dc21 99-006835

00 01 02 03 04 05 06 8 7 6 5 4 3 2 1

Acquiring Editor: Kassie Gavrilis

Production Editor: Denise Santoyo
Typesetter/Designer: Danielle Dillahunt
 CONTENTS

Preface ix

Acknowledgments ix

1. Introduction 1

Who Should Use This Book 3

How to Use This Book 3

2. Therapy Groups and Support Groups:

Differences, Goals, and Group Flow 5

The Overall Flow of Groups 8

3. Special Considerations in Setting Up Groups 13

Facilitators 13
Cofacilitating Groups 15
Gender of Facilitators 16
Grqup Set-Up 16

4. Group Format 25

5. Screening Group Members 27

Purposes of Screening 27
Screening the Parents of Children Being Considered for Group 30
Screening a Child for Group 33

6. Safety and Trust Exercises 41

Imaginary Object 43
Check-In 46
Safety Rules 49
 Group Mascot 53
Going Camping 57
Group Collage About the Abuse 61
Let It All Out/Sound Train 64
My Own Safe Place 66

7. Self-Esteem Exercises 69
Yes/No/Maybe Continuum 73
Ball Toss 78
Me, Through the Years (Therapy Group Only) 81
Friendship Medals 85
Sharing Our Stories (Minimal Disclosure) 88
London Bridge (The Escape Version) 92
The Parent Within (Therapy Group Only) 95

8. Internal and External Boundaries Exercises 99

Boundary Line 103
Internal/External Self (Therapy Group Only) 106
Feelings/Thoughts Mask 112
Life Vest 115
Feeling Image 119
Sentence Completion 123
Clay Faces 126
Target of the Offender 129
Animal Boundaries 133
Familiar Feelings 136
Talking to the Offender Psychodrama (Therapy Group Only) 139
My Own BASK Book (Therapy Group Only) 143
Lean on Me 152
If You're Angry and You Know It 156

9. Dynamics of Sexual Abuse Exercises 159

Letter From Angie 162
The Butterfly and the Spider 167
Personal Butterfly 171
Magic Tricks 174
The Trick Hat (Therapy Group Only) 177
Questions and Answers Box 180
Revised Cookie far Tune 183
Why People Sexually Abuse Kids 186
Letter/Video to the Offender 190
Sexual Assault Continuum (Therapy Group Only) 195
 The Alligator River Story 199
Letter/Video to Nonoffending Parent(s) (Therapy Group Only) 203

10. Trigger Response Exercises 211

101 Dalmatians 213
Elizabeth's Triggers (Therapy Group Only) 216
Centering 222
Drawing Where Molested (Therapy Group Only) 225
Triggered Memories (Therapy Group Only) 229
How We Sabotage Ourselves 234
Secret Soliloquy (Therapy Group Only) 239

11. Healthy Body Image and Self-Protection Exercises 243

Body Rights and Responsibilities 245
My Safety and Comforts 249
Healing Image 253
Body Tracing 257
Safety Plan 260
Simon Says and I Say 263
Prevention Skits (Therapy Group Only) 265
Date Rape 270

12. Closing Exercises 275

Wishes 277
Debriefing and Evaluating Group 279
Completion of Group Ceremony 282

Appendix: Sample Group Outlines 289

References 309

About the Authors 311

 PREFACE

W e believe it is important for you, the reader, to understand our

theoretical framework. This framework is based on our philosophy, which has formed
how we work with sexually abused children and their families and is the foundation
for the goals and objectives of our groups. The suppositions we are working under are
as follows:

• Child abuse exists.

• It is atypical for young children to lie about being sexually abused. In fact, children are more apt to
omit rather than commit information to avoid negative consequences.
• In order to treat the symptoms of sexual abuse, the therapist must treat the whole person: the
intellectual, emotional, physical, sexual, and spiritual selves.
• The entire family is affected when a member is sexually abused. Therefore, the entire family needs
and deserves treatment.
• There are no effective quick, short-term treatments for victims of ongoing sexual abuse, and a
combination of modalities is needed for treatment to be effective.
• Society is in various stages of denial about sexual abuse. Society is limited to the discovery and
assertion of only that which it sanctions.
• Abuse is perpetuated by a society that encourages people to be competitive, judgmental, and
controlling and where one or more groups of people are considered to be inferior to another. Victims
need to be educated about society's imbalance of power to minimize future victimization.
• Sexual abuse is a socially communicable disease that, if left untreated, is passed from one generation
to the next.

ACKNOWLEDGMENTS

This book, like many good things in life, is the result of a team effort. There are many
people we have learned from and been inspired by, and who have greatly influenced

ix
X GROUP WORK WITH SEXUALLY ABUSED CHILDREN

us. The first of these, of course, are the incredible children and their families with whom
we have worked over the years. To them we extend our gratitude and dedicate this
book. May your wounds be transformed into wisdom and the causes of your pain into
compassion.
A special thanks to all the staff and interns at the Center for Individual and Family
Counseling who challenged us, developed many of the exercises in this book, and had
and continue to have a major influence on our work with children. Our heartfelt thanks
to the following staff members: Patricia Godleman, Karen Farber, Gabrielle Clayton,
Dawn Larsen, Sandra Hurd, Katy Murray, and Jody Ferguson. We deeply appreciate
and admire your creativity, passionate dedication to your work, and impeccable clinical
skills. A specific thank-you to the following interns: Margaret Vest, Kendall Wark,
Susan Kravit, Sara Vanucci, Mike Holly, Linda Lunow, Christine Auvil, Jesalyn Green-
wald, Heather Brown, Elizabeth Marcus, Beth Rogers, and Marsha Zaritsky. Your
questioning and wonderment kept us on our toes and forced us to articulate how and
why we use the techniques we do. Thank you to Karen McQuivey, Lucy Berliner, Faye
Adams, Bev Emery, Melissa Allen, Jill Cooper, St. Peter Hospital's Sexual Assault
Clinic, the Washington Coalition of Sexual Assault Programs, and the Office of Crime
Victim Advocates for your wonderful ideas, help, or grants, which assisted us in
providing the therapy. For their great editing abilities, we wish to thank Jon Conte (for
sticking with us through so many years!), Georgene Marshman, Wayne Kritzberg, Lisa
Brodoff, Jolie Sandoz, Katy Lusson, and Lucy Bayer. And John Konovsky and Don
Martin, thank you for opening up your home and computer to us.
A joyous thank you and appreciation to our cover illustrators, 6-year-old Jesse and
9-year-old Micha Brodoff. Micha drew the loving hands with stamped hearts while
Jesse drew children attending group. Jesse, as your mother says, "you are a blessing to
her and now a blessing to others who have been hurt like you. You are so strong!" Thank
you, Jesse and Micha.
Most of all, we would like to thank one another for writing this book together. It is
said that what doesn't kill you makes you stronger. Melding three different writing and
clinical styles (not to mention egos) is a major challenge and accomplishment. This book
is an absolute combination of all three of our voices, beliefs, and styles. Over the years
we have worked, taught, learned, laughed, and cried together. The book is much
stronger because of this, and so are we.
Lynn Grotsky, Carel Camerer, and Lynn Damiano

I am forever indebted to and in constant awe of Lisa Brodoff, my life partner and
soul mate, whose unflinching support, humor, and dedication to me and our children
has allowed me to have the courage, confidence, and time to complete this book. In
addition, I thank all my friends, my family, my children, Evan and Micha, and the
Righteous Mothers, who have always been and continue to be there for me. After two
decades of working with sexually abused children and their families, your friendship
and support continue to humor, cajole, and cradle me, supplying me with the energy,
vision, and compassion to continue with this work.
L.G.
Preface xi

I am ever so grateful to Lynn Damiano, my life partner and twin flame, whose light
and commitment is an encouragement each day of this journey Thank you for sharing
your kind, gentle spirit and the brilliance of your wisdom. Songs, laughter, and love
flow through you like water, soothing me and all the souls you touch. Thank you to
my family for believing in me and encouraging me to complete this book, which at
times was a daunting task. Old friends and new have offered such gracious support
and thoughtful consideration throughout this project. Thank you to my dearest friends
for five-element acupuncture and big feelings.
C.C.

It isn't everyday that the opportunity arises to profess private gratitudes publicly.
I am thankful for the chance. To Carel Camerer, my life partner, best friend, and
coauthor of all meaningful things, thank you for being you and loving me. No words
are deep enough to express how your presence, love, and courage encourage me and
everyone in your path. To my family, thank you for loving me through the hard and
silent times and sharing in the good that came from them. To my friends, especially
Shannon Osborne, Peggy Zorn, and Cathay Webb, thank you for your loving support,
wisdom, and patience, and for listening even when your ears were threatening suicide.
L.D.
chapter
1
INTRODUCTION

S e x u a l assault is a trauma that affects the entire family as well as the

community of the person assaulted. It is a social disease that affects human develop-
ment and the ability to relate to others. It is treatable. The abused child is the primary
victim and other family members are secondary victims. Without treatment, the effects
of abuse can progressively undermine and overwhelm all areas of both the abused
individual's and the family's functioning (Deblinger & Heflin, 1996; Everson, Hunter,
Runyon, Edelson, & Coulter, 1989).
The courage to face the reality of childhood sexual assault as a society has led to
increased awareness of the problem and skill in identifying its presence. Over the past
two decades, the demand for therapy for sexually abused children has increased
exponentially To meet the growing needs and sheer numbers of often underresourced
children and families, clinicians have looked toward the group therapy model for its
therapeutic effectiveness and economy. Group therapy not only offers the advantage
of serving greater numbers of children at lower cost, it also is believed to be an effective
form of treatment for the broad range of cognitive, affective, and behavioral symptoms
associated with childhood sexual abuse (Celano, 1990; Friedrich, Berliner, Urquiza, &
Beilke, 1988; Mandell & Damon, 1989; Zaidi & Gutierrez-Kovner, 1995).
Group work with sexually abused children is not only effective, it is highly reward-
ing and creative. We believe that the sooner a child is treated, the easier it is to lessen the
early effects of sexual abuse: shame, self-blame, low self-esteem, poor social functioning,
fear, and isolation (Browne & Finkelhor, 1986; Gomes-Schwartz, Horowitz, & Cardarelli,
1990). By minimizing these destructive feelings and processing through the abuse,
children regain a sense of safety and trust, and learn to relate genuinely and spontane-
ously again.
In 1989, Jon Conte, John Briere, and Dan Sexton presented research that identified
more than 700 variables thought to have impacts on the sequelae of sexual abuse. Their
1
2 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

findings indicate that family a n d / o r other major adult support and peer support can
significantly reduce the long-term effects of sexual assault. When family members
believe and support the victimized child, long-term symptoms are significantly re-
duced. Unfortunately, it is common that many nonoffending parents are untreated
victims themselves, suffering from their own distress triggered by their children's
disclosures (Deblinger, Hathaway, Lippman, & Steer, 1993; Kelley, 1990). These parents
are often too wounded and unresolved to support their children's recovery. Even when
parents were not abused as children, their children's abuse will inevitably cause them
feelings of grief, anger, and victimization (Kelley, 1990; Sgroi & Dana, 1982). These
feelings can temporarily overwhelm their capacity to take care of their children's needs.
A family's support is as vital to a child's safety as peer support is to a child's sense
of belonging. Often, sexually abused children feel isolated from other children their
age, believing that they are the only ones who have been sexually abused and that they
brought the abuse on themselves (Carozza & Heirsteiner, 1982; Celano, 1990). They
worry that no one would like them if the truth were known, and they fear they will be
treated as outcasts by schoolmates. Imagine a child feeling alone and ashamed, coming
into a room of six to eight peers and finding out that all these other children have also
been sexually abused. For many, such an experience is the first time in their lives that
they feel connected with and accepted by others. The impacts we see on abused children
from this experience alone are significant.
Pamela Alexander (1993) discusses the importance of attachment in ameliorating
the long-term effects of child sexual abuse. She states that the attachment the child
develops with the therapist plays an important role in treatment outcomes. We believe
that an abused child's ability to attach to family members, peers, significant adults, and
therapists alike greatly decreases the child's symptoms.
Research also suggests that untreated childhood sexual abuse victims may grow up
to have a myriad of other problems, such as depression, anxiety, sexual dysfunction,
self-destructive behaviors, relationship problems, chemical dependency, and increased
likelihood of revictimization (Browne & Finkelhor, 1986). A survey conducted by
Benjamin Saunders and his colleagues found that children who were victims of physi-
cal sexual assault were more likely than nonvictims to meet the DSM-III diagnostic
criteria for a major depressive episode, agoraphobia, obsessive-compulsive disorder,
social phobia, a n d / o r sexual disorders (see Saunders, Villeponteaux, Lipovsky, Kilpa-
trick, & Veronen, 1992). Also, a high percentage of women diagnosed with borderline
personality disorder have been found to have been sexually abused as children (Line-
han, 1993). These coping patterns are difficult to unlearn. When abused children are
treated early, disorders such as these can be minimized or eradicated before they
become enduring personality traits and treatment becomes a long and arduous process.
Children do not have to maintain defensive coping once they learn that the abuse was
not their fault, that other children have also been abused, and that they deserve and
will receive love and protection.
To ensure positive treatment outcomes for children, we recommend that family and
individual therapy occur in conjunction with group work. We also require that parents
attend a parent/caregiver group while their children are attending the children's
Introduction 3

group. All parents of abused children need and deserve treatment, and those who
receive it greatly enhance and accelerate their children's recovery (Deblinger & Heflin,
1996; Furniss, 1987; McCarthy, 1990; Ribordy, 1989; Sgroi & Dana, 1982).

W H O SHOULD USE THIS BOOK

This book was written for anyone trained to facilitate support or therapy groups for
sexually abused children. This includes mental health therapists, advocates, school
counselors, and clergy. For individuals to be effective facilitators, we recommend that
they have specialized training in the following areas:

• The dynamics of sexual abuse

• The effects of victimization
• Grief and coping skills
• The roots of violence/oppression
• The state's mandated reporting laws
• Ethics rules and confidentiality requirements

To receive information about or to access training in the above areas, individuals can
contact their local rape relief organizations or statewide sexual assault coalitions.
Although this book is intended to be used for group work, with a few modifications,
most of the exercises included here can be used by therapists working with children in
individual therapy.

H O W TO USE THIS BOOK

This volume is designed as a resource for facilitators of both therapy groups and
support groups. Each exercise can be used on its own or in conjunction with others.
The exercises come from a variety of sources. Unfortunately, some can no longer be
traced back to their origins. Many have been passed along from one sexual assault
program to another through the years. Others are derived from well-known children's
games, stories, and therapeutic exercises that have been adapted to meet group goals.
Many of the exercises were originated by our staff. Their creativity and enthusiasm
constantly lead to new ideas as well as ways to adapt old ideas to each new group.
Following some of the exercises, we include sample materials written by members
of our groups. In these materials, the names of the children and their family members
have been changed out of respect for their privacy.
The appendix at the end of the book contains some sample outlines of groups for
preschoolers, girls, boys, and adolescents. It includes outlines for therapy groups and
support groups. We recommend the use of these outlines as jumping-off points for your
groups. We always outline the plan for any group in advance. This helps to ensure that
4 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

we will meet our goals and objectives for the particular group. We should note that
these outlines are almost always later revised. For instance, there may be a particular
child who could clearly benefit from a specific exercise, but on the day the exercise is
planned, she is absent. Do you still go ahead and do the exercise? Is there enough
flexibility in the plan that you can substitute another one that still focuses on your
goals? Maybe next week, when the child has returned, you can do the originally
planned exercise. Sometimes an exercise is so effective that the discussion leads in a
direction that is totally different from the one you had planned. Go with that. Do not
let your own agenda get in the way of the natural group process. On the other hand,
do not let the group process force you to lose sight of the group's goals and objectives.
Some of the exercises presented here carry the notation ' T h e r a p y Group Only" in
parentheses next to their titles. If you are leading a support group, do not do these
exercises. Although they may sound exciting, they are exercises that may easily trigger
memories or feelings to such a degree that children in the group deserve to have a
trained clinician help them process their emotions.
The exercises, which are presented beginning in Chapter 6, are divided into seven
topics: safety and trust, self-esteem, internal and external boundaries, dynamics of
abuse, triggers, healthy body image and self-protection, and closure. Each of these
represents a treatment goal. Because many exercises are suitable to more than one goal,
we list all the goals for which each exercise is appropriate below the exercise title.
In each exercise chapter, we explain in an introduction why a particular goal is an
important focus in work with sexually abused children. We explain normal develop-
ment, the interruptions in development that may occur due to abuse, and the focus of
the exercises in that particular chapter.
For the sake of ease, and to lessen confusion, for the most part we use only a single
gender for the pronouns in each exercise. Using he or she and her or his can be quite
cumbersome, so we have chosen to use male and female pronouns on a roughly
alternating basis from exercise to exercise. All of the exercises can be done with either
boys or girls.
At the end of each exercise is a section headed "Hints," which includes information
about what to do if participants are not responding as expected or if there may be other
ways to do the exercise. Facilitators should review all of the exercises thoroughly in
advance of doing them in group.
chapter
2
T H E R A P Y GROUPS
AND SUPPORT GROUPS

Differences, Goals,
and Group Flow

There are salient differences between therapy and support groups. The
purposes of a support group are to bring children and families with similar abuse issues
together so that they will no longer feel alone, to promote awareness and under-
standing about the impacts and dynamics of sexual abuse, to connect abused children
and their families with needed resources, to strengthen self-esteem, and to foster a
sense of belonging and hope during a time of crisis. The intentions of a therapy group
are not only to bring individuals together for support, encouragement, and education,
but also to assess, challenge, and intervene in the psychological, emotional, and
behavioral symptoms associated with child sexual abuse. In therapy groups, feelings
are delved into, distorted thought processes are examined, and inappropriate behav-
iors are questioned at the same time new behaviors are modeled and taught. The lists
below offer further clarification of the purposes of the two types of groups.
Therapy groups have the following objectives:

• Help children identify, understand, and ameliorate the effects of sexual abuse.
• Promote healing by helping children integrate the sexual abuse experience into their lives.
• Help children gain perspective on the role the sexual abuse plays in their lives.
• Assist children in reaching their own therapeutic goals.
• Confront distorted belief systems.

5
6 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

• Teach accountability for present behavior.

• Work actively to break down denial and defenses and rebuild a healthy ego.

The objectives of support groups are as follows:

• Provide emotional stability and avoid deep intensity.

• Build social skills.
• Decrease a sense of isolation and build a sense of belonging.
• Work actively to break down denial and defenses and to increase ego strength.
• Decrease self-blame.
• Support rather than confront.
• Help children make their own connections between feelings and actions.
• Help children reframe how they interpret situations.
• Support children in taking action when appropriate.
• Assist children and parents in obtaining therapy, when needed, by supplying them with information
and referrals.

Many support groups remain permanently open to new members (open-ended

groups), but we have found that trust among members is more easily established when
groups are closed to new members. An open-ended group cannot be limited in size,
but a closed support group is usually limited to 12 to 14 people. Naturally, the smaller
the group, the more time each person will have to share. We believe that therapy groups
should be small and intimate. They are most effective with only 5 to 7 children. Our
therapy groups are always cofacilitated, closed, and time limited.
For many abused children, the sexual assault group provides an opportunity for
them to no longer to feel alone or different, and friendships sometimes develop. When
this happens, we advise the children's parents to supervise them closely, and not to
allow them to play together behind closed doors. Parents of children who have histories
of sexual reactivity are encouraged to disclose this information to the parents of any
children in the group with whom their children become friends, in order to ensure the
childrens' safety.
It is important to maintain the distinction between support groups and therapy
groups. It is crucial that only trained clinicians facilitate therapy groups. Many children
who have been sexually abused can be easily retraumatized. A well-meaning but
untrained facilitator can cause great harm to a child by delving too deeply into the
child's psyche before the child is able to handle such exploration.
We list below some examples of the kinds of goals and objectives we typically use
when facilitating sexual abuse support and therapy groups. These lists may be used as
they are or may be tailored to fit particular groups' needs. The amount of group time
spent working on each goal is determined by the collective needs and progress of the
members in the group.

• Goals and Objectives for Support Groups

1. Trust and safety
Reduce levels of fear, shame, and isolation.
Therapy Groups and Support Groups 7

2. Self-esteem
Increase capacity to value self and others.
Increase capacity to desire, believe in, and hold hope for a positive future.
Increase ability to act appropriately in social situations.
Increase friendships and a sense of belonging.
3. Dynamics of sexual abuse
Understand the concept of grooming.
Understand the basics of the sexual abuse.
Understand societal influences of violence and oppression.
Increase capacity for appropriate placement of responsibility and accountability.
4. Self-protection/healthy body image
Introduce the concept of the rights and responsibilities of having a body to protect
and nurture.
Practice and increase self-protection skills.
Learn what is age-appropriate sexual behavior.
5. Closure
Bring conscious closure to the end of group.
Summarize and reiterate the learning.
Identify self-growth and put the abuse in perspective.

• Goals and Objectives for Therapy Groups

1. Trust and safety
Reduce levels of fear, shame, and isolation.
Increase capacity to be vulnerable and to interact authentically.
Increase ability to put the abuse experience in proper perspective without minimizing
or maximizing it.
2. Self-esteem
Increase capacity to value self and others.
Increase capacity to exert will and desire effectively and appropriately.
Increase capacity to desire, believe in, and hold hope for a positive future.
3. Internal and external boundaries
Introduce the concept that thoughts and feelings create an internal interpretation of
reality that affects behavior.
Increase the ability to identify, comprehend, manage, and express thoughts and
feelings appropriately.
Increase the ability to make conscious behavioral choices.
4. Dynamics of sexual abuse
Understand and articulate the particular grooming dynamics used by the offender.
Increase capacity to separate the self from the abuse/abuser.
Increase capacity to place responsibility and accountability appropriately.
Increase ability to define and express personal safety needs.
5. Triggers
Understand and articulate what trigger reactions are.
8 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

Identify and express the internal and external triggers that result in reactive coping
behaviors.
Begin to decrease and desensitize trigger reactivity.
Begin to increase the ability to manage trigger responses.
6. Self-protection/healthy body image
Introduce the concept of the rights and responsibilities of having a body to protect
and nurture.
Define age-appropriate sexual behavior.
Begin to decrease compulsive or sexually reactive behavior.
Begin to establish a subjective relationship with the body image that is consistent
with objective reality.
Practice and learn self-protection skills.
Define own values in regard to sexuality.
7. Closure
Bring conscious closure to the end of group.
Summarize and reiterate the learning.
Identify self-growth and put the abuse in perspective.

THE OVERALL F L O W OF GROUPS

The flow of groups is vitally important. The pursuit of goals and the sharing of
psychoeducational information follow a natural progression, with one concept leading
to and integrating with the next. For instance, an initial goal of group is to establish
trust and safety, which will continue to be a theme throughout all the sessions that
follow. As new concepts are introduced, previous goals are revisited and related to the
new concepts. For example, when teaching about triggers, the facilitator reiterates facts
previously given about boundaries.
Of course, members will progress at different rates based upon their individual
histories, symptoms, needs, and family and life circumstances. Learning how to pace
the dissemination of information is a useful and necessary skill for the group facilitator.
When concepts are introduced before children are ready, they will not be able to process
the information or may even be retraumatized by it. Group facilitators need to rely on
their best clinical judgment when determining what to do with the one or two children
who require more assistance. Individual therapy can be a way of helping children keep
pace with the group. An individual session can afford a child the time he or she needs
to integrate and process feelings about the information received in group. Some
children may simply need more individual attention in group. This may be possible
when the adult-to-child ratio is small enough that a cofacilitator can easily manage the
remaining group members. Ordinarily, within the first three sessions it is possible to
determine by children's behavior whether or not they are truly ready to participate in
group. Children who are highly distracting or very dissociative throughout these initial
sessions are not recommended for group.
Therapy Groups and Support Groups 9

Below, we provide overviews of the different ways support and therapy groups
ideally flow from one goal to another. We furnish more detailed information concerning
the importance of each goal in the introductions to the exercise chapters.

Overall Flow of a Support Group

Support group facilitators want first of all to establish safety and trust. The use of
exercises such as "Check-In," "Safety Rules," and "Group Mascot" can build a sense of
safety in group. When children feel comfortable in group they begin to take risks with
each other and with the facilitators. They may start sharing more of their feelings and
thoughts. As facilitators begin to notice the children's increased levels of comfort, they
can move on to self-esteem exercises.
Self-esteem exercises are designed to enhance the children's sense of worth and
value by encouraging them to interact with one another in meaningful and healthy
ways. These exercises motivate children to notice and affirm the positive qualities in
themselves and others. During this process, children will naturally begin to dem-
onstrate their abilities to be cooperative with and supportive of one another. When
group members begin to display this level of cooperation, they are ready to progress
to the next goal.
The exercises concerning the dynamics of sexual abuse focus on decreasing chil-
dren's sense of shame and self-blame while increasing their ability to place responsi-
bility for the abuse on the offenders. Therefore, it is helpful for facilitators to have the
children define what sexual abuse is. The facilitators should also explain to the children
the concept of grooming (see Chapter 9). Children need to understand that their abusers
knew what they were doing and knew that it was wrong.
To convey adequately the concepts involved in the dynamics of abuse, it is impera-
tive that facilitators recognize and understand the influence of societal violence and
oppression. This understanding will help facilitators to address such issues as (a) male
victims' fears of homosexuality when they have been abused by males; (b) the impor-
tance of empowering females to be assertive and self-protective; (c) the need for young
males to express their feelings verbally instead of physically; (d) all persons' rights to
be treated with respect and equality no matter their gender, race, sexuality, and so on;
and (e) the responsibility of those in roles of authority and power to observe and protect
the rights of others. Understanding these dynamics can help children to move away
from self-blame and shame, because they can then put the responsibility where it lies,
with the abusers.
Once they understand the dynamics of abuse, children gain perspective and sepa-
ration from the abuse and become psychologically available and ready to learn self-
protection skills. Through the self-protection exercises, children are taught to be assertive
and to seek help from adults who will protect them. They come to understand that the
best way to stay safe is to talk about their feelings and not to keep secrets. They also
realize that their bodies are their own, and that they have the right to choose who can
and cannot touch them. When children reclaim their bodies and integrate their rights
10 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

and responsibilities, it is time for them to practice these new skills and to live their lives
with less focus on sexual abuse.
As the group approaches closure, a process of review begins. Closure in group is a
time to celebrate the children's accomplishments and to summarize all that they have
learned. Children are given the projects they have worked on in group and certificates
of accomplishment or medals to commemorate their success.

Overall Flow of a Therapy Group

When a child has been sexually abused or has grown up in a highly dysfunctional
family, normal developmental tasks, emotional growth, and often physical growth are
interrupted. A therapy group may serve as a surrogate family for such children.
Facilitators assume a role similar to that of parent as they model positive nurturing,
boundary setting, consistency, and predictability. Throughout the group process, chil-
dren are essentially reparented and are given the opportunity to gain the skills they
need for emotional and psychological development. Children will not necessarily
completely achieve a particular developmental task before moving on from one goal
to the next, but they will have at least experienced it. When a therapy group is working
at its optimum level, the group will progress as described below.
All group work begins with the establishment of trust and safety among the
members (see Chapter 6). The collective creation of clear rules and guidelines, along
with the facilitators' reminders to follow them in a consistent manner, defines the
environment and helps children know what to trust. When children perceive them-
selves as safe, they will risk being vulnerable and begin to interact playfully with one
another. Children sometimes test their environment for safety, and the group facilita-
tors' responses need to be consistent. We have found a perfect definition of what it
means to be consistent with children on a parenting tape presented by Barbara Colo-
rosso: "You say what you mean, you mean what you say, and you do what you said
you were going to do." When these elements are present, children will learn to trust in
themselves, in others, and in the group as a whole. As children connect and develop a
sense of belonging, they gain the support they need to grow stronger and more fully
into themselves. This is a favorable time to introduce children to situations in which
they can develop their self-esteem.
A child's sense of self-esteem develops over time and in the context of that child's
relationship to the world and others. The self-esteem exercises presented here are
designed to create circumstances in which children can explore and improve their
social skills and increase their level of self-confidence. When children receive positive
peer and adult attention, they experience a level of acceptance that allows them to relate
to others openheartedly.
When children are cared for, they begin to believe that they are important enough
to be seen and listened to. When this occurs, it is time for the group to move on to
boundaries work (see Chapter 8). This begins with children's learning about their
external boundaries—that is, their own personal space and comfort levels with other
people. When children learn how to express their needs in respectful ways and are
Therapy Groups and Support Groups 11

responded to appropriately, they learn that they can positively affect their world, which
helps them to feel their worth and value.
Internal boundary work is concerned with the mechanics of reality making. It
teaches children how their thoughts, feelings, and bodily sensations relate to their
actions and behaviors. In group work, we teach children about their internal bounda-
ries by introducing a version of Bennett Brauns's (1993) BASK (behavior, affect, sensa-
tion, knowledge) model:

• Behavior: What am I doing?/How am I acting?

• Affect: How am I feeling emotionally?
• Sensation: What am I feeling in my body?/Where am I feeling it?
• Knowledge: What do I know/believe about myself and my situation?

Initially, we teach the children to identify their feelings. Once they attain some
proficiency with their emotions, we teach them how to relate their feelings with their
thoughts and bodily sensations. The "Life Vest" exercise and "My Own BASK Book"
are extremely effective tools for teaching children these concepts. When children can
separate their inner reality from external events, they learn that they have choices about
how they want to act or react in any given situation. A healthy boundary system
restores a child's will, choice, and power. When children feel safe enough to know their
thoughts, identify their feelings, and express their needs directly, they have less need
to defend or act out.
Once they have acquired healthy boundary systems, children can learn to separate
themselves from the abuse. As children begin to view abuse as an event instead of an
identity, they are able to confront the dynamics involved in their own abuse, such as
how they were groomed, who was responsible, and what really happened (see Chapter
9). Children need help to understand how they were manipulated into believing the
abuse was their fault. "The Butterfly and the Spider" and "The Alligator River Story"
exercises are especially helpful ways to communicate this information. When children
are able to transfer responsibility to their abusers, their shame is lessened and their
egos are strengthened.
As children achieve a measure of distance, they gain perspective and are able to
explore their unconscious reactions to the abuse (see Chapter 10). The facilitators help
the children to identify the sensations, feelings, and thoughts they associate with their
abuse a n d / o r their abusers. The exercises "101 Dalmatians" and "Elizabeth's Triggers"
are useful metaphors for teaching children how to identify triggers and gain perspec-
tive on their abuse. Perspective brings the ability to differentiate the past from the
present. Once they learn this concept, children begin to understand that their reactions
(triggers) have origins (the past) and sources (the abusers). This teaches them that it is
safe to be present, and that when they are being triggered by something that happened
to them in the past, they can become safe by centering themselves in the here and now.
When the children are fairly well able to understand that the hurt was in the past
and that they have some control over their trigger reactions, their level of internal threat
is greatly reduced. Their anxiety decreases and their self-confidence grows stronger.
12 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

With this awareness, children learn how to make decisions from a place of under-
standing, presence, and clear choice. These skills enable children to feel safe, take risks,
assume responsibility, and take control over those things within their ability to control.
By this point, the children feel very connected with other group members, have a
sense of belonging, and feel confident and accepted. They acknowledge their abusers'
responsibility for the abuse and have skills to manage their trigger responses.
The children's final task is to reclaim their bodies. Healthy body image and self-
protection exercises are designed to help children accept and establish body images
that are based in objective reality (see Chapter 11). This is not always easy, as many
abused children separate from their bodies as a way of coping with the abuse. Helping
these children to develop realistic views of their size, weight, and appearance gives
them clearer pictures of themselves. The more reality based children are, the safer they
become.
Once children recover their bodies from the abuse, they need help in learning how
to nurture and protect their bodies. Certain rights and responsibilities are inherent in
body ownership. To help children understand this concept, we present each one with
a "Body Bill of Rights" charter. The charter describes what their rights are, and the
exercises show them how to demonstrate those rights within their lives. Practicing
self-protection means learning how to control their actions and take responsibility for
their attitudes. By learning to become mindful and aware of their own thoughts,
feelings, and actions, children learn how to protect themselves as well as how to relate
to others with respect.
By this time in group, children are feeling connected to one another and are strong
and proud of themselves. Sexual abuse is becoming an event of the past and the
children are ready to resume their lives. It is time for closure (see Chapter 12). The
closure process allows the children time to make the transition from group back into
their everyday lives. During this stage of group children are encouraged to reflect on
what they have learned over the many weeks. The "Debriefing and Evaluating Group"
exercise helps children map their progress by asking them to describe how different
they are now from when they entered group. Closure is also a time to instill hope for
the future. The facilitators' summarizing of the children's efforts, achievements, and
resources helps to remind them of both their skills and their ability to be safe in the
world. To celebrate their success, the children all receive certificates, awards, a n d / o r
folders containing all the exercises they did in group as a reminder of the extraordinary
personal work they have accomplished.
chapter 3
SPECIAL CONSIDERATIONS
IN SETTING U P G R O U P S

^ ^ a n y factors must be taken into consideration in the setting up of

therapy and support groups. For instance, how many children should be in a group?
How many facilitators? What should be the age range of each group? Where will the
group sessions be held? Should groups include a mix of genders? Should a group be
open or closed? The following are some of our thoughts on these issues as well as some
tips based on what we have discovered in our own group work through the years.

FACILITATORS

The success of a particular children's group will depend largely on the facilitators'
skills and personalities. Their confidence level in supporting sexually abused children,
comfort level with children in general, understanding of child development, ability to
have and use outside support, and unique personalities all play roles in how the
children will respond.
It is essential that facilitators with a history of sexual abuse be in successful recovery
from its effects. Being in a group surrounded by sexually abused children is an
extremely triggering situation. All facilitators must have reliable support systems and
the ability to contain and manage their own emotions.
A group for sexually abused children is not a place for adults who need to rescue
or save children. Many abused children are caught in the dynamics of a legal system
that is not protective of them or in home situations that are not safe or supportive. As
13
14 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

such children act out against or withdraw from these circumstances, their behaviors
may keep them isolated from peers. Facilitators must establish boundaries and limits
that are both clear and firm. Otherwise, they may be overwhelmed by the neediness of
the children, and as a result the group could become too chaotic, exhausting, or
ineffective.

Effective Facilitators

To be effective, facilitators need to develop particular skills. We recommend the

following:

• Be enthusiastic and express your excitement about the group. Greet children by their first names as they
arrive and help them feel noticed by acknowledging something unique about their attitudes,
behavior, or social skills. For example: "Sarah, you have the most wonderful laugh. I feel warm inside
every time I hear it."
• Treat each child with respect. We often use talking sticks or talking stones in our groups. The person
with the talking object is the only one allowed to speak. The object is passed around so that everyone
has a turn to talk uninterrupted. When a child is disruptive, be firm and ask for quiet in a kind manner.
For example: "Trish, I am having trouble hearing what Mary is saying. Remember, you will get a
chance to speak/'
• Act childlike at times, but remember, you are the adult! Join in with the children during the exercises. Your
involvement as a role model will give the children permission to be themselves. Be silly and active,
yet remain aware of how the group members are responding and participating.
• Share real feelings with the children. Let group members know why you do this work; share your
personal feelings. For example: "When I was a child, someone touched me and I was too frightened
to tell anyone"; or "I am feeling very sad today because my cat just died." This will encourage the
children to express their feelings openly. Be careful, however, not to dominate the group with your
own feelings. The group is for the children, and your input is appropriate only when it facilitates their
healing process or is pertinent to the group topic or goal.
• Physically stand or sit at the children's level. Looking up at a looming adult is both intimidating and a
physical strain for children. When you are physically on the children's level it is easier to develop
rapport and a sense of trust with them.
• Be clear about your own boundaries. Do you feel comfortable having a child sit on your lap, and is it
therapeutically appropriate given the child's history? How much distraction are you able to tolerate?
Act as a role model by clearly stating your own needs in the group. For example: "The noise is too
loud for me in here. Let's all whisper for a few minutes"; or "For this game we need to hold hands.
I like people to ask permission to touch me so I always try to ask others for permission before I touch
them. Do you mind if I hold your hand?"
• Be flexible with your planned activities. Although it is very important to plan for each group in advance,
you must also be willing to change those plans. During check-in, children might reveal information
that should be dealt with quickly, or a conflict may arise between group members that demands
immediate attention. Be prepared to deal with these issues right away rather than your planned
activity. Your own goals and plans are important, but they can often be reached by following the
group process.
• Respond sensitively to group members' disclosures of abuse. Sexually abused children will rely on your
responses to them in determining how much information they will disclose. Therefore, it is very
important that you monitor your responses. Do not show shock, disgust, extreme anger, or fear while
a child is sharing her story. She needs to know that you can handle anything she says, and that her
story is not so different from others you have heard. It is fine to show empathy while a child is sharing
her story. For example, you might say, "How did you feel when he did that?" or "From the look on
Special Considerations in Setting Up Groups 15

your face, it looks like you felt frightened." Children need to know that you are listening and that
you care. Do not put them in the position of having to take care of your feelings as well as their own.
• Seek outside support and consultation. This work is very demanding. Often, facilitators can be triggered
by the stories they hear in group. Consult with other skilled clinicians regularly, and allow time after
each group session for facilitators' debriefing.

COFACILITATING GROUPS

It is difficult to run a group with just one facilitator. Our groups are always facilitated
by at least two therapists. We recommend this for a variety of reasons, including the
following:

• Bonding/attachment: The opportunity for each child to find at least one adult with whom he or she
will be able to bond increases when a group is led by two or more facilitators. Each child will also be
more likely to receive nurturing from one of the group leaders during the group process.
• Role models and boundary setting: Many sexually abused children are extremely needy and starved for
appropriate affection. They may ask for a lot of attention in such forms as being held, being listened
to, and other kinds of close contact. With at least two facilitators in a group, one facilitator can be
free to teach about appropriate boundaries (e.g., "You need to ask me if I want to be hugged" or "You
can sit next to me, but not on my lap right now") while the other continues to focus on the group as
a whole.
• Competition for attention: Many abused children are extremely needy; others have learned to be
antidependent. The presence of two or more facilitators allows each adult to give additional special
attention to each child. However, cofacilitators should be aware that some children may try to create
a split between them. It is important for cofacilitators to stay aware of their own issues and not take
it personally if some children gravitate toward the other facilitator.
• Opportunity to confront or challenge: With two facilitators in a group, one can play a more nurturing
role while the other can be more confrontational. The cofacilitators can then alternate these roles.
(This technique is used more often in therapy groups than in support groups.)
• Better observation and response: When a group is cofacilitated, while one facilitator is leading an
activity, the other has more freedom to manage behavior(s) through observation, response, and
intervention.
• Dividing the group: When a group has two facilitators, the group can be divided in two for specific
activities that work more effectively with fewer children. This allows each smaller group to have its
own facilitator.
• Dividing case management: With two facilitators, the responsibilities of the children's case management
needs are cut in half. It is extremely time-consuming, but essential, for facilitators to keep in touch
with every child's individual therapist as well as teachers, parents, and so on. Good case management
results in a stronger support network for the child and helps to establish a more cohesive and unified
treatment plan and intervention strategy on the child's behalf.
• Focus on note taking: At times, facilitators want to take notes in group. A child may say something
significant that a facilitator wants to be sure to remember, or the group may be brainstorming
thoughts or feelings that should be recorded. When a group has two facilitators, one can take notes
while the other directs the session. This is especially useful when a child makes a spontaneous
disclosure during group.
• Management of discipline and dissociation: If a child is being triggered, his or her response may require
individual attention, regardless of whether the child's behavior is dissociative or disruptive. In a
cofacilitated group, one facilitator can work with the triggered child's behaviors while the other
continues activities with the remainder of the group.
16 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

GENDER OF FACILITATORS

There is no single absolute right or best way to establish the gender makeup of group
facilitators. Although many argue for same-sex facilitators, others, with equally sound
clinical reasons, argue for mixed-gender facilitators, and a few argue that gender is or
should be irrelevant. The resolution to this controversy is far beyond our scope.
Gender alone can negatively trigger some children's abuse histories and defenses,
interfering with their ability to participate in group. Facilitators need to be mindful of
children's potential to generalize and transfer their abuse issues to gender or to the
facilitators themselves. The more aware facilitators are of each child's history, the more
effective they can be and the more precise they can be with interventions.
We are most comfortable staffing our girls' groups with two female facilitators and
our boys' groups with one male and one female facilitator. Children need and deserve
to have both males and females introduced as healthy role models at different times in
their recovery process or whenever possible.

GROUP SET-UP

We discuss below some of the issues that are important considerations in the setting
up of groups.

Open Versus Closed Groups

When a group is open, new members can join at any time. There may not be a
designated ending date, in which case group members leave when they feel ready to
do so. Closed groups consist of the same members, who usually meet for a designated
number of weeks.
We strongly believe that all therapy groups should be closed, and we encourage the
same for child sexual abuse support groups. Closed groups have clear beginning and
ending dates. The establishment of these dates provides perspective for the children
on the work they will do and an understanding that it is for a limited period of time.
Closed groups help to create a sense of trust and safety at a faster rate, as new people
are not entering the group week after week. Closed groups allow for predictability and
consistency, which make deeper therapeutic work possible. They also keep the group
rules consistent and understood by everyone.
In a closed group, a sense of family can be created. Children learn how to relate to
one another in new and healthy ways. As in any family, conflicts and other problems
will inevitably arise between group members. With trust established between mem-
bers, each can be taught how to express and resolve these conflicts in constructive ways
that build, strengthen, and deepen their relationships with each other. Group members
form much stronger friendships in closed groups than in open ones and take more risks
regarding what they share about their sexual abuse and themselves. Because of this,
Special Considerations in Setting Up Groups 17

closed groups are able to cover more ground, and participants feel they are moving
forward rather than repeating the same old material every time new people join.
The benefits of closed groups became clear to us through our work with teens who
lived in a small town. There was a lack of support services available to the community,
so we set up an open group to accommodate more teenagers. The first week began with
5 girls; the next week they brought their friends, and by the third week we had 15 with
absentees and newcomers. This made it difficult to establish trust among group
members. Some of the teens had a basic understanding of the dynamics of sexual
assault and others had just disclosed sexual abuse the day before. With group members
at such different levels of awareness, it was difficult to do many of the planned
exercises. A lot of time was spent with the newcomers explaining the dynamics of their
abuse and having everyone share basic information about themselves over again. We
also learned why group members were less apt to come on a weekly basis: When the
duration of a group is open-ended, it suggests a feeling of ''we can always work on this
another time." It also seems to imply that healing from sexual assault trauma will take
forever.
This is not to say that open support groups cannot work. Open groups need to be
less structured than closed groups. It may be enough for an open support group to
focus on a different emotion each week. The wonderful part about an open group is
that those who have been attending for a while can take leadership and support roles
with new members. This can increase their sense of self-worth, and it may even free
them up to share more feelings than they would have otherwise because they want to
be good role models. In a school setting, an open group can work well to lessen
isolation, because it offers immediate support for a child who has just disclosed: Not
only are there others this has happened to, the "others" are even students in the child's
own school.
An emphasis on confidentiality is especially vital in a school setting and must be
strictly adhered to, or group members may be teased or ostracized by their peers. If
children attend a group during school hours, it should have an innocuous name, such
as "friendship group." The facilitators should go over the rules of confidentiality
individually with each child before he or she even enters the group. An explanation of
confidentiality needs to include simple examples of how a child can answer other
children's questions about the group. Further, the issue of confidentiality should be
revisited with the group as a whole every few weeks.

Age Categories

Groups operate most effectively when the group members are close in age. Children
within a 2-year age range will usually be at close developmental levels, making them
similar in their abilities to verbalize, read, and draw. They will have comparable
understanding of sexuality and the abuse. Also, they will be at similar levels in their
intellectual capacity to assimilate and comprehend what is being taught in group. In
addition, age often affects a child's ability to pay attention. Whereas a 5-year-old may
18 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

have trouble sitting for more than 5 minutes, an 8-year-old can usually sit for 10 to 15
minutes. Thus the exercises chosen for groups should vary accordingly.
What 5-year-olds may reveal about their abuse is often very different from what
9-year-olds might say Older children might describe their experiences in more detail
than younger children are capable of hearing or understanding, and as a result, the
younger ones might be disruptive in group. We have found that the age span can be a
little more spread out with older children, so we offer one group for 11- to 13-year-olds
and another for 14- to 18-year-olds.
The placement of a child with a group is determined during the initial screening
process. A developmentally delayed child who acts much younger than his or her
chronological age should be put in a group with children at a comparable developmen-
tal level. When deciding which group is right for a given child, facilitators should
consider the child's abilities to read, write, and so on as well as the child's capacity to
understand the information presented. If a child is exceptionally mature, it is best to
keep him or her with others of the same age unless it is clear the child will not fit in.
This helps to discontinue the pattern of forcing the child to grow up too fast or to act
in a parentified manner. Every child deserves to be a child and to act childlike while
receiving protection from supportive adults.
Sometimes there are not enough children of the same age to form an effective group.
In such cases, we recommend making a comfortable-sized group covering a broader
age span and adding at least one facilitator for every 2 years of age difference. For
example, if a group has six children ranging in age from 6 to 10, it should have three
facilitators. This allows the facilitators to split the group up into smaller groups for
specific exercises. Extra facilitators can also give age-appropriate prompting to chil-
dren and provide more individual attention.

Size of Group

A group needs to have enough children that it feels like a group yet not so many
that each child cannot get some individualized attention. When considering size,
facilitators should make sure that there are enough members to absorb the inevitable
absences without disrupting the feeling of being in a group. Our ideal size for a therapy
group is six children. If there are two facilitators to a group, each child gets some
focused attention and the group can easily be divided in half for role-plays, letter
writing, and other exercises when even smaller groups are desired. A support group
can tolerate a higher ratio of children to facilitators.

Same-Gender Versus Mixed-Gender Groups

Many facilitators run mixed-gender groups. Sometimes such groups are formed
because it is difficult to have enough children to form a group if only a boys' group or
a girls' group is offered. The issues raised by the inclusion of both boys and girls within
groups are similar to those raised regarding whether groups should be led by facilita-
tors of the opposite sex.
Special Considerations in Setting Up Groups 19

We have found same-gender groups to be more effective than mixed-gender

groups. This is true both because of the developmental differences between boys and
girls and because girls seem much more willing to disclose facts about abuse when boys
are not in the room. The only mixed-gender groups we offer are for preschoolers.

Preschool Groups

Naturally, there are limits to how much preschool children can understand and
should be told about sexual abuse. We facilitate groups for children 4 to 5 years old.
Our preschool groups are gender mixed, but we always try to have more girls than
boys in a group to maintain a calmer level of energy. At least two boys are needed in
group, so that a lone boy does not feel isolated or singled out. The focus of a preschool
group is to help the children learn to identify and express their feelings appropriately.
This includes feelings in general and feelings specifically about the abuse. They learn
about safe and unsafe touch and how to assert themselves if someone is trying to touch
them. Young children are also taught about being tricked and about what secrets should
be told. Finally, they are helped to identify who the safe adults are in their lives and
how to go to them for protection.
Puppets are wonderful teaching tools for showing preschoolers the dynamics of
abuse and other prevention skills. Preschool children also love stories that work on a
metaphorical level. Many popular fairy tales and their Disney adaptations contain
messages about grief, survival, and the importance of hope and resilience. We use an
exercise based on 101 Dalmatians to explain about both trickery and trigger reactivity.
Songs are also highly effective with preschoolers. Facilitators can pick a goal or subject
and make up a ditty to be sung to one of the children's favorite tunes. The parents will
report the children's singing the new words everywhere.
Our preschool groups are usually just 8 weeks long and last for only an hour each
week. When the children arrive, we ask their parents to encourage them to use the
bathroom before the group starts. This is essential—otherwise we would have a sudden
mass exodus in the middle of the group session. We always do a very quick, fun
check-in, and then we play a game that is tied in with our goal for the week. This is
followed by the group's singing a song that pertains to the goal and a drawing exercise.
We do another game, often one such as Duck, Duck, Goose, and end with story time
and a snack (pretzels or popcorn and juice) to eat while everyone listens to the story.
The story is always one that ties in with the objective of the week. Preschoolers also
love being videotaped. We often videotape them doing an exercise and then replay the
tape for them (review childrens' abuse history before videotaping them). This repeti-
tion serves the further purpose of reinforcing the goal for the week.
It can be especially difficult to contain preschool children when the group is dealing
with an uncomfortable topic. Their anxiety level is often so high that they will do
anything to avoid their feelings. To help with containment, we put everything away—
toys, drawing materials, paper, and snacks—so the children cannot see them until they
are ready to be used. We also hang posters on the wall of children expressing different
feelings.
20 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Also to help with containment, we have small chairs for preschoolers to sit in, so
they are not stretching out and kicking one another or rolling into each other. As we
begin doing exercises, we move the chairs back and sit closely together on the carpet.
At that point the children are more focused, and each is better able to stay in his or her
own space.
Often in preschool groups there will be someone who is too anxious to stay seated.
We allow that child to walk around as long as he or she is not disturbing others. Many
times children will want to sit on the facilitators' laps. We leave that up to each
facilitator, depending on both the facilitator's individual comfort level and the child's
individual issues. A sexualized child may be stimulated by sitting on a facilitator's lap.
It is common in a preschool group to have at least one child who wants to leave the
room or be with a parent (or other caregiver) during the group session. In this case we
do one of two things. If the child's parent is someone who will not disrupt group, but
will sit quietly and unobtrusively in the room, we will allow the parent in for the first
15 minutes or so of the session, until the child is comfortable. A second option, which
we use to avoid distracting the other children, so they all don't want their parents in
the room too, is to allow the child to go and sit with the parent in the waiting room. We
instruct the parent not to entertain the child or make the time in the waiting room fun.
We ask the parent just to sit quietly with the child. The child is told that he or she is
welcome back to the group whenever he or she wants to rejoin it. Usually, after leaving
two or three times, a child will choose to join the group on a regular basis and not try
to leave the room again. Because facilitators are trying to establish safety and trust, they
should never try to force a child to stay in the room.

Girls' Groups

Girls' groups are usually the easiest to facilitate. Ideally, we have a 5- to 6-year-old
group (which would include the more mature 5-year-olds), a 7- to 8-year-old group,
and a 9- to 10-year-old group. Groups work best when they include from five to seven
girls. In general, girls are more adept at articulating their feelings than are boys. They
often enjoy discussions and can stay focused on exercises for fairly long periods. They
are excited to connect with the other girls in group and want to build friendships with
them.
Overall, if members of girls' groups rebel, it is more often by withdrawing than by
acting out. Early on (see the rule-setting exercise in Chapter 6), the facilitators can help
them express what they need from the group when they do start to withdraw or act
out. Generally, we start the group with a snack as everyone is coming in. We run our
girls' groups for 15 weeks, and each session is 1V2 hours long.

Boys' Group

Boys' groups can be quite challenging and invigorating to facilitate. Boys need more
active exercises than do girls, and the exercises need to be shorter. In general, sexually
Special Considerations in Setting Up Groups 21

abused boys have a harder time discussing issues regarding sexual abuse, and they are
unable to sit still and focus long enough to do thorough processing. Many of them feel
anxious just walking into the room and will express this anxiety through physical
aggression or loud, raucous play. Boys, however, often become enthusiastic when they
recognize the common ground they share with others in group, and want to develop
friendships.
The boys' groups that we have run most effectively have been led by two to three
facilitators, including at least one male and one female. Our boys' groups run for 8
weeks. In our experience, by the fifth or sixth week of group, boys seem to develop a
"pack mentality" such that they join together against the facilitators and against the
idea of wanting to work on the issues of abuse. By that point they've formed a "boys'
club" and are ready to play. Therefore, 8 weeks is more effective for boys to make
connections, break down their sense of isolation, and work on the abuse issues. Any
remaining concerns can be effectively dealt with in individual and family counseling.
Our younger boys' groups meet for 1 hour each week, and the older boys' groups (10+
years) meet for hours.
We usually pass out snacks in boys' groups when we want to have a discussion or
want to process an exercise. This settles them down for a little while. Boys like to be
videotaped, so we line them up one behind the other and have each answer a question
in turn while looking at the camera, and then have them go to the end of the line again
to wait for another turn. If there is time at the end of the session, we watch the video
together. This is great to do using exercises such as "Talking to the Offender Psycho-
drama," "Triggered Memories," and "My Safety and Comforts." To safely use video
cameras in group, ensure that no member of the group was videotaped while being
abused. Using a video camera may be a volatile trigger for such children.
Because boys tend to be physically active, boundaries need to be clearly defined so
that they do not hurt each other in their play. We have our boys all sit in chairs in the
beginning of group so that they do not accidentally bump into one another (we
recommend the use of sturdy chairs, as they always try to tilt them backward).
The goals of boys' groups are to create trust and safety and to teach them gentle
ways to show affection, nonhurtful ways to express anger, and how to protect them-
selves in the future. In therapy groups, boys are also helped to understand when they
are being triggered and how to manage their triggers (see Chapter 10). They are given
the opportunity to express their anger about their offenders (see "Letter/Video to the
Offender" and "Talking to the Offender Psychodrama").

Adolescent Groups

Working with teenagers can be fun and enlightening as long as the groups are led
by facilitators experienced with teens. Many teens love to participate in long discus-
sions. One of the roles of the facilitator in an adolescent group is to keep the teens on
track, talking about themselves and the abuse, as opposed to talking about their friends
(including the ever-popular topic of who has a crush on whom).
22 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

Many teens in sexual abuse groups are sexually active. They often make poor
choices when they are hanging out with friends—for example, they may be pregnant
and still smoking cigarettes or drinking alcohol. It takes a skillful facilitator to join with
the teens and concurrently guide them without being judgmental. Some exercises that
work especially well with teenagers are "How We Sabotage Ourselves," "The Alligator
River Story," and the "Date Rape" role-plays.
In our adolescent groups, we spend one session with a guest speaker from Planned
Parenthood who discusses sexuality and answers any questions group members may
have. (Group facilitators who elect to do something similar must make sure that they
receive written permission for teens to attend this session from the group members'
caregivers.) We also have a question-and-answer box in a discreet place outside of the
group room, where teens can anonymously deposit any questions they have. We
periodically go through the questions in group and answer them to the best of our
abilities.
Teens, for the most part, gravitate toward and love coming to group. Often they
want to socialize with other group members outside of group, too. If they do, facilita-
tors must talk to the teens' parents about the importance of setting strict guidelines
relating to safety, responsibility, and curfew. We have heard about more than one
incident in which teens from a group have gotten together and gone out on the streets
after midnight or shown up at parties that put them all at risk. To prevent such
situations, facilitators should spend group time doing role-plays about peer pressure
and how to resist it.
Teens usually get a snack halfway through the session in our groups. They often
also beg for cigarette breaks, which we do not allow. Our teen groups run for 15 weeks,
and each session is hours long. We give the teens the choice of whether they want
to sit on the floor or in chairs.

Group Setting

Children in a group need to feel safe before healing can begin. Facilitators should
choose a meeting place that is both private and kept secret from offenders. Children in
the room should not be visible from the street, and no one but group members should
be able to walk into the room during the group session.
It is important for the children to feel they have privacy from their parents (or other
caregivers), as this enables them to share their thoughts and feelings relating to their
abuse. They often will censor themselves if they think their parents may hear what they
are saying. The best way to ensure privacy is for the group room to be situated away
from the waiting area. Otherwise, the group room should be well soundproofed, and
the facilitators should demonstrate to the children that it is.
It is important that the group room feel comfortable and inviting for the children.
A kids' space can be created with brightly colored posters. We have learned through
the years to be very selective about how many things are within children's reach in the
group room or they will be too easily distracted. Teenagers feel more comfortable in a
setting that is used for adults, something like a living room. We also have tape
Special Considerations in Setting Up Groups 23

recorders, drawing materials, old magazines, and other craft materials on hand but out
of sight for the various exercises. Usually, we put projects that kids have completed on
display in the group room for a few weeks before they take them home. This gives them
a sense of ownership and belonging, which boosts their self-esteem and offers comfort
in the group setting. Writing a group list of safety rules to post in an easily visible spot
helps begin this process, as does displaying the group's "mascot" if one has been made.

Accessibility

Accessibility of both the waiting room and the group room is another issue to
consider. We have worked with a number of children who are differently abled, some
in wheelchairs as well as some visually impaired and hearing impaired. Accessibility
for such children is not a problem as long as the facilitators are prepared and the space
is properly equipped. Some advance planning is necessary for these children, and any
special help they need should be set up ahead of time. This may involve securing the
services of an interpreter for hearing-impaired children or special transportation for
those with physical disabilities. Facilitators should think about what the group mem-
bers need help with and be sure they can do the exercises that are planned for the group.
Differently abled children should also be given a chance to lead activities at times in
group so that they will feel equal in ability with the other group members.

Confidentiality

Confidentiality in work with sexually abused children is extremely complicated.

What group facilitators can and cannot keep confidential often depends on individual
state laws. All facilitators must know their states' reporting laws and should inform
the children of their reporting responsibilities. We usually tell children at their screen-
ing sessions that we will not report anything to their parents without their permission.
We then go on to say that sometimes the law requires us to report to a social worker or
a detective any suspected circumstances in which children may be harmed or may
cause harm to others. We also tell them that we must report if a child is actively suicidal.
We tell children that if we feel we need to report something (and it will not be
detrimental to them), we will let them know first, before we report. We also review this
information during the first session of group with all the children.
Caseworkers, parents, attorneys, and school personnel often ask facilitators how
particular children are doing in group. Facilitators can respond in general terms,
explaining the types of exercises used and how well a child is participating. Before a
facilitator can give out more specific information, a release form must be signed. The
facilitator should let the child know in such a case that he or she will be speaking with
others about the matter in question. The facilitator should ask the child if there are
things that he or she wants or does not want the facilitator to talk about with the
questioner. The facilitator should try to gain an understanding as to why the child
might have these needs and determine what conversation with the questioner might
24 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

be most effective. Again, as we have mentioned, in certain legal situations facilitators

do not have a choice—they must report what children have disclosed.

Record Keeping

Whether or not facilitators should keep detailed records of group sessions is quite
controversial. Some state laws require that notes be taken in group. In many states, all
records can be subpoenaed. Because of this, many group facilitators are tempted not
to take any notes. On the other hand, writing down what happened in group and how
children responded to various exercises can be very helpful for facilitators in their
planning for group goals week after week. It is all too easy to forget who said what in
group a week or two later. Unless a facilitator is required by insurance or a managed
care company to keep notes on individuals in group, it generally comes down to a
personal choice as to how many notes to take. It is especially important, however, for
a facilitator to take detailed notes if a child is disclosing any new information regarding
the abuse that by law needs to be reported to the proper authorities.

Absences

It is essential for children to attend every group session. Inconsistently attending

therapy group can be very harmful to the child as well as detrimental to the group. The
child's issues may be triggered, and without the support of therapy, he or she may not
have the skills to manage or contain the triggered feelings. In group, children learn to
care for each other, develop concern for one another, and rely on one another. If a child
misses too many sessions, he or she may not be able to continue in group. Aside from
the disruption this causes for the other children, the frequently absent child may be
unable to experience the same level of connection that other group members share, or
may miss out on vital information and processing.
To make a final determination about a frequently absent child's group status,
facilitators must judge, based on the dynamics of the group, whether the goals for the
child can be met given the absences and whether the child's parents are able to follow
through. If the facilitators determine that the child could benefit from continuing in
group but the parents are unable or unwilling to follow through, finding an adult
sponsor for the child may be a viable option.
 4
GROUP FORMAT

O u r group sessions consist of directed play through planned exercises

and discussions. We use a variety of methods derived from many theory bases,
including cognitive and behavioral theory, grief work, attachment theory, child devel-
opment, learning theory, and object relations and other psychodynamic theories. In our
experience, groups need to be directed and focused, with set goals, and yet flexible
enough to allow for processing of spontaneous incidents and statements that arise
during group sessions.
For both support and therapy groups to be successful, they must, on a weekly basis,
provide children with (a) trust and safety, (b) predictability and consistency, and (c)
skills for containing emotions. Trust and safety are created through the setting of
specific guidelines or rules regarding confidentiality, how each person will be treated
in group, and the types of behaviors allowed and not allowed in group. Group needs
to be a fun and warm place where each child is cared for, respected, and has worth. It
is critical that participation in any of the exercises and discussions be voluntary.
Predictability and consistency increase the potential for trust and safety. Because
many sexually abused children come from homes where they have experienced vio-
lence or the unpredictable nature of a chemically dependent parent, it is vital that
facilitators remain supportive and in consistent good humor each week. Facilitators
provide further predictability by following through with appropriate interventions
when any rules are disregarded. Predictability also is reinforced when the group starts
and ends in similar ways each week. We usually start our groups with check-in and
end with a fun, upbeat exercise or a story. In addition, children ages 8 and older often
appreciate being told what is on the agenda for the following week. They then know
what to expect each week when they walk in the door. Children also feel more secure
if the group is held in the same room each week.
25
26 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

The middle part of each week's session usually includes an exercise that reinforces
the goals of the week before and one or two new exercises that pertain to the current
week's goals. For example, if the previous week's goal concerned boundaries, the
group does one boundary exercise and then moves on to one or two other exercises
related to the next goal, understanding the dynamics of abuse.
At the close of group each week, children need to leave feeling that they can handle
their emotions and not fall apart. Exercises are done that help bring a sense of centering,
balance, and closure to the group's work that day The children know that the group
room is a place to think and feel about the abuse. They learn how to release feelings
and thoughts so they do not leave the session overwhelmed by emotion.
When trust and safety, predictability and consistency, and containment needs are
all met, the group gains the feeling of a healthy family. The children now have a
relatively secure place where they know what to expect, feel validated, are given
guidance, and are nurtured.
chapter 5
SCREENING G R O U P M E M B E R S

The screening process is the backbone of any good group. A solid

screening procedure increases the likelihood of the formation of a cohesive group made
up of children with similar issues and ages who are ready and excited to participate.
Screening also allows the group facilitator to explain the group's goals and objectives
to both parents and children. In this chapter, we provide general information on
screening for both support and therapy groups. We include information on the pur-
poses of screening, hints on the screening process, and, at the end of the chapter, a
screening tool that helps determine readiness for group (Table 5.1).

PURPOSES OF SCREENING

In screening sessions, information is gathered from parents and children to determine

whether the children's issues can be addressed by the goals and objectives of the group
and, conversely, whether the group is relevant or suitable for the children's issues. The
fact that a child has been sexually abused does not necessarily mean that he or she is
an appropriate candidate for group therapy, or that he or she is ready for group. For
those children who need only additional parental protection, the screening process can
also serve as a tool to educate parents on safety and protection issues so that their
children can become ready for group. In deciding whether or not a given child is ready
to participate in group, a facilitator must consider and compare many factors. Whether
screening for therapy groups or support groups, facilitators should address the follow-
ing issues.
Has the abuse been reported to the appropriate authorities? The facilitator must find out
whether the abuse has been reported to a child protective services agency or to law
27
28 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

enforcement. If not, by law, the facilitator is required to report the abuse. If the parent
has not reported the abuse, the facilitator should find out why—the answer may help
to determine how protective of the child this parent is. If the parent has not reported
in order to protect the perpetrator, then the parent is putting the needs of the abuser
above the needs of the child and may not be adequately protecting the child. In this
case, the child may not be in a safe enough situation to allow the vulnerability needed
to recover from the abuse, and group might add to the child's sense of isolation and
confusion. If the parent has not reported the abuse because of a lack of understanding
of the legal system or because she is minimizing the abuse, the screening session can
be used to educate the parent about the system and about the dynamics of sexual abuse.
With additional information, the parent may then be in a better position to protect the
child. As the child feels safer, he or she will find it easier to work through the feelings
of the abuse in a group setting.
Has there been any legal activity regarding the abuse? Is there any past, present, or
potential legal activity relating to the abuse, such as a criminal case against the abuser
or a child custody case involving the abuser? If so, the facilitator a n d / o r his or her
records may be subpoenaed. The parent should be informed of this possibility. We tell
parents that we will not release the records without their permission. If they do not
give their permission, we require a judge's order before we will release them. In a
custody battle, the facilitator should try to ascertain whether the parent's motivation
for therapy is related to the child's recovery or to the belief that therapy will help her
win custody. If the latter is the case, it may be in the child's best interest to put off
entering group therapy until after custody is determined, so that the facilitator a n d / o r
the child does not end up a victim of the battle. If criminal prosecution is pending, some
prosecutors may consider the child's participation in group harmful to the case. This
is often true when the children are young, as the defense can raise issues around their
suggestibility. Defense attorneys may argue that a child has been influenced by the
group process and made to believe that the abuse happened after hearing the stories
of other children. Therefore, it may be prudent for the facilitator to talk to the prosecu-
tor on a child's case before accepting that child into the group.
What has the child disclosed? The facilitator needs to determine what information the
child has given the parent (or other caregiver) about the abuse. Has the child been able
to tell the parent details of the abuse? Is the parent able or willing to hear details about
the abuse? Children who deny the abuse, become anxious or frightened at the mention
of abuse, or cannot talk about the abuse at all may be better served in individual
therapy, as their anxiety may prove to be too disruptive to the group process. Parents
who do not want to know any details of the abuse may need to be in individual therapy
to help them better support their children through the group process. Gaining specific
information from the parent about the abuse can also help the facilitator to understand
the symptoms the child is displaying and to get a clearer sense of what the child may
be exhibiting in his or her play. Sometimes children are willing to talk more openly to
facilitators about the abuse when they know the facilitators already have the informa-
tion and they can see that the facilitators manage and contain it effectively. Knowing a
child's abuse history prior to screening may offer the facilitator the opportunity to tell
Screening Group Members 29

the child about others in group (without revealing names) who have similar abuse
stories. This can help the child feel less isolated and may lessen his or her anxiety about
attending group. Any information about the child's abuse will be useful in proceeding
with an effective treatment plan for a therapy or support group.
How was the abuse disclosed? The facilitator should discuss with the parents (or other
caregivers) how they discovered their child was being abused and what their reactions
have been to this information. This communication provides a valuable education
about parent-child relationships and how able the parents are to support their child's
recovery. This information is crucial for the facilitator in deciding whether the family
is capable of the effort needed to support the child's return to health and safety. Often,
a child's disclosure of abuse will activate a parent's childhood feelings and issues,
which may include abuse. These feelings can interfere with the parent's capacity to
provide support for the child, and some may sabotage the child's efforts to heal. In such
a situation, the child should not be in group without the parent also being in individual
or group therapy to work through his or her own issues.
Is there still contact with the abuser? This information is relevant because the child
may not be safe, or may not feel safe enough to disclose information about the abuse.
When contact with the abuser continues, it is difficult for the child to process thoughts
and feelings. The recovery process is slowed or halted when the child is in a threatening
or potentially dangerous situation. The needs of a child in this position would be better
met through individual and family therapy, a n d / o r legal intervention. Children who
have supervised visitation with their abusers may do well in group as long as they are
well protected during the visits.
Will the parents be able to follow through with treatment? The facilitator should explain
to the parents (or other caregivers) their responsibilities if their child participates in
group. These include transportation, scheduling, finances, and the ability to protect the
child from contact with the offender or allies of the abuser who might try to undermine
the child's recovery process. The parents must have a reliable car, or access to public
transit and a willingness to use it, a n d / o r a reliable person who is willing to provide
transportation weekly for the family. They must have the ability to arrange their
schedules and meet at the appointed times for groups. They must have the necessary
finances or know how to access financial resources to cover the cost of group. (Families
who are involved with state social health service systems often have case managers
who can be of assistance with these issues.) A parent who still allows the child to have
contact with the offender (even by phone or mail) or contact with the offender's allies
who disbelieve or minimize the abuse is unlikely to have the capacity or desire
necessary to support a child's emotional needs throughout the duration of the group.
A parent in this situation most likely needs her own individual therapist to direct and
educate her in protective parenting skills. If, however, another protective adult—
whether family member or friend—is willing to take responsibility for the child's
support and participation in group, the child may still be considered appropriate.
(When this alternative is not available, we have successful graduates from previous
groups who volunteer to sponsor families in these situations.) If the parents cannot
meet all of these requirements, the child is not appropriate for group.
30 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

Has there been any assessment for chemical dependency? Older children and all parents
and other caregivers need to be assessed for chemical dependency, and the screening
process should address their use of drugs and alcohol. The facilitator should develop
an abstinence contract for them to sign in which they agree to abstain from using all
mood-altering substances for the duration of group. Participants need to agree that, in
the event that they find they are unable to meet the terms of the abstinence contract,
they will receive a professional drug/alcohol evaluation if the facilitator deems it
necessary. We insist that parents abide by the abstinence contract, too, as they often
must drive their children to and from group and need to be clean and sober to help
their children through the recovery process. Failure of child or parent to agree to these
conditions makes the child inappropriate for group.
Has the child been sexually acting out? Although it is common for all children to have
some sexual curiosity, abuse can stimulate sexual acting out. We sometimes allow
sexually reactive children to participate in group when we have determined that they
are not exhibiting extremely coercive, obsessive, or offending behavior. Children who
are very aggressive or controlling of others need to be in a group that focuses specifi-
cally on the abusive behavior.
Was the abuse exceptionally violent or ritualistic in nature? Children with histories of
extremely sadistic abuse may not be appropriate for group. When their abuse has been
very severe, they need more individual attention than a group setting can provide.
Survivors of ongoing violent or sadistic abuse are often highly dissociative. Individual
therapy is a more effective modality of treatment for children to process these traumas.
Trauma reenactment in a group setting is not therapeutic for anyone. A facilitator who
is considering for group a child who has been violently abused should meet first with
the child's therapist to be certain that the child has worked through enough of the
trauma to make the group experience a success for all participants.
Does the child also have a diagnosis of attention deficit disorder? Abused children
diagnosed with attention deficit disorder (ADD) have difficulty concentrating and are
more easily distracted than other children, making them more reactive and less able to
process their thoughts and feelings about the abuse. Children with ADD do better in
group settings after they have learned how to manage, tolerate, and contain their
feelings through their work in individual therapy

SCREENING THE PARENTS OF

CHILDREN BEING CONSIDERED FOR GROUP

We highly recommend for both support and therapy groups that the parent always be
screened before the child. This will give the facilitator a much clearer picture of the
family dynamics, the child's history, and the child's readiness for group. We also
suggest that the screening session be administered by the child's group facilitator. This
allows one of the group's cofacilitators to be acquainted with both the parent's and the
child's issues before the group actually starts.
Screening Group Members 31

While screening the parent, the facilitator should establish the level of the parent's
ability to follow through with therapy and to support and protect the child. Regardless
of whether the screening is for a support group or a therapy group, the facilitator
should look for a parent who (a) supports the child emotionally, (b) allows the child to
clarify his or her own needs and to be assertive, and (c) permits the child to get well
(without sabotaging the child's efforts).

Information to Give Parents During Screening

Educating adults is a vital part of the screening process. It is helpful during

screening for the facilitator to give parents a sense of how their children are likely to
respond to sexual abuse. The facilitator can discuss the child's symptoms with the
parent and determine whether or not the parent noticed the child acting differently
after disclosure. The facilitator can also explain how research shows that children who
have parents who believe, support, and protect them have increased capacity to heal
from the abuse.
During screening, the facilitator can discuss with parents the more common behav-
ioral changes that are displayed by sexually abused children. For instance, children
frequently regress to behaviors that are normal for younger children, such as thumb
sucking, baby talk, clinginess, bed-wetting, throwing tantrums, and being fearful of
the dark or of abandonment. The facilitator can reassure parents that, although it can
be difficult, they will be able to help their children through such behavioral changes.
We often hear comments from parents such as "We thought she had outgrown this a
long time ago." Caregivers need to understand that, although their children have
outgrown certain behaviors, the trauma of abuse can cause regression. The facilitator
can explain to parents that the regression helps free the child from any feelings of
responsibility for the abuse. After all, how could a helpless baby possibly be responsible
for what happened? Or perhaps the regression is the child's subconscious attempt to
return to a time of safety.
It is beneficial for parents (and other caregivers) to understand that their children
will likely have feelings surface during group. These feelings, especially feelings of
anger, may be misdirected toward the adults they feel closest to, usually nonoffending
parents. Children can have difficulty accepting that their nonoffending parents were
unable to protect them from the abuse. Some children focus anger inward, blaming
themselves for the abuse. Throughout the duration of the children's group, parents will
need support in learning how to cope with their children's anger and other emotions
affecting their behavior. Screening sessions are a good time to get parents started in a
positive direction to help their children.
If it appears from the parent interview that the child may be appropriate for group
involvement, the facilitator should set up an appointment to screen the child. If the
facilitator finds that the parents are unable to protect the child or to commit to the
child's safety or recovery and there are no other responsible adults to take on this role,
he or she should refer the child and family to other appropriate resources.
32 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

Screening the Parents of Children

Considered for Therapy Groups

The screening session for a parent (or other caregiver) whose child is being consid-
ered for therapy group is used to gain a history of the child's abuse and to assess the
child's compatibility with group goals. It is also a time for the facilitator to judge the
parent's capacity to protect and support the child in recovery. By gaining a better
understanding of the parent's coping style, the facilitator gathers a more complete view
of the child. A glimpse into a child's family environment allows the facilitator to
determine how safe and protected the child actually is.
Screening for a therapy group is a considerably longer process than screening for
a support group. The type of information to be assembled is multifaceted. Often, we
screen the parents in two separate sessions. The initial session is scheduled for 90
minutes and is concerned with establishing the history of the abuse, the parent's ability
to provide transportation, the legal aspects of the case, and an understanding of the
child's symptoms. If at that point the parent is still interested in group for the child
and, from the information gathered, it appears that the child is a likely candidate for
group, we make an additional 1-hour appointment to assess the child.
A side benefit to screening and assessing the parent to determine the child's
appropriateness for group is that it allows us to assess appropriate treatment for the
parent. We require parents to attend our nonoffending caregivers' therapy group.
While interviewing parents, we evaluate them for traits associated with personality
a n d / o r character disorders such as narcissism, borderline personality disorder, and
dependent personality disorder. By doing a thorough assessment, we can clarify the
goals for each child and family member. Depending on the severity of any detected
disorders, some parents may need to be in individual therapy rather than group
therapy. However, if a parent's symptoms are relatively stable, a combination of
individual and group therapy may be beneficial to both parent and child. This evalu-
ation helps us to determine what to focus on in individual, group, and family therapy.
It may also play a part in the establishment of group makeup. We have found it
especially helpful to have parents with similar issues in our parent groups.

Screening the Parents of Children

Considered for Support Groups

The main reasons for screening the parents of a child who is being considered for
a support group are to gain a general history regarding the child's abuse, to find out if
the child is currently safe, and to assess how the child feels about the abuse and about
participation in a group.
Screening for support groups generally requires less time than does screening for
therapy groups, because of the type of information being gathered and its relatively
lower level of complexity. A parent screening for a support group can usually be
completed in one 60-minute session.
Screening Group Members 33

We recommend that the parents of children in support groups attend a "parents'

support group" while their children are in group. Because many support groups are
open attendance, a commitment to have the child attend each week is not vital, but it
is preferable. However, assessing the child's current safety is of critical importance.

SCREENING A CHILD FOR GROUP

When screening a child for either a support group or a therapy group, the facilitator
should meet with the child alone. Children who are unable to meet with a facilitator
without a parent in the room are probably not ready for group. They may first need to
establish a level of comfort through family or individual therapy.
Facilitators should attempt to build rapport with children during screening. They
might let the children know that they like children and ask open-ended questions about
their schools and their families. To elicit more than simple yes or no responses, they
should word questions in such a way that they require full answers. Some good ways
to start the conversation include asking the child to "tell me about your school" or "tell
me about your family," or the facilitator might ask, "What kind of games do you like
to play?"
We keep some drawing materials, a sand tray, and toys available during screening
sessions for the children to play with. Having an activity to do, such as coloring or
playing with clay, helps children relax. When children appear nervous at screening,
facilitators should ask them if they are feeling nervous and what they think might help
them to feel more comfortable.
The facilitator should let children know the boundaries right away, explaining
limits and expectations. This helps them feel safe. For example: "This is our play
therapy room for kids. You can do anything here as long as you don't hurt yourself or
anyone else. We'll talk and play for about an hour today and then we will clean up
when it is time to go."
Early in the session, the facilitator should ask the child being screened if he or she
knows the reason for the meeting. The sooner this is addressed, the better for the child,
who will then no longer need to anticipate or avoid the topic. If the child does not know,
the facilitator should ask if the child was ever touched in a way that made him or her
feel uncomfortable or confused. If the answer is no, the facilitator should state the
information he or she has in a general way; for instance, "Your mother had some
concerns about unwanted touch." If the child denies being touched again, the facilitator
can profess confusion and ask the child if he or she knows what the child's m o m might
be talking about. If the child still says no, he or she should be referred to individual
therapy to become more comfortable discussing the abuse before being placed in a
group situation.
Facilitators should not push children at screening to tell about their abuse. Children
need to be able to decide who they will tell. The more comfortable a child feels with an
individual, the more likely he or she is to tell that person what happened. The facilitator
34 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

should try to normalize the child's feelings; for example, "There are other children in
group who experienced being touched, or touching others in their private parts." If a
child fears that no one in the group will like him or her, the facilitator can tell the child
that most of the other kids feel that way too. The facilitator might tell the child that he
or she reminds the facilitator of someone else who will be in group and how much fun
they might have together. We always tell the children that group is an exciting place
because they can be completely themselves and not have any secrets. All the other
children have been touched, too, and share many of the same feelings.
Sometimes a child will ask whether the interviewer has been abused. Each facilita-
tor must use his or her own judgment when answering such questions, taking into
account how impressionable children are and what the particular child's motivation
might be in asking. If a facilitator who has been abused decides to disclose that fact, he
or she should give very few details. The facilitator may decide to share some of the
feelings he or she had then as a point of connection with the child. The focus needs to
stay on the child, however; it should not shift to the facilitator.
Young children who have already disclosed often later recant. While screening a
child who has recanted, a facilitator should use the history obtained from the parent
as well as any corroborative background received from individual therapists, teachers,
school counselors, extended family members, and others. Facilitators must rely on their
own experience and intuition in trying to determine whether particular recantations
are made out of fear or the child really was not abused. We reassure children in these
situations that if they want to tell what happened, it will be kept private unless there
is a chance of their still being hurt. We also let the children know that many children
"wish the disclosure away." Because disclosure often results in many changes in the
lives of children and their families, children often hope that by saying the abuse didn't
happen everything will return to normal. If at this point a child is still uncertain and
nondisclosing, we explain to the child that we understand and that we would like him
or her to participate in individual therapy now, and possibly in group later.
Facilitators should tell the children who are accepted into group what they can
expect from group, including specifics about games and other activities. The facilita-
tor's enthusiastic descriptions can make group sound like fun. The facilitator should
also take the time to explain that groups help sexually abused kids become friends with
one another, so they will no longer feel alone.
Children should be given a choice about being in group. If they don't want to be
there, they may be disruptive, and the other participants may suffer. When the facili-
tator has a strong sense that a child would both like and benefit from group but the
child is unsure, the facilitator might suggest that the child try it for 3 weeks and
reevaluate after that time.
In the event that parent and child information gathered at screening is markedly
incongruent, or the child discloses unreported abuse, the facilitator should reevaluate
any decision and take appropriate steps to meet the emergent needs of the situation.
If, however, after assimilating all the facts, the facilitator feels the child and family are
ready for group, he or she should take the following steps: (a) Inform them of their
Screening Group Members 35

acceptance into group; (b) provide them with a group itinerary that includes dates,
times, and places; and (c) review the commitments and responsibilities of participation.

Screening Children for a Therapy Group

The primary reason for screening children for therapy groups is to determine their
readiness to disclose and process their thoughts, feelings, and behaviors about the
abuse. A child is ready for a therapy group when all of the previously mentioned
criteria have been sufficiently met and when the child can say who abused him or her,
has some memory of it, can be in group without being too disruptive or dissociative,
and can interact with other children safely and appropriately.

Screening Children for a Support Group

The main reasons for screening a child who has adequately met the previous criteria
for support groups are to determine whether the child is safe, able to talk in general
terms about the abuse, able to do well with other children in a group setting, and able
to contain his or her feelings well enough in a group; and to determine which age group
best fits the child's needs.
In a child's support group it is not absolutely necessary to group children according
to their ages. However, it is most effective to do so, and we recommend it whenever
possible. The exception to this is when a child's development is delayed or advanced
beyond his or her age group.

Once screening is completed, it is time to start the groups. In the following chapters
we provide exercises for both support groups and therapy groups. Remember that all
of the exercises can be used for both, except those exercises marked "Therapy Group
Only." You will also notice that within some exercises certain portions are labeled
"Therapy Group Only." Do not use these parts of the exercises in work with support
groups. To help you further with group organization, we provide in the appendix some
sample outlines for preschool groups, boys' groups, girls' groups, and teen groups.
36 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

TABLE 5.1 Screening Children for Support Groups

Child Support Screening Child Readiness Questions Ready for Group Not Ready for Group
Do you know why you
Psychological/emotional: Child acknowledges Child is unable to talk
ability of the child toare here today? How do abuse and shares or cooperate, denies
acknowledge and you feel about being in a thoughts and feelings abuse, and is
share thoughts and group for children who about it. Child frightened and
feelings about the have been touched? expresses interest in anxious.
abuse Would you tell me a group participation.
little about the touch?
Behavioral: the child's Do you want to play a Child is cooperative Child's behavior is
capacity to interact game or draw while we and interacts safely disruptive and
safely with others in a talk? What kind of and appropriately. dangerous to self and
group setting games do you like to others.
play? Are their behavior
problems that might
interfere with group?
Intellectual: ability of Do you go to school or Child perceives Child is unable to
the child to day care? Tell me about environment perceive reality
understand and your school. Who do realistically, is able to accurately and is
integrate the concepts you go to when you understand questions, unable to concentrate,
introduced in group need help? and responds comprehend, or
appropriately. respond coherently.
Developmental: ability Do you have friends you Development is Child is not
of the child to play with? What do you average and developmentally
participate in group like to play? What age compatible with other compatible with same
based on emotional group does the child children in the same age group, but may be
maturity seem appropriate for? age group. compatible with
younger or older age
group.
Resources and systems: Who do you trust or feel Child has adequate Child's support
ability of the child to safe with? If something support or knows system is
receive the necessary really bothered you, or who to go to and impoverished or is
emotional and you needed something, where to go for help. too unstable to
practical support who would you talk to? support recovery
needs.
NOTE: In a child's support group, it is not absolutely necessary to group children according to their age. However, it
is more effective and we highly recommend it whenever possible. The exception to this is when a child's development
is delayed or advanced beyond their age.
Screening Group Members 37

TABLE 5.2 Screening Children for Therapy Groups

Child Therapy Screening Child Readiness Questions Ready for Group Not Ready for Group

Psychological/emotional: How comfortable is the Child is able to talk Child is unable to

ability of the child to child with you? How about the abuse, share talk, unable to
identify, articulate, does child respond at feelings, and interact cooperate, denies
and process issues mention of sexual appropriately. being abused, and is
abuse? How does child frightened and
feel about being in anxious.
group? Can you tell me
about the touch? What
happened? Tell me more
about the abuser. What
parts of the abuse do
you remember a lot?
Behavioral: the child's Are there behavior Child's behavior is Child's behavior is
capacity to interact problems that might containable and disruptive and
safely with others in a interfere with group? Is manageable, not dangerous to self and
group setting child sexually aggressive harmful to self or others. Medication
or reactive? Is child on others. Medication side effects interfere
any medication that may has no negative with concentration
affect behavior in group? influence on behavior. and performance.
Intellectual: ability of Now that everyone Child is able to Child is unable to
the child to knows about the abuse, perceive environment perceive reality
understand and what is it like at your realistically, is able to realistically. Child is
integrate the concepts house? Have you ever understand questions unable to concentrate,
introduced in group been in a therapy group and respond comprehend, or
before? rationally, and is respond effectively.
intellectually Child has
functional. developmental delays.
Developmental: ability What age group does Developmentally, Child is not
of the child to child seem to be child is compatible developmentally
participate in group appropriate for? Is child with other children in compatible with same
based on sexually active? How the same age group. age group, but may be
psychosocial, extensive was the abuse? Child's psychosexual appropriate for
psychosexual, and Would disclosure in the experience and level younger or older age
emotional maturity group stigmatize the of maturity are group. Extent and
child? compatible. Severity severity of child's
and extent of abuse is abuse experience is
in accordance with potentially
others. traumatizing to
others, or child's
abuse experience is
subtle, thus the child
may be traumatized
by the severity of
others' abuse.

(continued)
38 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

TABLE 5.2 Continued

Child Therapy Screening Child Readiness Questions Ready for Group Not Ready for Group

Resources and systems: What adults in your life Child has adequate Child's support system
ability of the child to do you trust or feel safe emotional, is impoverished or is
receive the necessary with? If your friend psychological, and too unstable to support
emotional and talked you into taking physical resources to recovery needs.
practical support to candy from the store, and support recovery
assist in recovery you felt bad about it, obligations and
would you tell anyone? commitments.
Who? What do you think
they would do?
Screening Group Members 39

TABLE 5.3 Screening Parents of Children in Support Groups

Parent/Child
Parent Support Screening Readiness Questions Ready for Group Not Ready for Group
Psychological/emotional: What happened when Parent believes the Parent blames the
the ability of abuse was disclosed? child and is able or child for family and
parent(s)/ caregiver (s) Was it reported? How willing to learn how legal problems. Parent
to protect and support did you respond to to use social and legal is unable or unwilling
the child's recovery child? History of your systems to prevent to utilize social and
process as well as child's abuse? If not further contact with legal systems to protect
their own disclosed, why not? the abuser. the child. Parents are
Does child have contact unwilling to
with offender? If yes, do acknowledge how their
you believe child is safe? own issues and
Do you use alcohol/ reactions are interfering
drugs or take any with their child's
medication? Does the ability to recover.
child?
Financial: the ability of Do you have adequate Parents are able to Parents are unable to
parent(s)/caregiver (s) financial resources to meet the family's meet the family's
to meet financial care for your family's basic needs on their basic needs and are
obligations and needs (food, clothing, own or are willing to unwilling to accept
commitments or shelter, medical, therapy, learn how to access assistance.
ability to access legal, and resources.
financial resources transportation)?
Community: the ability Do you have any family Parent has adequate Parent is unwilling or
of parent(s)/ support or other outside emotional support or unable to develop or
caregiver(s) to access support? Do you have is willing to develop it maintain emotional
and utilize emotional reliable transportation, with family, friends, support within the
and practical support or access to public or outside community family, among peers,
to assist in the child's transportation? organizations. Parent or within the
recovery is willing to prioritize community. Parent
scheduling and has no reliable
transportation needs transportation and/or
for support group. is unwilling to access
other resources.
Child and family issues How does your child Parent is willing to Parent is severely
and concerns: the cope with the abuse? Are learn about the overwhelmed,
ability of parent(s)/ you aware of sexual impact of the abuse unwilling or unable to
caregiver(s) to assess, acting out? If yes, how on the child's supervise, protect,
attend to, and report do you deal with that? emotions and maintain, or report on
on issues relevant to How does child relate to behaviors. Parent is child's behavior,
the child's safety and peers? How does child willing to learn how health, emotional, and
the abuse, the effects feel about coming to a to supervise, protect, safety needs.
of the abuse on the support group? What maintain, and report
child, and/or any does child need most on child's behavior,
other circumstances from group? Any legal health, emotional, and
affecting the family's actions expected? safety needs.
coping
40 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

TABLE 5.4 Screening Parents of Children in Therapy Groups

Parent/Child
Parent Therapy Screening Readiness Questions Ready for Group Not Ready for Group
Psychological/emotional: What happened when Parent believes the Parent blames and
ability of the abuse was disclosed? child and is able to punishes child for
parent(s) /caregiver(s) If it was not disclosed, protect child from family and legal
to believe in, protect, why not? Who abused abuse by either problems resulting
and support the the child? Is the enforcing no-contact from the abuse.
child's recovery suspected abuser still in orders or supervised Parent is unwilling or
process and their own contact with the child? visitations when court unable to provide
What steps have been ordered. Parent is safety and protection
taken to ensure the willing or able to meet for child. Parent is
child's safety? How did child's recovery needs incapable of placing
you respond to your by separating their child's needs above
child? What are your own feelings from own and actively
feelings about the child's feeling about sabotages child's
offender? Do you have the abuse and the safety and recovery.
contact with the abuser. Parent is able Parent is
offender? How often? to empathize with dysfunctionally
Where is your child and emotionally self-absorbed and
during that time? support child incapable of
Describe the details of appropriately. Parent providing or
your child's abuse. Has is willing or able to unwilling to provide
your child ever been participate in own emotional and
sexually abused before? recovery. physical support
If the offender is a necessary for the
spouse or boyfriend, ask child's recovery.
about physical, sexual,
or verbal abuse. How are
you handling the fact of
the abuse now? Do you
use alcohol or drugs, or
take any medications? Is
this typical? Were you
ever sexually abused?
Are you or your child in
individual therapy?
chapter 6
S A F E T Y AND T R U S T EXERCISES

T h e initial goal of group is to establish a safe and trustworthy environ-

ment for the children. Safety is a basic human need and a necessary condition of
survival. Children rely without reservation or choice upon adults for protection. Those
who are secured from danger are free to thrive. Over time, a thriving child comes to
believe in, trust in, and even hope for a continuous future. A child's dependence upon
others for physical, psychological, emotional, and spiritual well-being is an interactive
process. It requires the participation of both the caregiver and the child. If the parent
is a healthy or adequate caregiver, the interactions of parent and child will be experi-
enced as mutually successful and satisfying. The experience of the world as a benevo-
lent place prepares the child to negotiate his needs with others effectively and
confidently. This simple act of relationship helps to develop a sense of belonging, of
being a part of a family, a community, and a society.
Trust and safety are often primary issues for children who have been sexually
abused. Many of them have been violated, manipulated, and betrayed by family
members or trusted family friends. Power and control have been substituted for
relationship, and the children are left without resources to manage confused and
overwhelming feelings.
One of the roles of a group facilitator is to be a resource for the children. Facilitators
provide a consistent and predictable environment with clear and appropriate bounda-
ries while they model effective communication skills. Responding to children's fears
or confusion with empathic acknowledgment helps them to feel that they are being
connected with and understood by someone who cares. This helps to reduce feelings
of anxiety Encouraging children to express their thoughts and feelings verbally greatly
reduces the potential for destructive acting-out behavior. Reassuring them of their
present safety and offering them suggestions for future self-protection help them with
emotional management and containment.
41
42 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Trust-building exercises are initially used to help children feel comfortable in the
group setting and with one another. Nonconfrontational activities help to create safe
connections among group members (see "Imaginary Object," "Check-In," and "Group
Mascot"). Subsequent trust and safety exercises are designed to shape and influence
behaviors and beliefs distorted by abuse and to strengthen healthy attitudes and the
children's ideas about themselves, others, and the world around them (see "Ball Toss,"
"Going Camping," and "Group Collage About the Abuse").
Safety- and trust-building techniques are good opening and closing activities and
are a consistent thread woven throughout the entire group experience. In addition to
the exercises described below, thematic variations on common children's games—such
as Duck, Duck, Goose; Musical Chairs; Operator; Telephone; and Mother, May I ? —
work wonderfully with the children. To create bonds and to reduce feelings of anxiety
in the initial session, facilitators can have each child make a collage of him- or herself
and share it with the group. For other activities, The New Games Book (Fluegelman, 1976)
is a resource filled with many fun, group-focused games. The children often have many
great ideas, too. Facilitators can use games that they know and suggest. Even quick,
simple techniques such as a group hug, group cheer, or applause for a session well done
can go a long way toward building a sense of safety and belonging.
Safety and Trust Exercises 43

Imaginary Object

GOAL

To build feelings o f trust and safety

AGES

4 through 8

TIME

10-15 minutes

PURPOSE

This exercise provides a creative w a y for children to introduce themselves in

group, using their imaginations.

DO THIS EXERCISE TO

• R e d u c e levels of fear.
• Set a fun and creative tone for group.
• Build connections a m o n g group m e m b e r s .
• Validate group m e m b e r s for w h o they are and what they h a v e to say.
• Increase group m e m b e r s ' ability to relate authentically.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
44 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

WHAT YOU NEED

No special materials needed

INSTRUCTIONS

Direct group members to stand or sit in a circle facing one another. Begin this
exercise by pretending to hold something in your hand. Describe the imaginary
object and state what it is. It may be a cat, roller skates, a rowboat—anything.
Describe the object by using your voice and hands, and by making body movements
to illustrate clearly what the object is. For example, if your object is a mouse, hold
your hands really close together and make a petting motion. Explain that you are
holding a mouse and what you like about mice. Then answer the questions you
want the children to answer while you are still holding and petting your imaginary
object. When you are done, pass your object gently on to someone else in the group.
The following are examples of some questions you may want group members to
answer. Ask no more than three questions at a time:

• What is your name?

• What school do you go to?
• How old are you?
• What is your favorite thing to do?
• If you could have any pet in the world, what would you have?
• How do you feel about being in this group?
• What do you like about yourself?
• What is your favorite story?

As the imaginary object is passed, each person changes it into whatever she
wants it to be. Ask each child about why she changed it into what she did. Have
the child answer the questions you are asking for the day and then pass the
imaginary object on to the next person. The next person can change the object into
anything of his choosing.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 45

HINTS

Children generally love this exercise. We give group members time to ask their
own questions about the object, too. We had a bqy who turned an object into a cat
We asked him what he liked about cats and whether he had a cat It turned out that
he had a cat that he cuddled with when he felt sad.
As the facilitator, consider making your object something active, like a bail. Then
you can pretend to bounce it, throw it up in the air, jump around with it, and toss it
to someone else. This stimulates everyone's imagination and sets a tone that
encourages the children to be relaxed and enthusiastic.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
46 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Check-In

GOAL

To build feelings of trust and safety

AGES

4 through 18

TIME

5-20 minutes

PURPOSE

This exercise helps group members become present in their thoughts, which
enables them to focus on group while providing them with ways to both express
and contain their feelings. This exercise encourages a sense of trust in members and
offers them an opportunity to develop their social skills.

DO THIS EXERCISE TO

• Discuss current concerns the facilitators or group members may have.

• Bring focus and direction to that day's session.
• Teach basic communication skills, including listening, empathic response,
and appropriate disclosure of thoughts and feelings.
• Give children a sense of safety by providing a predictable beginning to each
week's session.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 47

DO NOT DO USE THIS EXERCISE WHEN

There is no reason not to do this exercise; however, you need to put clear time
limits on it.

WHAT YOU NEED

No special materials needed

INSTRUCTIONS

Have everyone sit in a circle facing one another. Decide whether you want to go
around the circle, pick people randomly, or have individual members respond to
your initial query.
This exercise helps direct the children's attention and awareness to their present
emotional state or most recent concern. It places them in context with one another
and the issues they are dealing with. The questions asked can be either general or
specific, open-ended or directive. Typical general check-in questions are open-
ended and invite voluntary responses from members. Questions such as "How are
you today?" and "How has your week been?" allow current or new information to
arise and be processed. We prefer to let children respond on a voluntary basis so
that we can witness their interactive styles. Although long silences between re-
sponses can be somewhat uncomfortable, they yield useful information. Noticing who
responds first or last, who waits to be called upon, who dominates, and who distracts
or dissociates increases our capacity to assess and treat each child's specific needs.
Time limits are helpful for group management and may vary depending upon
age group and daily group agendas. You may want to set a time limit for responses,
such as 2 minutes. To encourage responses that have emotional content and
informational relevance, we ask the children to explain their opinions and feelings.
For example, when a child responds that she is feeling "fine," the facilitator or
another group member will ask for more information or clarification by asking why,
or what is helping her to feel fine.
The specific check-in is a more focused and directive technique. It is typically
used to tie activities from one week to the next or as a lead-in to the current session's
topic or activity. Following are some suggestions for directive check-ins:

• What was the most outrageous thing you did this week?
• What thoughts or feelings did you have this week regarding the sexual abuse?

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
48 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• Finish this sentence: The worst thing about being sexually abused was . . .
• Share a dream you had this week.
• Share one great thing and one rotten thing that happened this week.
• Share one way you were tricked or manipulated this week.
• Was anyone triggered this week? Talk about one thing that happened.
• How has the sexual abuse affected your feelings about dating?
• What's your favorite thing about group?
• If you could change one thing about yourself, what would it be?
• Has being sexually abused changed you in any way? If so, how has it changed
you?
• Is there anyone you trust? If so, what about them helps you to trust them?
• Do you think you could have stopped the sexual assault? If so, how?
• Do you have a secret that doesn't feel good? What stops you from telling it?
• Name three things you like about yourself.

HINTS

Teenagers can really get off track during check-in, spending a lot of time talking
about anything but sexual abuse issues. You should definitely place a time limit on
a "general" check-in so that you don't spend an hour of your session discussing
boyfriends, school, or who dropped whom as a friend this week.
Be sure to keep group members on track. Let them know in a kind way when
they are getting sidetracked or if they are taking up too much time. Gentle confron-
tation helps them learn appropriate communication skills. Make sure that group
members are answering the questions you asked and that they are talking about
themselves and not their friends down the street
When doing check-in as an exercise, be flexible with your agenda, important
information is often disclosed and can need immediate attention. For example,
during check-in we have had children mention plans to visit their offenders for the
first time that evening. Another time a child had just learned she had to go to court
the following week to testify. One of the hardest surprises we experienced during
check-in was when a girl was told, while walking into our office to attend the group
session, that her grandfather (her offender) had just committed suicide. Naturally,
these issues took precedence over our previously planned activities and became the
focus of group that day
Melping children deal with their immediate issues and situations in a group setting
helps everyone and generates a great deal of strength, support, and confidence.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 49

Safety Rules

GOAL

To build feelings of trust and safety (Always do this in the first group session.)

AGES

4 through 18

TIME

10-15 minutes

PURPOSE

Creating clear group rules establishes a safe, consistent, and predictable envi-
ronment. T h e involvement of group m e m b e r s in developing the rules builds
cohesion, a sense that their input is important, and a feeling of o w n e r s h i p o f the
group and its process. M o s t of all, it encourages t h e m to express their n e e d s and to
b e e m p o w e r e d to speak up w h e n the rules aren't b e i n g followed.

DO THIS EXERCISE TO

• C r e a t e / e s t a b l i s h group cohesion and a sense of control and predictability in

the group.
• Increase the capacity of group m e m b e r s to risk being vulnerable and to
express their needs safely.
• Stress the importance of confidentiality a m o n g group m e m b e r s .
• Increase group m e m b e r s ' understanding that a sense of safety is b o t h internal
and external.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
50 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

Always do this exercise.

WHAT YOU NEED

• Large sheets of paper, and a place to hang up the rules

• Markers

INSTRUCTIONS

Instruct group members to think about what they need to feel safe in the group.
Give some examples, asking:

• Would you feel safe if anybody could walk through the door?
• Would you feel safe if people could get really wild in here and jump on all the
furniture?
• Would you feel safe if anything you said in here could be told to other people?

When they respond negatively to such questions, ask them what would help them
to feel safe in the room.

THERAPY GROUP ONLY: Continue by asking the group members how their
insides tell them they are not feeling safe. Give examples:

• Some people get a stomachache when they do not feel safe.

• Others think thoughts like "I don't like you" or "She hates me."
• Others want to go in a corner and hide.
• Some people get angry and start hitting objects or people.

Continue by saying, "For example, if someone said something that hurt your
feelings, how would your body tell you that you did not feel safe? What would you
do?" If a child says, "Fd hide," or "Fd yell," ask the child how the group could help
her feel safe and connected again if that happened. Offer ideas to be considered by
asking questions such as the following:

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 51

• Would you like the group to ignore you?

• Would you like someone to gently put a hand on your knee or shoulder?
• Would you like us to joke with you?
• Would you like us to check in with you and ask you how you are feeling?

Examples of internal safety rules children have chosen in the past include these:

• Jenny: If not feeling safe she will withdraw and we leave her alone.
• Sally: If not feeling safe she will cry or get teary. The facilitator can sit near her
and hold her.
• Diane: If not feeling safe she will say mean things to others. Group members
can let her know they notice she is not feeling safe and tell her why they like
her.

For both therapy and support groups, as kids make suggestions, write them on
a piece of paper marked "Rules for Safety in Group." (For therapy groups, make
sure you include the above internal safety rules on your list.) Children will need
some prodding and some help with ideas. Typically our groups include many of
the following rules:

• No hitting, kicking, spitting, or slapping.

• No touching another person without his or her permission.
• Whatever is said in this room stays in this room.
• Hugs are great if a person asks for one.
• Always listen to the person talking.
• Show you are listening by being quiet and looking at the person who is
talking.
• Respect all group members by being nice to them and treating them as you
want to be treated.
• Use your words to describe how you are feeling.
• All feelings are okay.

Make sure all of the children understand each of the written rules. The rule that
will need the most discussion will probably be one about confidentiality. The
children need to agree that they will not reveal the names of other children in the
group. Each group member has a choice about who he wants to tell about his own

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52 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

abuse. It is n o t permissible to disclose details of any other group m e m b e r ' s abuse.

If that is done, the group's sense of safety will b e destroyed.
Confidentiality can be a difficult concept to explain. We tell group m e m b e r s n o t
to share anything private that another group m e m b e r has said. T h e y also should
not tell others the last n a m e s of anyone in group. We tell group m e m b e r s it is o k a y
to talk to a parent about group and share what they are learning a n d h o w they are
feeling. T h e y m a y w a n t to say, "Johnnie shared something that h a p p e n e d to h i m
and it h a p p e n e d to m e too. I w a n t to talk about it."
B e sure to review the group rules during the second session and allow group
m e m b e r s to add any n e w rules they h a v e thought of during the w e e k .

HINTS

Display the rules on the wall each week, so that members have a visual reminder
of them. Dont drag this exercise out too long, or you'll lose their attention.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 53

Group Mascot

GOAL

To build feelings o f trust and safety

AGES

3 through 18

TIME

45-60 minutes (Aside from check-in and a quick closing exercise, this exercise
easily takes an entire group session for children ages 7-18. For 4 - to 6-year-olds, the
exercise takes about 2 0 minutes.)

PURPOSE

Building a m a s c o t together gives group m e m b e r s a sense of cohesiveness and

ownership of the group. It is a fun w a y to express their individuality while
simultaneously learning to w o r k cooperatively together. This exercise w o r k s best
if it is d o n e the second w e e k of group. Patricia G o d l e m a n brought this exercise to
us. T h e children love it.

DO THIS EXERCISE TO

• R e d u c e levels o f shame.
• Build group cohesion and a sense of belonging.
• Increase group m e m b e r s capacity to b e vulnerable and to interact w i t h other
7

group m e m b e r s authentically.
• Teach cooperation.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
54 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise.

WHAT YOU NEED

• O n e large piece of poster board

• A selection of large pieces of colored paper and white p a p e r
• C o l o r e d markers
• G l u e sticks

(Glitter, buttons, ribbons, and so on are also great to h a v e o n h a n d for added

decoration)

INSTRUCTIONS

Part I: Begin with a guided imagery for ages 7 and older. H a v e y o u n g e r children
simply close their eyes and imagine an animal, real or pretend, that they w o u l d feel
safe with. T h e n ask them s o m e of the questions listed below. Instruct older group
m e m b e r s to lie d o w n or remain in a sitting position, w h i c h e v e r they are m o s t
comfortable with. H a v e them close their eyes and take three r e l a x i n g / c l e a n s i n g
breaths. Instruct them to feel themselves b e c o m i n g more and m o r e relaxed and to
allow their bodies to rest comfortably on the floor. Then instruct t h e m to picture a
place in their minds that feels safe and wonderful. This can b e a real place or a
m a d e - u p one. A s k them to imagine w h a t the place looks like. L e a d t h e m through
an exploration of the place: H o w do y o u feel inside your b o d y w h e n y o u are there?
Notice if it's dark or light there. W h a t is the temperature there? L o o k around and
notice w h a t about this safe place fills y o u r heart with warmth. W h i l e in that safe
place, y o u notice an animal. It c a n b e a real one or a made-up one. This animal will
protect you. Notice h o w good and safe y o u feel w h e n y o u are near it. L o o k at the
animal closely. W h a t do y o u notice about it? Notice the animal's colors and its
expression. L o o k at its face, ears, tail, feet, and body.

• D o e s the animal have fur, scales, hair?

• Is it b i g or small?
• W h e r e does it live? U n d e r your bed? In the closet?

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Publications, Inc.
Safety and Trust Exercises 55

• D o e s it h a v e wings, eyes, teeth, horns?

• D o e s it h a v e special powers to protect y o u ?

W h i l e the group m e m b e r s ' eyes are still closed, assign a different section o f the
animal for e a c h person to study closely. For example: "Jan, y o u notice y o u r animal's
eyes, ears, and the top of the head. Sally, y o u notice your animal's nose, m o u t h ,
chin, and neck. Rosie, y o u focus on the animal's legs. Jean, notice w h a t y o u r animal's
body, the torso, looks like."
Tell t h e m that they will b e leaving their safe places, but their animals will b e
able to see them, b e with them, and protect t h e m wherever they go. Tell t h e m to
begin to feel the floor beneath them and to notice sounds they're hearing around
them. Tell t h e m to return to the room b y slowly opening their eyes.

Part II: Instruct the group m e m b e r s to draw the sections of their animals they
were assigned. H a v e them draw their sections on pieces of paper large e n o u g h to
fit on the poster b o a r d in proportion to the rest o f the pieces of the animal. R e m i n d
t h e m to d r a w only the parts of their animals that y o u assigned to them. F o r e x a m p l e ,
if a person pictured a lion and you assigned h i m the tail, he is only to d r a w the lion's
tail.

Part III: H a v e each m e m b e r cut out the b o d y part she just drew and h a v e the
group together arrange and glue the b o d y parts onto the poster board to create a
protector animal. This mascot m a y h a v e a lion's legs, a snake's tail, and a shark's
teeth.

Part IV: Together, decorate the animal. A s k the children questions about the
animal as it is b e i n g formed. For instance, " D o e s it have any extra qualities, such as
poison sacs, eyes that see everything, lightning bolts to electrocute offenders, or
scales all over that emit slime?" A s time permits, while decorating, ask each m e m b e r
about the individual animal he visualized.

Part V: A s k group m e m b e r s what the group mascot will say to protect them.
Write up these w o r d s on a piece of paper and place them so that they are c o m i n g
out of the animal's mouth, as if the animal is saying them.

Part VI: A s k the group to come up with an agreed-upon n a m e for the m a s c o t

(this process alone can b e quite fascinating). T h e n h a v e the group decide if the n a m e

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
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56 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

will be accepted by majority rule or consensus. Should there be silent voting? Notice
the dynamics in the group while a name is being chosen. Does one member take
charge? Do others follow her? Is one upset if the name he suggests isn't chosen?

DISCUSSION
(THERAPY GROUP ONLY)

Following the exercise, discuss the process. Is everyone happy with the mascot?
Describe the ways they cooperated and the times when cooperation broke down.
Ask them how they felt when or if it broke down. Ask if everyone felt heard and
recognized during this process. If not, why not? If you notice a child had shut down,
ask her what that felt like for her. Ask her what she would like the group to do if
this happens again. Does she want to be recognized or ignored? Would she like a
hug or someone to sit near her? Would she like people to joke with her or be serious?
This is the same process that is done in setting up the rules for the group. This gives
you a chance to expand on the importance of group members' learning to identify
and express their needs.
If there is time, ask the same question of every group member: If you are feeling
not included, or sad, scared, or angry, how can you let the group know and what
would you like from the group?

HINTS

Some group members may be resistant to drawing only parts of their animals.
Encourage them to do so anyway. Once they join in on the group animal they'll enjoy
it and be proud of their particular contributions.
The mascot is now an important member of the group. Therefore, always be sure
to display it in the room for every subsequent group session.
Often, the facilitators will go to a copier store and photocopy reduced colored
copies of the mascot for each member to take home.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 57

Going Camping

GOALS

To learn about internal boundaries; to build feelings of trust and safety

AGES

4 through 6

TIME

30 minutes

PURPOSE

This exercise, developed b y one of our therapists, Karen Farber, helps group
m e m b e r s increase their ability to self-soothe and control their anxiety. It helps t h e m
to identify and express their needs and thus get their needs met.

DO THIS EXERCISE TO

• Build a personal sense of safety.

• Teach the children to express their feelings and articulate w a y s they feel safe.
• G i v e the children a sense of control over their environment.
• Increase group cohesiveness.
• Increase the children's capacity to b e vulnerable and to interact authentically.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
58 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• A n y child in the group w a s abused on a camping trip (in such a case, y o u

could turn this into a day hike in the forest or a day at the b e a c h )

WHAT YOU NEED

• I t e m s u s e d on camping trips, such as a children's tent b i g e n o u g h for all group

m e m b e r s (or a card table and a large bed sheet), stones for a campfire, one
flashlight for each child, a couple o f pieces of firewood
• E n o u g h chairs for each child
• Paper
• C o l o r e d markers
• A stuffed animal that each child brings from h o m e (have a few extras available
in case s o m e children forget to bring them)

INSTRUCTIONS

Part I: Tell the group that y o u are all going on an imaginary c a m p i n g trip.
A r r a n g e the chairs as if they were the seats in a car, and h a v e e v e r y o n e get in the
car and b u c k l e their seat belts. Drive to the beach, describing s o m e o f the sights y o u
see o n the way.

Part II: W h e n y o u arrive at the beach, have the children help set up the tent and
gather firewood and rocks for the fire circle. (If y o u h a v e n o tent, m a k e one b y
putting the b e d sheet over the card table.) T h e n m a k e a campfire b y putting the
rocks in a circle and placing the w o o d in the center. C o o k up and eat an imaginary
dinner, a n d then h a v e everyone brush their teeth and get into b e d in the tent. Pass
out the flashlights so that each group m e m b e r has one.

Part III: W h e n everyone is in the tent, explain that it is nighttime and it is getting
dark. A s k e v e r y o n e if it is okay to turn out the lights to remind t h e m it is nighttime.
Turn off the lights only if everyone agrees. N o w ask, "Are y o u scared of the dark?
W h a t are y o u afraid of in the d a r k ? " If they're afraid of monsters and animals, ask
t h e m w h y they are not afraid of these things during the day. They'll probably
m e n t i o n that they can see t h e m during the day. Let them k n o w that people can see
at night, too. W h e n y o u first turn out the lights it is dark and hard to see, but then

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 59

your eyes adjust and y o u can see a lot of things, even in the dark. A s k t h e m , w h e n
they are feeling scared, h o w they can feel safe? H a v e them try everyone's ideas; for
example:

• Let's turn on the flashlights.

• Let's sit on s o m e o n e ' s lap.
• Let's sing a song.
• Let's hold hands.

Part III: W h e n everyone lies d o w n to go to sleep, ask, "Did anyone h e a r that

noise? I think it's a bear. H o w can w e scare the bear? Let's figure out w a y s to feel
safe from the b e a r together." S o m e suggestions might be:

• Turn the flashlights on.

• M a k e lots of noise.
• Call on the cellular p h o n e for help.
• H o l d each other.
• R e m i n d ourselves that bears are really scared of people and don't w a n t to b e
around us so w e just have to b e loud enough to let the bear k n o w w e ' r e here.

Part IV: H a v e everyone lie d o w n for a peaceful sleep, then w a k e t h e m up and

tell them it is morning. H a v e everyone help p a c k up, and then drive h o m e in the
car together.

Part V: B a c k in group, talk about h o w m e m b e r s can feel safe at h o m e . A s k

questions such as the following:

• D o e s a n y o n e get scared w h e n there is a storm and lightning?

• Is a n y o n e scared of spiders? T h e dark?
• W h a t can y o u do at h o m e to feel safe?
• W h o can y o u tell that y o u are scared? Will they help you?
• W h a t can y o u do to help yourself feel less scared? W h a t can y o u think in your
head? W h a t can y o u feel in your b o d y ? W h a t can you hold or d r a w ?

Part VI: H a v e each group m e m b e r d r a w a picture that shows s o m e t h i n g he is

afraid of and w h a t h e can do to feel safer.

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60 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

Put away the flashlights when you pack up the car, or you will have major
distractions.
When children have difficulty thinking of ways to be safe for their drawings, make
suggestions, such as getting help checking that all the doors and windows are locked
at home at night or asking someone to check under their beds and in the closets
before they go to sleep.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Safety and Trust Exercises 61

Group Collage
About the Abuse

GOALS

To learn about internal boundaries; to build feelings of trust and safety

AGES

5 through 18

TIME

60-90 minutes

PURPOSE

D o i n g a collage together builds a group b o n d and provides a safe outlet for

expressing feelings about the abuse.

DO THIS EXERCISE TO

• Build group cohesiveness.

• Introduce a safe w a y to begin identifying and expressing feelings about the
abuse.

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Publications, Inc.
62 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• The group room is too large for everyone to work side by side comfortably.

WHAT YOU NEED

• One large piece of butcher paper

• Crayons and markers
• Old magazines
• Yarn and glitter
• Photographs
• Construction paper, tissue paper
• Scissors
• Glue and tape

INSTRUCTIONS

Part I: This exercise can be done as an introduction for group members to tell
their personal abuse stories. Roll out the butcher paper so that everyone is sitting
side by side with the paper in front of them. Then instruct the group members to
use the materials at hand to describe all their feelings and thoughts about the abuse,
even though some may be contradictory or confusing.

Part II: When the collage is finished, have the group members share what they
have created. Encourage them to ask questions about others' creations. Point out
the feelings that the children have in common with one another. Hang the collage
up to use during future sessions as a reminder of the multitude of emotions children
feel when they are abused.

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Publications, Inc.
Safety and Trust Exercises 63

HINTS

Do not give too many directions on this exerise. If kids want to work on a section
together, Fine. You'll find that they are taking notice of what others are doing and will
be talking and commenting throughout the exercise This exercise also gives you a
glimpse into their social skills as you observe how they interact and how willing or
unwilling they are to share their materials. (Because the finished collage may be
displayed in a room with some public viewing, ask the children not to use swear words
or their names.)
Consider having many precut pictures available for younger children, Otherwise,
finding the pictures and then cutting them out can take the entire group time.
This can be a calming exercise. We had a group of wild 7- and 8-year-olds, some
of whom were so full of rage they had difficulty sitting for more than 2 minutes at a
time, others in the group were so ashamed of the abuse that they had only revealed
who touched them and nothing more. They were completely engaged during this
exercise, which had a more cathartic and cohesive effect on the group than did any
other. Group members took great care in the pictures they drew and cut out. They
began helping each other write comments next to their pictures. The following week,
when we discussed each person's section, we found out that one member was still
having contact with the offender and was overwhelmed with fear that the abuse
might happen again. Another felt "dead" during the abuse and began to describe how
she completely dissociates whenever she remembers it A third finally admitted that
she was abused by an additional offender recently and others graphically described
their own feelings of anger and fear toward their offenders.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
64 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Let It All Out/Sound Train

GOAL

To build feelings of trust and safety

AGES

4 through 18

TIME

2-5 minutes

PURPOSE

This is a wonderful exercise that helps to release pent-up e m o t i o n s in the group

in a safe way. It provides support and permission to a c k n o w l e d g e and express b i g
feelings instead of acting them out or avoiding them altogether. (This is a quick, fun
w a r m - u p or closing exercise.)

DO THIS EXERCISE TO

• Release feelings of fear, shame, and isolation.

• Release feelings after the group has done s o m e hard emotional work.
• Teach stress m a n a g e m e n t and containment skills.
• Relieve feelings of anger, disgust, or hurt before group m e m b e r s leave the
room.

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Publications, Inc.
Safety and Trust Exercises 65

DO NOT USE THIS EXERCISE WHEN

There is no reason not to do this exercise.

WHAT YOU NEED

No special materials needed

INSTRUCTIONS

There are two versions of this exercise. For both, group members stand next to
one another in a circle, about half an arm's length apart. In the first version, "Let It
All Out/' the facilitator starts by making a sound and motion that expresses how
she is feeling, such as a karate yell with a karate chop. The rest of the group then
copies that same motion and noise. Then another group member who chooses to
do so makes a noise and sound, and again the entire group follows by simultane-
ously making the same sound and movement. Continue doing this until everyone
who wishes to has initiated an emotional release.
The second version, "Sound Train," is very similar. The only difference is that
after the first person demonstrates a sound and movement, this action and sound
are slowly built upon. The person to the initiator's right does the same sound and
motion while the initiator keeps doing it. Then the following person joins in, so now
three people are doing it all at once. This continues until finally the entire group is
imitating the initial person. Once that sound train is completed, someone else
initiates a sound and movement and the process is repeated.
End both versions with one or two quiet and calming motions to help group
members settle down before they leave the room.

HINTS

You can use this exercise often, whenever you believe feelings need to be released
or the group is growing restless. Once the children are familiar with this exercise, they
will often recognize their need for it and request it themselves.

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Publications, Inc.
66 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

My Own Safe Place

GOALS

To learn about internal boundaries; to build feelings of trust and safety; to learn
to m a n a g e triggers

AGES

3 through 18

TIME

15-20 minutes

PURPOSE

This exercise helps each child find and define his o w n safe p l a c e in the world.
This place m a y b e real or imagined. It is a place where a child c a n m o m e n t a r i l y
escape w h e n feeling threatened; w h e r e h e can bolster his strength and confront his
fears.

DO THIS EXERCISE TO

• Increase the children's understanding that a sense of safety is b o t h internal

and external.
• Increase the children's capacity to risk being vulnerable and to express their
n e e d s safely.
• Increase the children's ability to identify, comprehend, m a n a g e , and express
thoughts and feelings appropriately.

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Publications, Inc.
Safety and Trust Exercises 67

• Decrease dissociative behavior w h e n abuse is mentioned.

• Increase the children's ability to m a n a g e trigger responses.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise. In fact, w e believe it should b e d o n e

in all groups.

WHAT YOU NEED

• Drawing paper
• M a r k e r s or crayons

INSTRUCTIONS

Part I: Instruct everyone to close their eyes for a few minutes and to i m a g i n e the
safest place possible. This can b e a real or imagined place. A s k them:

• H o w does this place help y o u to feel safe?

• A r e there other people there? If so, w h o ?
• Are there animals there?
• W h a t does this place look like?
• Is it indoors or outdoors?
• W h a t is the temperature like?
• A r e there colors, sounds, or sights y o u especially notice?

E n d the i m a g e b y stating, " K n o w that this is a place where n o one c a n h a r m you.

You will always b e safe here. In your m i n d ' s eye, add in everything y o u n e e d to b e
safe in this p l a c e . "

Part II: Instruct everyone to open their eyes and to draw their safe places.
Encourage t h e m to include as m u c h detail as possible.

Part III: H a v e everyone share their drawings with one another b y describing
their safe places and w h a t about their places helps them to feel safe.

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Publications, Inc.
68 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

You will be able to use the image of a safe place over and over again. When doing
other guided imagery exercises, you can have each child first imagine her safe place
as a way to hasten the relaxation process. We often mention the children's safe places
on the personalized certificates they receive at the close of group (see "Completion
1
of Group Ceremony ')-
Some sexually abused children have never had a sense of safety and so have a
difficult time imagining a safe place. Work with these children individually to help
them begin to visualize the possibility of such a place existing. Ask each child if she
can remember one time when she felt happy. Have her describe that time to you.
Ask her if she can remember a place where she felt she might have some protection.
Have her describe that place to you. Use the child's answers to help her develop an
image of a safe place. Sometimes using the word soothing in place of safe can help
a child to develop an image.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
chapter
7
SELF-ESTEEM EXERCISES

T h e development of a child's self-esteem is not an event, but a process.

Self-esteem evolves over time and within the context of relationships. Developing
healthy self-esteem is an inside job that requires outside help. To develop a strong sense
of self, a child must learn that she is a valuable person who is loved, enjoyed, and
respected. She must be afforded opportunities to feel and demonstrate that she is an
integral part of her family and community. How well she develops this positive sense
of self is strongly influenced by the main caregivers in her life.
We believe that there are five stages in the development of a healthy self-esteem: safety,
attachment, affection, achievement, and socialization. All of these five stages are intricately
woven between the child and the relationships she has with those around her.
Let's begin with safety, which has both physical and emotional components. Physi-
cal safety protects the integrity of the body. It provides the child with an environment
that will ensure her ability to thrive. Parents with healthy self-esteem are able to be
present and focused on their children's needs. When the child is very young, the
healthy parent makes sure the child is safe. She protects the child physically from a
dangerous environment filled with cars, hot burners, and myriad other potential
harms.
Emotional safety requires conditions that allow and contribute to a child's emotional
safety and development. Children need guidance to navigate successfully the un-
charted world of sensations, emotions, and events. They need help learning to put
words to their feelings. They need to be encouraged, comforted, and corrected so that
they can learn to nurture themselves and relate empathically with others. A parent who
is sufficiently attuned to her child's needs will positively influence the child's ability
to learn how to identify, interpret, tolerate, and regulate emotions. When the child gets
hurt, the parent soothes her with comforting words and gentle embraces. The words
also teach the child about emotions and thoughts. A 4-year-old who bursts into tears
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70 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

when the family dog runs by and knocks her over would be swept into the arms of an
emotionally healthy parent and held. That parent may comfort her by saying, "Oh,
honey, are you all right? That must have scared you. You were standing there as happy
as could be and then boom, you're on the floor. I don't think you're hurt. I'm glad you're
not. It's okay to cry, sweetheart." In such an interaction the child's feelings are validated
and mirrored, and she is taught words for her emotions. She is also told that it is okay
to express those emotions and to receive comfort when she needs it. A parent with the
capacity, energy, and desire to recognize and respond to her child's physical, psycho-
logical, and spiritual needs adds greatly to her child's feelings of emotional safety and
esteem.
Attachment is a way of describing feelings of connection and belonging. The expe-
rience of feeling connected or belonging to something or someone benevolent and
greater than oneself is at the heart of human relationships. A person's first experience
of attachment begins during infancy. You have probably noticed how babies often try
to maintain eye contact with their parents as the parents are moving away. Very young
children can follow only with their eyes, but as a child becomes mobile he will
physically follow the parent. You may have watched a baby happily respond when he
hears his mother's voice. Although the infant is unable to articulate feelings, his
movements demonstrate the attachment he has already developed with the parent.
It is through this relationship with the parent that a child learns about the world
and himself. How he feels and relates to others will be largely determined by the quality
of this primary relationship. In the example above, of the little girl accidentally knocked
down by the family dog, the mother compassionately intercedes and provides the child
with comfort, understanding, and perspective about the event. The mother's empathic
response teaches the child how to relate to life's experiences with shared understanding
and compassion.
When attachment fails to develop adequately between a parent and child, the child
is at risk. A parent too wounded or self-absorbed to respond to a child's needs may not
provide a sufficient experience of bonding (Horney, 1991). At worst, this could result
in the child's failure to thrive, disorders of attachment, or sociopathy. At best, it could
lead to the child's impaired ability to relate to the world, other than in an antagonistic
or objectifying way.
Affection may be pictured as the emotional energy that allows attachment to occur.
It is an emotion that conveys warmth, positive regard, and love. Over time, this feeling
of affection flows toward a child, creating a core belief and a felt sense that she is, at
center, someone who is both lovable and worthwhile. Children who feel loved and
valued are more secure and confident. They are able to handle new situations, changes,
and difficulties with some measure of hope and composure. When M o m sweeps her
capsized little girl into her arms and says, "Oh, honey, are you all right?" she is
conveying concern about her daughter's physical condition and emotional experience.
She is affectionately letting her child know that what happens to her matters and that
she deserves time, attention, and comforting.
When children are neglected or abused, their self-esteem is greatly impaired. If a
parent ignores or punishes a child for expressing needs for affection, attention, or help,
Self-Esteem Exercises 71

the child will learn to adapt—at a grave cost to himself. The absence of affection in
combination with other negative treatment may cause feelings of abject worthlessness.
Children who feel bad about themselves treat themselves and others in ways that
demonstrate their lack of self-esteem.
Achievement is the ability to transform ideas into actions. When children have an
underlying sense of emotional security and confidence, they have the courage to assert
themselves effectively in the world. Children need more than encouragement, however,
to be successful. They need skills. They need to learn how to direct and sustain effort
in order to achieve desired results. A child who is learning to walk first crawls and most
often falls. Parents who teach their children how to tolerate the frustrations that come
with learning, by modeling patience and commitment transfer skills, and greatly
increase their children's potential for success. When the little girl in our example learns
how to dodge her overly enthusiastic dog effectively, she feels a sense of accomplish-
ment. When her parents teach her how to communicate with the four-legged family
member through commands such as "sit" and "stay," she is deeply impressed with both
herself and the dog. Her burst of pride comes from acquiring skill as well as from
establishing a means of communication and relationship with her dog. Children who
are guided, corrected, and praised become adults who know their limitations and
realize much of their potential.
We have observed that when children are made to feel incompetent, they have
difficulty with performance. Parents who shame, humiliate, or inappropriately punish
their children for exercising their will damage their child's self-will and self-esteem.
These children often feel defeated before they even start. They frustrate easily when
things don't go just right and they sometimes fear that there will be retaliation for
mistakes made.
Socialization is learning gained from a system of collective values, practices, and
habits. Children initially are socialized through their interactions with their parents
and other family members. Ideally, children are guided by their parents. They are
taught how to think and behave, instead of what to think and do. A child's ability to
grow into responsibility and become a positive member of society depends on his
capacity to understand the values or consequences of his actions and their effects on
the whole. If our little girl's impulse to kick her dog because he made her fall were to
go uncorrected, she might never learn how to manage her problems or hurt feelings in
ways that lead to self-respect and consideration of others. She might similarly mishan-
dle other life situations as well, and her relationships would suffer.
Children who learn at the hands of parents who themselves are irresponsible,
immature, or mentally unbalanced usually have difficulty relating effectively to others.
In situations where children are sexually abused by parents or other family members,
lessons of responsibility and accountability are confused and distorted.
When a child has been sexually abused on an ongoing basis, her self-esteem is
greatly impaired. Instead of learning about mutual relationships through the love and
respect of an adult, the child learns about power and control (power over someone or
something substitutes for connection with others). Instead of learning how to express
herself and negotiate her needs, she learns about manipulation and control. Instead of
72 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

learning about attachment, she learns to feel guilty and responsible for others' feelings
and behaviors. Instead of learning about loving affection and to trust the support of
others, sexually abused children learn that people are dangerous and can hurt you.
The group is a perfect venue for sexually abused children to develop healthy
self-esteem. Through facilitated social interaction, children learn what to value and
trust inside themselves, in the environment, and in others. Self-esteem exercises pro-
mote cooperation as well as competence, which enables children to gain confidence as
well as a sense of belonging.
The role of the group facilitator is to model and teach the concepts of safety,
attachment, affection, achievement, and socialization through self-esteem exercises.
Self-esteem is the heart and soul of a child's life. Every exercise contained within this
book offers an opportunity to address one or all of the components of self-esteem.
Children want to be liked, want to belong, want to get along and have friends—remind-
ing them of this and helping them to learn these skills is both a necessary and a
gratifying responsibility.
The following exercises emphasize the creation of a positive self-image (see "Ball
Toss"), a sense of belonging with other group members (see "Friendship Medals" and
" Y e s / N o / M a y b e Continuum"), rebuilding children's views of themselves based on
reality ("Me, Through the Years"), thus helping children develop a sense of hope for a
positive future.
Self-Esteem Exercises 73

Yes/No/Maybe Continuum

GOAL

To build self-esteem

AGES

6 through 18

TIME

10-20 minutes

PURPOSE

This exercise is used to help reduce levels of fear, shame, and isolation that
children often feel w h e n disclosing the details of their abuse. T h e w a y s in w h i c h
the children respond to questions can generate n e w information about their circum-
stances, attitudes, and behaviors. This exercise also allows the children to witness
other children's experiences of abuse, w h i c h increases a sense of b e l o n g i n g and
decreases a sense o f feeling different from everybody else. This exercise is adapted
from a p s y c h o d r a m a workshop w e attended in the 1980s led b y psychodramatist
A n n Taylor.

DO THIS EXERCISE TO

• R e d u c e levels o f fear, shame, and isolation.

• Increase group members' capacity to be vulnerable and to interact authentically.
• Create a strong feeling of group cohesiveness and identity.

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74 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise.

WHAT YOU NEED

• T h r e e signs: one that says " Y e s , " one that says " N o , " and one that says
"Maybe"

INSTRUCTIONS

Prior to beginning the group, post the three signs along a straight line in the
r o o m , w i t h the " M a y b e " sign in the middle.
B e g i n expressing yourself with excitement and enthusiasm about this exercise
to get and keep everyone's attention while y o u explain the instructions. Explain
h o w group m e m b e r s will stand under the signs, using their bodies instead of their
voices to a n s w e r the questions being asked in this exercise. F o r e x a m p l e , if the
question is " D o y o u like frogs?" y o u will stand under the " N o " sign if y o u really
don't like t h e m or under the " Y e s " sign if y o u do like them. You will stand under
the " M a y b e " sign if y o u sort of like t h e m or sometimes do and s o m e t i m e s don't.
W h e n e v e r y o n e understands h o w the " g a m e " is played, b e g i n b y asking s o m e
fun and nonthreatening questions. This will encourage e v e r y o n e ' s involvement,
e v e n those w h o might otherwise b e reluctant to participate in group activities. F o r
e x a m p l e , y o u might ask, W h o likes chocolate? pizza? dogs? cats? s n o w ? to s w i m ?
music? and other "get to k n o w y o u " questions. After everyone gets the idea, begin
asking questions that are more specific and therapeutically oriented.
T h e questions used in this exercise include two different types: (a) the "fun
j o i n i n g " or the "get to k n o w y o u " questions, such as " W h o likes to w a l k in puddles
o n rainy d a y s ? " and (b) the therapeutic questions. T h e first kind o f questions can
b e ad-libbed and are asked mainly b y facilitators, though w e often invite children
to ask these or any other kinds of questions they have. W h e n the g a m e is well under
way, w e b e g i n asking therapeutic questions, using the sequence s h o w n below.
T h e first time a group does this exercise, use these therapeutic questions.
( R e m e m b e r to begin with fun joining questions.) T h e following 10 questions w o r k
well for a n e w group:

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Self-Esteem Exercises 75

• Did y o u feel scared about coming to group?

• A r e y o u still feeling scared?
• A r e y o u still feeling nervous?
• H a s a n y o n e b e e n touched in a w a y that m a d e them feel confused, uncomfort-
able, or y u c k y ?
• Were y o u touched b y someone y o u k n e w ?
• Did y o u think it w a s your fault?
• D o y o u think the person w h o touched y o u should not have?
• D o y o u w a n t to help everyone feel safe in this group?
• D o y o u w a n t to have fun in this group?
• A r e y o u ready to go h o m e now?!

For the second session of group in which this exercise is used, ask these questions
after s o m e initial "get to k n o w y o u " questions:

• Was a n y o n e here touched b y their brother/uncle/stepdad/grandfather/fa-

ther/neighbor?
• Did y o u tell y o u r m o t h e r / f r i e n d / t e a c h e r / e t c ?
• Were y o u believed?
• Did a n y o n e here have to talk to law enforcement?
• D i d a n y o n e h a v e to go to the doctor because of the touch?
• D o y o u or did y o u go to court?
• D o e s a n y o n e w o r r y about their b o d y ?
• D o e s a n y o n e think people k n o w about the abuse b y looking at y o u ?
• D o e s a n y o n e h a v e b a d dreams about the stuff that happened?
• D o y o u feel safe in your room at night?
• D o y o u think a family m e m b e r / f r i e n d is m a d at y o u for telling?
• D i d y o u think y o u were the only one w h o w a s touched?
• Were y o u told y o u w o u l d be hurt or thought something awful w o u l d h a p p e n
to y o u if y o u told?
• Did y o u think, or were you told, that s o m e o n e else w o u l d get hurt if y o u told
about the touch?
• A r e y o u glad y o u told about the abuse?

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76 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• Do you think it was [start here with the facilitators' names, then the least shy
person in group, until everyone's names have been used] fault they were
abused?

THERAPY GROUP ONLY: Later on, this game can be used to teach children the
BASK (Behavior, Affect, Sensation, Knowledge) model when the focus is on internal
boundaries and the expression of thoughts, feelings, and actions. Some items for
y e s / n o / m a y b e responses would then include the following:

1. When I was touched, I thought I was bad.

2. When I was touched, I thought Mom would get mad.
3. When I was touched, I thought, "I wish this would stop!"
4. When I was touched, I thought I would get in trouble.
5. When I was touched, I thought, "This is fun."
6. When I was touched, I felt frightened.
7. When I was touched, I felt angry.
8. When I was touched, I felt alone.
9. When I was touched, I felt confused.
10. When I was touched, I felt embarrassed.
11. When I think about the abuse, I feel shivers in my body.
12. When I think about the abuse, I feel like someone's still touching me.
13. When I think about the abuse, I feel pain.
14. When I think about the abuse, I feel excited.
15. When I was touched, I pretended I was asleep.
16. When I was touched, I pretended to fly away.
17. When I was touched, I touched back.
18. When I was touched, I closed my eyes and waited for it to stop.
19. When I was touched, I froze and couldn't move.
20. When I was touched, I kicked and hit.
21. When I was touched, I did what I was told to.
22. When I was touched, I said no.

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Self-Esteem Exercises 77

HINTS

Be sure to word questions in this exercise in such a way that they can be answered
with yes, no, or maybe, on the continuum. After the children respond to a question
it is useful to ask other variations of the initial query. For example, if you ask, "Who
was sexually abused by your dadr then add "stepdad?" or "mom/stepmorn?" or
"brother/stepbrother?" there may be a few children who answer no to all the
questions being asked about the offender. Therefore it is important to ask specifically,
"Who was the person who touched your (As the facilitator, you should already know
the answer to this question for each group member. If anyone comes up with a
different person, note it for the individual therapist) When a child is hesitant to
answer, give him room and wait until he is ready to talk later
Often, more information is volunteered without any prompting. Pay particular
attention to these cues as they often reveal details of the abuse that may not have
been initially reported. It is especially important to take careful notes when there are
court cases pending.
Children may not have the vocabulary to describe their feelings. However, when
feelings are named through questions such as "Who felt angry, or sad?" group
members can more easily identify and recognize emotions. Children can also better
understand feelings when they are allowed to express their personal experiences of
feelings. In one group a little girl asked, "Who had a hurt heart?" This gave her
permission to share her knowledge of sadness, which in turn encouraged others to
talk about their feelings.
While you are asking questions, be sure to keep track of the answers that kids
have in common with each other. Note the similarities for the children; for example,
"Wow, everyone here was touched by a male* or "Everyone felt confused/ Children
will then begin to notice the things they share with others, which will help to build
bonds and a sense of belonging to the group,
One question we always ask is, "Who has a friend?" in one group, we had a child
who responded with a no to this question. The other group members spontaneously
1
responded by offering their friendship, with each child saying, "You can be my friend/
As the group progressed, we often checked in with this little girl who hadn't felt that
she had any friends, to remind her she had made friends with all of us. After 10 weeks
of group, she was confidently boasting to her family about how many friends she
now had.
If you do allow the children to come up with some of their own questions, limit
them! You may decide that each child can ask one question only, or that each
question must be about the touch. Without limits, this exercise will turn into the only
one you do that session.
This exercise is a real hit in groups. It has repeatedly been the favorite of many
children. Often when we have a little extra time at the end of a group, someone will
request that we play the "Yes/No/Maybe Game."

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78 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Ball Toss

GOAL

To build self-esteem

AGES

3 t h r o u g h 18

TIME

10-15 minutes

PURPOSE

This activity promotes social interactive skills a m o n g group m e m b e r s while

increasing their capacity to value themselves and others. It also assists children in
learning the n a m e s of others in group.

DO THIS EXERCISE TO

• Increase the children's capacity to value self and others.

• G a t h e r information related to the children's feelings and beliefs about them-
selves and others.
• H e l p group m e m b e r s get to k n o w each other.

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise.

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Self-Esteem Exercises 79

WHAT YOU NEED

• A soft ball or small stuffed animal

INSTRUCTIONS

H a v e the group form a circle, either standing or sitting. Explain that o n e person
will start b y tossing the ball (or stuffed animal) to s o m e o n e else in the circle while
saying something h e likes about that person. T h e person w h o receives the ball will
then gently throw it to another person and compliment her. The ball can b e tossed
to anyone—it doesn't h a v e to go in a circle or in any specific direction. Play
continues until everyone in the group has received at least three or four compli-
ments.
This exercise is v e r y versatile and can b e used as a fun w a y to elicit a variety o f
information. There are m a n y kinds of statements y o u can have the children m a k e
as they toss and catch the ball. S o m e examples:

• S o m e t h i n g about myself that I a m p r o u d of is . . .

• The best part of being in this group is . . .
• I feel m o s t scared w h e n . . .
• T d like to b e friends with you because . . .
• I a m a g o o d friend w h e n I . . .

HINTS

As the facilitator youll need to fill in the gaps during this exercise. There may be
one or more group members who are not so popular. You can help them feel included
by directing your compliments toward them and by asking other group members to
choose someone they have not chosen before for each toss.
If you have concerns about someone being left out by others, prior to starting
you can add more structure. For example, in some groups we have asked each person
to say something he likes about each individual in the group.
Group members will often need help to recognize the difference between
behaviors and appearances. Because sexually abused children are often quite or
overly focused on their appearance, we suggest that compliments be made about
behaviors only We have found it is necessary to exaggerate a bit to model this clearly
for younger group members. For example, you might start by saying something like,

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80 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

"Lets see, what do J like that Sara does in group? Oh, i know, I like how well Sara
listens while other people are talking/
Young children will often copy the child who went before them. Therefore, with
3- to 6-year-olds, you may want to set a rule that each person must say something
different from what the person who went before them said.
The younger the group, the faster paced the exercise needs to be, otherwise
children will lose interest You may want to tell them that the ball is a "hot potato,"
so they need to pass it fairly quickly.
You may also use this exercise as a name game, if it is being played this way, have
the child with the ball say her name first, then the name of the child she is passing
the ball or stuffed animal to.

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Publications, Inc.
Self-Esteem Exercises 81

Me, Through the Years

(Therapy Group Only)

GOAL

To build self-esteem

AGES

7 through 18

TIME

45-60 minutes (This can b e done over two sessions: In the first session, d r a w the
lifelines; in the second, share them.)

PURPOSE

This exercise helps to put the sexual abuse in perspective. Being sexually abused
is not the only identity group m e m b e r s have. T h e y also are students, children,
artists, writers, and more. Like anybody, they have h a d both good and b a d experi-
ences in their lives. Rather than having the sexual abuse be their entire focus, this
exercise helps build their self-esteem b y encouraging them to r e m e m b e r s o m e of
the other experiences in their lives.

DO THIS EXERCISE TO

• Increase the children's capacity to separate the self from the a b u s e / a b u s e r .

• Increase the children's capacity to desire, believe in, and hold h o p e for a
positive future.

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Publications, Inc.
82 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• A n y group m e m b e r has suffered a great deal of misery and at present is

probably not safe. It m a y reinforce to him that his life truly is horrible and
m a y decrease his sense of h o p e for a positive future.
• A n y group m e m b e r is easily triggered and gets o v e r w h e l m e d and out o f
control w h e n this happens.

WHAT YOU NEED

• Pieces of newsprint from 3 to 5 feet long (the older the group, the longer the
newsprint)
• M a r k e r s , pens, a n d / o r crayons

INSTRUCTIONS

Part I: Instruct group m e m b e r s to draw timelines of their lives. These can b e

straight lines or lines with m a n y twists and turns. A s k t h e m to start their lifelines
with the age o f 0 and go through the ages they are now. H a v e t h e m leave r o o m at
the e n d to include the future. Tell them to include the following on their timelines:

• Positive memories in their lives: These m a y b e events they r e m e m b e r or that

others h a v e told them. T h e y m a y include being born, special birthdays,
starting school, learning to ride a bicycle, and the like.
• Memories that are not happy: These include the abuse. If the abuse h a p p e n e d
m o r e than once, they should include the n u m b e r of times they r e m e m b e r and
a little about w h a t happened. T h e s e memories m a y also include deaths o f
loved ones, times they were hurt, and so on.
• Anything else that stands out in their minds: These m e m o r i e s m a y include
different places they have lived or schools they h a v e attended.

A t the v e r y ends of their timelines, h a v e them draw their wishes for the future.
W h a t will their futures look like? W h o will b e there with them? W h a t will they b e
doing?
Let group m e m b e r s k n o w that they can use more paper if they need it. For each
age on the timeline, beginning with 0, they need to include everything, good and

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Self-Esteem Exercises 83

b a d m e m o r i e s , before m o v i n g on to age 1 and then age 2, and so on. T h e y c a n write

or d r a w pictures to explain their memories.

Part II: Display all the lifelines on the wall. O n e at a time, h a v e each p e r s o n share
his lifeline. A s e a c h person shares, ask h i m to talk about each m e m o r y o n e at a time,
telling about it and expanding on w h a t is on the paper. Group m e m b e r s m a y ask
clarifying questions.

Part III: A s e a c h person finishes sharing his timeline, have the rest o f the
m e m b e r s tell h i m about a wish or a h o p e they h a v e for h i m for the future. H a v e
h i m write these w i s h e s and hopes d o w n in the space for "future" on his timeline.

HINTS

Group members who want to avoid feelings regarding the abuse will rush through
this exercise and try to do it very superficially. Slow them down and ask them about
each yeat Prompt them to come up with more examples, both positive and negative.
Remind them that the abuse was then, and this is now. They are safe now. Remind
them that once they learn how to process through the painful memories, those
memories will no longer carry such a powerful emotional charge in their lives. They
are just memories. Remembering will eventually help them to have more control over
their feelings and over their lives.
If a child does not want to share his timeline with the entire group, then try to
encourage him to share it one-on-one with a facilitator, if he will not agree to that,
then tell him you will give the lifeline to his individual therapist and he can share it
§ § j ^
During sharing, be aware of any children who are fidgety or withdrawing. Check
in with them about how they are doing and determine if they are being triggered.
Ask them what they need from the group to help them stay present They may need
to be held or to sit close to a person they feel safe with in the room.
This exercise may bring up previously undisclosed incidents of abuse. Therefore,
it is helpful to ask permission of the group members to share the lifelines with their
individual therapists. Those therapists wilt know if any further reporting needs to be
done or if further therapeutic interventions are needed.
The other place group members get lost in this exercise is when considering the
future. Some of them may assume they will not live to be adults. Help them to imagine
what their lives could be like as adults. Will they want children? is there any type of
work or job they might like? Where might they want to live? Guide them in imagining
realistic futures. Many may want to imagine themselves as unicorns or fairies. Ask

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84 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

them what they like about those things and try to take those qualities and form them
into something that could really be. For instance, a child may respond, "l like unicorns
because they can fly and they are kind, people are nice to them, and they are
magical." You might respond with, "Well, you cant really grow up to be a unicorn,
but you could learn to fly. Maybe you could be a pilot and fly a big airplane. I think
that it is very magical how in a short time you could fly thousands of miles and make
your passengers so happy. People are usually really nice to pilots and have a lot of
respect for them. Would you be interested in something like that?"

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Self-Esteem Exercises 85

Friendship Medals

GOAL

To build self-esteem

AGES

7 through 18

TIME

20-30 minutes

PURPOSE

This exercise helps group m e m b e r s learn to give and receive positive feedback.
It also builds a sense of identity b y showing t h e m h o w others perceive them. This
exercise also gives group members concrete reminders of their connections with
other children w h o have experienced abuse, w h i c h in turn reduces their sense of
isolation.

DO THIS EXERCISE TO

• Build a sense o f identity and worth.

• Increase group m e m b e r s ability to recognize and verbalize their o w n per-
7

sonal qualities.
• Increase group m e m b e r s social skills.
7

• Decrease isolation a m o n g group m e m b e r s .

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86 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

DO NOT USE THIS EXERCISE WHEN

• There is someone in the group who is disliked by all or most of the others in
group and there is a likelihood others will have nothing positive to say about
her.

WHAT YOU NEED

• Small strips of paper with a group member's name on each one

• Enough 8- to 12-inch brightly colored circles of paper for each member
• Paper doilies or ribbons to be used for borders on the circles
• Markers, glitter, and stickers
• Glue

INSTRUCTIONS

Part I: Have each group member choose a colored paper circle to make into a
friendship medal for another group member. Have each person pick, with eyes
closed, a slip of paper from the pile of slips with group members' names. (If someone
draws her own name, have her return it to the pile and pick again.) Ask the group
members not to tell whose names they have drawn. Each member then decorates
her medal for the person whose name she drew, leaving room for others to add
positive comments. (An element of surprise makes this exercise fun and exciting.)

Tell group members that they should decorate their medals in ways that express
their appreciation for the persons who will receive them. Encourage them to
personalize the medals by drawing or writing what they like about the persons as
friends. For example, a child who has a nice smile might have a big smile drawn on
his medal. Another child's medal might have written on it an expression that the
receiver likes and uses in group. Other children might put nicknames on their
medals as a way of expressing affection.

Part II: When everyone has finished making their medals, have them come
together in a circle and take turns passing them out. Then ask each person to express
to the recipient why she is a friend or what qualities she has that make her a friend.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Self-Esteem Exercises 87

Part IV: After each child has given her m e d a l to the person it w a s m a d e for,
circulate the medals around the group so that each person can write a positive
quality o n everyone's medal.

HINTS

We treat these medais as awards for friendship. They are very important Be sure
group members understand the concept of awards, their significance, and the reasons
they are given to others. Usually, from our enthusiasm and the fun of receiving the
medals, group members do not need any reminders to be proud-they just are.
A variation on this exercise is to have group members decorate their own medais
and to write down 10 things they like about themselves. We ask them first to write
down as many things as they can come up with on their own and then ask other
group members for further ideas.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
88 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Sharing Our Stories

(Minimal Disclosure)

GOALS

To build self-esteem; to build feelings of safety and trust; to learn about the
d y n a m i c s of abuse

AGES

5 through 18

TIME

15-30 m i n u t e s (depending o n the size of the group)

PURPOSE

F o r p e o p l e w h o have been sexually abused, the healing process begins w h e n

they learn that it is safe to talk about w h a t happened with others they trust. Usually,
as survivors talk more about the abuse with other survivors, they feel less s h a m e ,
fear, and isolation. T h e y recognize similarities they share and learn that they are
liked, e v e n with their "terrible s e c r e t s / ' This exercise helps build tremendous b o n d s
a m o n g group m e m b e r s .

DO THIS EXERCISE TO

• R e d u c e levels of fear, shame, and isolation.

• Increase the children's capacity to b e vulnerable and to interact authentically.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Self-Esteem Exercises 89

• Increase the children's ability to put experiences or events into proper per-
spective, without minimizing or m a x i m i z i n g them.
• Increase the children's ability to identify and express feelings.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

WHAT YOU NEED

• Big pillows to sit on, or chairs for each m e m b e r (to provide a sense of personal
space)

INSTRUCTIONS

H a v e e v e r y o n e sit in a circle. Explain to the group that sharing their stories of

abuse helps survivors to feel better and rids t h e m of the "awful secrets" that they
h a v e kept inside. A l s o , children m a y realize that others have h a d similar experi-
ences and that they are n o longer alone.
A s k each person in the group the same questions, starting with the facilitators
as models:

• W h a t is y o u r n a m e and what w a s your age at the time of the abuse?

• W h o w a s the abuser?
• A r e y o u safe n o w ?

K e e p disclosure at this level. It provides boundaries and safety so that there is

predictability about the limited amount of information to b e disclosed. A l t h o u g h
these questions m a y s e e m basic, they are difficult to answer, and for a child to
answer t h e m h e m u s t feel trust and safety. S o m e children m a y w a n t to disclose
more. We ask y o u n g e r children to wait to disclose additional information w i t h their
individual therapists or privately with a group facilitator.

THERAPY GROUP ONLY: With children 8 years old or older, in the following w e e k
of group w e go through this exercise again, using the same group of questions and
adding other questions. Again the leaders answer the questions first, acting as
models for group m e m b e r s to follow:

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
90 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• W h a t is your n a m e and w h a t w a s your age at the time of the abuse?

• W h o w a s the abuser?
• N a m e one feeling you had at the time of the abuse.
• N a m e a thought y o u had at the time of the abuse.
• H o w did the abuse stop?
• H o w do y o u feel n o w ?
• D o y o u ever see the person w h o touched you? If yes, h o w do y o u feel w h e n
y o u see that person?

The following week, in therapy g r o u p for children 8 to 18, ask the following
additional questions:

• W h a t is the worst part about the abuse to you?

• D o y o u think y o u are a different person than y o u w o u l d h a v e b e e n if you
h a d n ' t b e e n abused? If yes, h o w are you different?

T h e s e questions are harder than they seem, even the second time around. Your posi-
tive e n c o u r a g e m e n t really helps the group members to feel capable and confident.

HINTS

It is helpful to set a relaxed yet serious tone for sharing sexual abuse stories. What
you decide to do will vary depending upon the makeup and size of the group. Here
are some ideas to try we have turned the storytelling into a ritual by lighting a candle
as each person tells his story. The candle represents taking the dark secret thats
inside and bringing it out into the light of day. In another group we gave each person
a shell that represented her own beauty and strength, we told each group member
that she was like a shell that had been tossed and turned in turbulent waters, then
washed ashore and bathed in the sunlight; becoming stronger, brighter, and more
beautiful than before.
Sometimes we give group members lumps of clay to work with to help them
release their tension as they tell their stories. The transformation of the clay during
a child's telling of his story consistently matches the relief the child feels after sharing
his story with the group. We encourage group members to make positive comments
about the changes they see in the clay We ask the children who have told their stories
to leave their clay visible to help other group members as they tell theirs.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Self-Esteem Exercises 91

Younger children may be frightened by other children's stories. We have found

that children who have been molested by relatives are sometimes frightened to hear
that other children were abused by friends, relatives, or strangers. Take the time to
talk about these fears and explain what group members can do to protect them-
selves. Remind them that if someone attempts to make them do anything they do
not want to do, they can tell someone they trust. Assure them also that most people
do not behave in this way.
We have had some therapy groups where minimal disclosure has not been enough
for the children, in some cases, the children wanted to disclose more and not allowing
them to do so created the impression that the abuse was too shameful to talk about
in detail. In those cases, we divided the intitial group into two smaller groups, and
each child told more detailed accounts of the abuse to the smaller group* in doing
so, we could determine which member was appropriate for which group. Those that
were abused once, or were fondled as opposed to violently raped were put into
separate disclosure groups.
At the end of storytelling, you may want to give each person the choice of asking
for something she wants or needs from the group. This may be a hug, a cheer, or
positive feedback from everyone in the group. Ending activities for the whole group
are equally important.

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Publications, Inc.
92 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

London Bridge
(The Escape Version)

GOALS

To build self-protection skills and a healthy b o d y image; to build self-esteem

AGES

4 through 8

TIME

5-10 minutes

PURPOSE

This exercise encourages children to w o r k cooperatively and teaches them h o w

to negotiate and m a k e choices. A s they learn to ask for help, their self-esteem is
e n h a n c e d and they discover h o w m u c h stronger they are w o r k i n g together than
alone.

DO THIS EXERCISE TO

• Increase the children's ability to m a k e conscious behavioral choices.

• Increase the children's ability to define and express personal safety needs.
• Increase the children's capacity to exert their will and desire appropriately
and effectively.
• Increase the children's capacity to value self and others.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Self-Esteem Exercises 93

• Introduce the rights and responsibilities of having a b o d y to protect and

nurture.

DO NOT USE THIS EXERCISE WHEN

• A n y child in the group is too afraid, or too uncomfortable, to h a v e the level

of physical contact that this exercise requires.

WHAT YOU NEED

N o special materials needed

INSTRUCTIONS

Find out if the children in group k n o w the g a m e L o n d o n Bridge. Explain to t h e m

that y o u will b e playing a different version of L o n d o n Bridge. Introduce the song
first, to m a k e certain everyone knows the words:

L o n d o n B r i d g e is falling d o w n ,
F a l l i n g d o w n , falling d o w n .
L o n d o n B r i d g e is falling d o w n ,
M y fair lady.

Take t h e k e y s a n d lock h e r up,

L o c k h e r u p , l o c k h e r up.
Take t h e k e y s a n d l o c k h e r up,
M y fair lady.

Usually, the t w o facilitators should start out b y being the bridge. Later on,
children s o m e t i m e s w a n t to try being the bridge with one of the facilitators.
Begin singing and have the children w a l k in a circle under the b r i d g e until, on
the words " M y fair lady," the person under the bridge is captured.
W h i l e the second verse of the song is being sung, encourage the child w h o has
been captured to get free if he doesn't want to b e locked up. H a v e e v e r y o n e else in

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
94 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

the g r o u p try to help the captured one escape. The captured child can go under or
over the bridge, or the others can just pull him free. The people forming the bridge
should b r e a k their hold w h e n the captured child tries to escape.
With a little encouragement, the children really get into singing and helping
each other escape. They have a lot of fun with this one.

HINTS

Sometimes children like the feeling of being held gently by the bridge because it
feels like safe and soothing touch. When a child is captured and she chooses to be
held by the bridge, we gently rock her while singing.
After this exercise, be sure to spend a little time talking with the group about
how it felt to be helped by others. Encourage them to ask for help when they need
it and ask them who they can go to for help in their lives (away from group). One little
girl in our 4~ to 5-year-old group kept choosing another little girl in group when we
asked her who was a safe person she could go to for help. After a few times it was
clear that she felt very safe with her group friend, but that still didn't answer the
question of who was safe at home. Finally we asked, "Before you were in group, who;
were the safe people in your life?" She came up with several family members, but
still wanted her new friend on the list.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Self-Esteem Exercises 95

The Parent Within

(Therapy Group Only)

GOAL

To build self-esteem

AGES

9 through 18

TIME

60-90 minutes

PURPOSE

Learning about the parent within helps group members learn techniques for
self-soothing and self-love. It lends perspective and understanding to the victim's
inability to stop the abuse w h e n it w a s happening. This exercise also helps reduce
s h a m e and increases the children's confidence and ability to empathize and support
themselves and others.

DO THIS EXERCISE TO

• R e d u c e self-blame for the abuse.

• R e d u c e the negative effects of adults w h o responded nonsupportively to
disclosures of abuse.
• Increase the children's capacity to desire, believe in, and hold h o p e for a
positive future.

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96 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• L e s s e n the children's sense of isolation.

• Increase the children's capacity to value self and others.

DO NOT USE THIS EXERCISE WHEN

• A n y group m e m b e r lacks the maturity needed to b e attentive e n o u g h to

follow the stages of the exercise.

WHAT YOU NEED

• Pencils or pens
• Writing paper

INSTRUCTIONS

Part I: D i v i d e the group into smaller groups of three. Assign the letter A , B , or
C to e a c h group member. A is the child, B is the parent, and C is the scribe.
Part II: T h e facilitators first demonstrate a role-play of an abbreviated version
of a disclosure. In this role-play, the child tells the parent that h e has b e e n touched
o n his private parts. For the group m e m b e r s ' role-plays, assign ages to those playing
the child's role that are younger than their present ages. For e x a m p l e , h a v e a
9-year-old role-play a child at age 7. If m a n y children in the group w e r e abused b y
relatives, use a family m e m b e r as the abuser in your scenario. H a v e the parent
respond exactly as she would if a 7-year-old child actually disclosed to her. R e m i n d
the children role-playing parents to b e emotionally supportive rather than j u m p i n g
to i m m e d i a t e solutions such as "I'll call the police right now." D u r i n g the role-play,
the scribe quickly writes d o w n everything the parent says.
F o l l o w i n g is an example of w h a t a facilitator role-playing the parent hearing the
disclosure m i g h t say:

O h , honey, I a m so glad y o u told m e this. That was very b r a v e of you. I love

y o u and I ' m so sorry this happened to you. I will do everything I can to protect
y o u and keep y o u safe from him. Everything is going to b e okay. You are going
to b e okay. N o w that I know, I can get help for you. Others can m a k e sure that

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Self-Esteem Exercises 97

he gets help so he doesn't do this to other children. I am so proud of you for

telling me. Is there anything else that he said or did that is frightening you? Is
there anything more you want to tell me now? I want you to know that Til
always be here for you so if you want to talk about this again, we can. You are
so wonderful. I LOVE YOU!

Part III: Have the groups of three do similar role-plays of a child disclosing to
an adult. Have each member spend at least 5 minutes being in each role.

Part IV: Guided imagery is a method that directly communicates to the subcon-
scious the supportive messages of the "parents." Darken the room slightly and have
everyone sit or lie in a comfortable position. Begin with a progressive relaxation
routine: Have the children flex and then relax their feet, legs, pelvis, back, chest,
shoulders, and so on. Tell them to take deep breaths and feel their bodies resting
closer and closer to the chair or the floor. Help them remember themselves at 7 years
old. Ask questions such as these:

• What did you look like at 7 years old?

• How did you feel at 7?
• What clothes did you wear?
• What adult did you trust the most?
• What made you feel happy when you were 7?

Tell group members to imagine themselves playing or doing something that

makes them feel good all over. Remind them that they are safe and cannot be hurt.
Then have them imagine walking up to the person they trust the most. Tell them to
see and hear themselves telling this person that they have been touched.
While the children are still relaxed and quiet, have them imagine their trusted
person comforting them while you read aloud all the papers from the scribes. When
you are done, tell the children that they are safe and very brave. Reiterate that the
abuse was not their fault. Remind them that they can protect themselves. Whenever
they feel sad, lonely, guilty, angry, or the like, they can say their scripts to the little
children inside themselves. They know just what to do to take care of themselves.
They will never be alone again.

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Publications, Inc.
98 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

The kids may balk at first about doing the imagery and start to giggle. Remind
them that they need to give it a fair try and should be as quiet as possible. Their
cooperation makes this a very powerful exercise.
During the role-plays, make sure that the children who are hearing the disclosures
understand that they are playing adults, not themselves. After the role-plays are
completed, you may wish to collect the scripts and type up copies to be given to
each child at the next session.
Four examples of scripts from our groups follow:

That sounds pretty scary. Can you tell me what happened? Have you told anybody
like your Mom? I'm glad you told me. it's important that we make you safe so it
w o n t happen anymore. Well, I think that you and I can go talk to your Mom
together and tell her. I know it is scary but it is brave of you to tell me so we can
tell your Mom and make it stop. (Barbara, age 12)
Hey! I'm really glad you decided to talk to me about this. I know how radically
scared, confused, and overall freaked you must feel. My dad did just about the
same thing to me when 1 was about your age. Everyone you've ever trusted has
turned their backs on you, and overall there isn't a lot of things 1 can tell you. Please,
if not for yourself, for me, tell somebody who has the power to help you out, don't
turn yourself inside out, don't be a massively violent person, don't hide what you
feel, because once you start, you can't stop. I guess I've begun to drone, so I will
sum this up, I c a n t make you help yourself, but, PLEASE don't turn away from what
you feel, make him PAY! Don't let him kill you inside, don't feel bad. Believe in
yourself, I do. (Sarah, age 15)

1. Have you told anyone else?

2. He's a pervert.
3. It's not your fault
4. Get him help.
5. I'll help you.
6. Who cares what people think as long as your privacy is protected.
7. Tell someone you trust
8. Its not your fault
9. He's sick.
10. Don't blame you, blame him.
11. Put it out in the open. (Tricia, age 11)

Well, I'm really glad you came and talked to ME about this, 'cause something
similar happened to me when 1 was your age. 1 want you to know that it was not
your fault 'cause the only way this can happen is if the person who did this to you
is SiCK-1 dont mean like a cold. I mean there is something wrong with them down
where you keep their guts. You are probably really mad about this and I can relate
to that, but don't let what happened and your feelings about it tear you up inside.
'Cause if you let it get to you it'll turn your heart black-not literally—but that is
how you will feel. And when that happens to you, you let that happen and it'll take
a lot of time and energy to make you feel right with the world again. (Jill, age 14)

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
chapter 8

INTERNAL AND E X T E R N A L
BOUNDARIES EXERCISES

A child's capacity to organize and interpret reality effectively is

strongly influenced by the development of a healthy boundary system. The boundaries
we develop affect how we process and respond to information and experiences about
ourselves, others, and the surrounding world. Like gatekeepers, boundaries allow us
to select with discernment what can safely be shared between the inside and outside
worlds. Until children learn to negotiate their own boundary systems, their parents act
as their external regulators. Like guardians at the door, they monitor and protect
children from physical and psychological harm.
Boundaries also delineate where one person ends and another begins. Boundaries
act as thresholds that both separate us from and connect us to the world. Children's
ability to conceptualize the difference between themselves and others is a fundamental
predictor of their future success in relating to the world in realistic and effective ways.
People with poor boundaries perceive little or no separation between themselves
and others. Like sponges, they soak up others' beliefs and emotions, unable to separate
out their own values, thoughts, sensations, and feelings. Other people wear their
boundaries like armor, to shield themselves from the harmful words and intentions of
others.
The exercises in this chapter are designed to help children learn their rights and
responsibilities in relationship to others by teaching them to identify and express their
own thoughts, feelings, and behaviors in safe and respectful ways. The exercises focus

99
100 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

on showing that boundary systems play a fundamental role in helping children to

understand that they

exist,
have bodies,
live in relationship to other people and things,
have both inner and outer experiences of reality, and
have rights and responsibilities regarding all of the above.

Exercises concerning external boundaries are the first to be introduced in group.

These exercises bring up issues of personal space, physical touch, and psychological
distance and intimacy. Children who have been guided by emotionally healthy parents
learn how to protect themselves in the world. They learn that their bodies are important
and need the proper food and care to keep them healthy. They learn that they have the
right to say no to touch that feels uncomfortable or invasive and that they have the
right and responsibility to assert themselves in situations that feel disrespectful or
dangerous to them. They know they are separate individuals with their own thoughts,
feelings, and preferences.
We have observed that children who have suffered ongoing sexual abuse often
display behaviors associated with boundary impairment. The invasive, insidious na-
ture of sexual abuse can distort a child's developing perception of self. Abused chil-
dren's ideas about who they are, who others are, and what the world around them is
like are often corrupted. Abused children can experience the world as dangerous. Their
trust, innocence, and sense of safety and connection are diminished. Their ability to
trust in their own internal experience is confused by the bewildering and sometimes
violent words and actions of their abusers. The projections and actions of their abusers
divert these children from developing healthy relationships with themselves and
others. Instead, abused children must direct their energy toward the development of
adaptive behaviors in order to survive.
Children with external boundary issues have difficulty knowing where they begin
and end as individuals. Consequently, these children experience confusion about
physical distance, touch, personal rights, and responsibilities. They are often detached
from their bodies, unaware of simple sensations such as cold or hot, pain or comfort.
They sometimes feel they deserve to be hurt physically or used sexually, having
adopted the distorted thinking of their abusers, believing these are expressions of love.
Other sexually abused children display confused external boundaries by being ex-
tremely clingy and overly demonstrative or physically or sexually aggressive. One
exercise that helps to heighten children's awareness of their external boundaries is
"Boundary Line."
Once the children in group have demonstrated an ability to understand and practice
appropriate external boundaries, they are introduced to the concepts of internal bounda-
ries. Internal boundaries involve identifying and processing feelings, thoughts, beliefs,
and sensations about reality in order to make appropriate behavioral choices and
Internal and External Boundaries Exercises 101

decisions. Children brought up in healthy environments learn how to identify, express,

and manage themselves and their circumstances successfully. When they are scared,
they can tell others who will help them feel safe. When they feel hurt by what someone
says to them, they can respond rather than react. When they lash out in anger, they are
allowed to express it, but are taught how to do so without harming themselves or
others. These children have a sense that they are valued, understood, and heard. With
guidance and practice they learn how to identify and express their own needs while
respecting the needs of others.
Children who have been sexually abused often have a difficult time knowing and
expressing directly what they need or want in any given situation. They have often
been told that their feelings are invalid. To cope, they minimize, deny, avoid, act out,
project, or dissociate. Unexpressed emotions in children also surface as somatic symp-
toms, such as stomachaches, headaches, panic attacks, and bed-wetting. When they
have expressed anger about spending time with their abusers, they have sometimes
been admonished, misunderstood, threatened, or punished, which creates overwhelm-
ing feelings of shame and self-doubt.
Some sexually abused children learned to disassociate. Disassociation is a way to
numb and separate from emotions. This is a survival technique used by some children
enduring abuse. The feelings of fear, pain, panic, and anger are too overwhelming to
experience, so these children "numb out." They escape from the unmanageable reality
of abuse by retreating into the world of imagination. Some children imagine themselves
crawling into the wall, flying out the window, or floating above their bodies. The end
result is a separation of body and mind and a learned technique of cutting themselves
off from any feelings. Often these children "daydream" in school or are yelled at for
not paying attention.
Abused children can be so detached from their inner lives that they are unaware of
their own thoughts or feelings. Because they are so removed from themselves, and have
been taught to fear retaliation if they are direct about their needs, their attempts to meet
their needs are often manipulative, indirect, and unsuccessful. They can be passive or
aggressive depending on their experiences and coping styles.
To avoid revictimization, abused children need to separate from the abuse, not from
themselves. They need to learn to distinguish between what happened to them, who
they truly are, and how the abuse affected their beliefs about who they are. This enables
them to take the information that their feelings provide and protect themselves. For
instance, if a child is not allowed to feel fear, he will not know when to fight or flee
from a dangerous situation. This is why it is critical for abused children to understand
their feelings and to rely on them.
In our group work with children, we teach internal boundaries by interweaving
versions of Bennett Brauns's (1993) BASK model into the exercises. The model consists
of four parts:

• Behavior: What am I d o i n g ? / H o w am I acting?

• Affect: How am I feeling emotionally?
102 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• Sensation: What am I feeling in my b o d y ? / W h e r e am I feeling it?

• Knowledge: What do I k n o w / b e l i e v e about myself and my situation?

Children learn that their thoughts and feelings create an internal interpretation of
reality that affects behavior. Our use of the BASK model is more fully explained in the
exercise "My Own BASK Book." Other exercises that are useful to help children with
internal boundaries include "Life Vest," "Internal/External Self," and "Boundary
Line."
We teach the BASK model by first teaching children to identify their feelings. Once
they begin to be able to do this, we teach them to associate their feelings with their
thoughts and also with any bodily sensations they may have. Finally, we teach them
that by being aware of their feelings, and the thoughts that go with those feelings, they
can give themselves choices about how they want to act or react in any given situation.
Internal and External Boundaries Exercises 103

Boundary Line

GOAL

To learn about internal boundaries

AGES

4 through 18

TIME

15-20 minutes

PURPOSE

This c o m m o n self-defense exercise, which has b e e n passed d o w n through the

years, teaches group m e m b e r s to pay attention to their inner feelings a n d their
intuition. A s a result they are able to m a k e educated choices based u p o n their o w n
inner messages.

DO THIS EXERCISE TO

• Help facilitators assess group m e m b e r s ' senses of personal safety w i t h each

other.
• Introduce the concept of the rights and responsibilities of h a v i n g a b o d y to
protect and nurture.
• Increase the children's ability to m a k e conscious behavioral choices.
• Increase the children's ability to define and express personal safety needs.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
104 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise.

WHAT YOU NEED

N o special materials needed

INSTRUCTIONS

Part I: Begin b y asking the group m e m b e r s to imagine that they do not k n o w

a n y o f the other people in the room. H a v e them divide into t w o equal lines and
h a v e the lines stand on opposite sides of the room, facing each other. E a c h person
in o n e line should b e standing across from a person in the other line. A s k each person
to stand across from s o m e o n e she does not k n o w well.
T h e cofacilitators then demonstrate the exercise to the group m e m b e r s b y taking
the following steps:

1. F a c e e a c h other w i t h a b o u t a 10-foot s p a c e b e t w e e n y o u .
2. O n e facilitator stays still w h i l e the other s l o w l y w a l k s t o w a r d her.
3. T h e facilitator w h o is s t a n d i n g still tells the o t h e r facilitator to stop
w a l k i n g t o w a r d h e r w h e n s h e n o t i c e s h e r s e l f b e g i n n i n g to feel u n c o m -
fortable.
4. T h e facilitator w h o is s t a n d i n g still h o l d s out h e r a r m t o g a u g e h o w m u c h
s p a c e she n e e d s in o r d e r to feel safe. (For e x a m p l e , s h e m a y n e e d o n e
a r m ' s l e n g t h from m o s t p e o p l e , b u t m a y b e she n e e d s the l e n g t h o f t w o
a r m s in order to feel safe.)

Part II: Designate the two lines as line A and line B. H a v e those in line A (the As)
m o v e t o w a r d those in line B (the Bs) while those in line B remain stationary. E a c h
A is to m o v e toward the B across from h i m until B senses that b e i n g a n y closer w o u l d
b e too close and uncomfortable. B then says, "Stop!" Each individual decides w h e n
to stop A b a s e d upon his o w n feelings.

Part III: Take a few minutes to discuss the experience the group m e m b e r s just
had. Select s o m e o n e to start and find out h o w he decided w h e n his partner w a s

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Internal and External Boundaries Exercises 105

close e n o u g h to h i m to tell h i m to stop. After a person from line B responds, ask

that person's partner from line A to share his experience. The children will often
m a k e statements such as " H e couldn't look at m e anymore," or " H e started to
smile." Ask, " D i d anyone from line A w a n t his partner to say stop sooner than h e
d i d ? " I f a n y o n e answers yes, ask, " W h a t did you d o to let the person k n o w y o u
w a n t e d h i m to say ' s t o p ? ' "

Part IV: M i x up the order of persons in b o t h lines so that no one is with the s a m e
partner as before, but all are still in the s a m e lines. N o w have the B s follow the
instructions y o u previously gave to the As.

Part V: R e p e a t this exercise but A should stop w h e n he believes that B really

w a n t s h i m to stop. This means that B must use a v e r y serious and strong voice w h e n
saying " S t o p ! " and h e m u s t not smile.

HINTS

Try using different scenarios with the boundary line exercise to help participants
be sensitive to their personal boundaries in a variety of situations. We use scenarios
involving (a) a stranger, (b) an acquaintance, (c) someone you are angry with, (d) a
good friend, (e) your mom or dad, and (f) a person who is drunk.
This exercise works best when each person takes it seriously and makes it reaJ.
if a child is having difficulty saying "Stop!* convincingly, have him say *Nor or "Go
awayr If these dont work, have him imagine that he is a fierce animal, such as a lion,
a tiger, or a gorilla. Then have him try saying "Stop!" while imagining the fierce animal
inside of himself.
Many kids have a difficult time being assertive when saying "Stopr One of the
facilitators should do this exercise with any child who needs help being assertive.
Have him stand while you walk toward him, and keep walking toward him if he doesn't
say "Stopr or if he says it so quietly you can hardly hear it. Repeat the steps until he
blasts you away with "Stop!" Videotaping this exercise and playing the tapes back for
the children can help them see how they look and sound to others. Many are able to
react in a stronger manner after viewing themselves on tape.
Children really can be assertive and can trust their bodies if you give them the
chance to practice and learn. Unfortunately assertiveness is something that is not
taught to a lot of children, so be patient and keep trying.

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106 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Internal/External Self
(Therapy Group Only)

GOALS

To learn about internal boundaries; to build self-esteem and feelings of safety

and trust

AGES

8 through 18

TIME

30 m i n u t e s (This exercise can b e done over two sessions: 10 minutes the first
w e e k and 2 0 minutes the second.)

PURPOSE

This exercise helps m e m b e r s understand that they h a v e feelings and thoughts

inside o f t h e m that they m a y or m a y not s h o w to others. W h e n a person has
incongruent internal and external selves, often her personal needs are n o t met, and
m a n y o f h e r actions m a y b e misinterpreted. For example, a p e r s o n w h o feels shy
and uncomfortable in social situations but does not c o m m u n i c a t e this m a y b e
considered s n o b b y and arrogant b y others because she hardly ever talks to them.
U n d e r s t a n d i n g this can help children to realize that they h a v e s o m e p o w e r to create
their o w n reality. The more they can feel confident in themselves and show their
vulnerable sides to others, the better they will b e understood and the m o r e likely
they will b e treated in a m a n n e r congruent with their needs.

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Internal and External Boundaries Exercises 107

DO THIS EXERCISE TO

• Introduce the concept that thoughts and feelings create an internal interpre-
tation o f reality that affects behavior.
• Teach that w h e n thoughts and feelings are not expressed, others will often
misinterpret w h o y o u are based on your behavior.
• Increase the children's capacity to exert their will and desire effectively and
appropriately b y understanding the self and expressing thoughts and feelings.
• Increase the children's capacity to be vulnerable and to interact authentically.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

WHAT YOU NEED

• "Inside T h o u g h t s and Feelings' and "Outside Thoughts and F e e l i n g s " work-

7

sheets
• Pens, pencils, or fine-tipped markers

INSTRUCTIONS

Part I: Pass out the "Inside Thoughts and Feelings" worksheet to all group
m e m b e r s . Instruct t h e m to write down, within the drawing of the b o d y o n the
worksheet, h o w they v i e w themselves on the inside. A s k the following questions
to help guide them:

• W h a t thoughts go through your head about yourself?

• Are these thoughts sometimes conflicting, such as " F m a g o o d friend" and
" F m a m e a n friend"? Write all conflicting thoughts down.
• D o y o u h a v e any thoughts about the abuse such as "I could h a v e stopped it"
or " I liked the w a y the touch felt"? Write those thoughts d o w n also.
• D o y o u h a v e thoughts about w h a t others think about you—thoughts such as
" N o o n e likes m e " or " T h e y think F m smart but I don't think I a m " ?

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108 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• What feelings do you have about yourself? "I feel happy/' "I feel like crying
a lot/' "I feel like hurting others"? Write all your feelings down.
• Do you have feelings about the abuse? Write those down too.

Pass out additional worksheets if members need more space to write down all of
their thoughts and feelings.

Part II: Pass out the "Outside Thoughts and Feelings" worksheets. Ask the group
members to write on the worksheets, around the figure of the body in the middle,
their thoughts and feelings about how they think others see them. To help them get
started, ask:

• When someone first meets you, what do you think they would say about you?
"She is nice," "She is shy," "She seems friendly"?
• As they get to know you better, what would they say about you?
• How would they describe you as a friend?
• How would they describe how they think you feel on the inside?
• How do you think their view of you would change if they knew all about your
inside feelings and thoughts?

Part III: When everyone has completed both worksheets, come together again
as a group and have members take turns sharing what they have written. Note the
congruencies and incongruencies that you notice for each child. If a child says she
is a good friend but her outside worksheet states that people do not like her or think
she is mean, ask her how that happens. If she thinks she can be a good friend, why
don't others know that? Follow up these questions with an assignment for each
person to choose one thing she can do in the coming week that will better match
her inside feelings or thoughts to what she shows others on the outside.

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Internal and External Boundaries Exercises 109

HINTS

This exercise can give you a quick glimpse into how group members view the
world and can help you to assess whether individual children's views of themselves
are based on any reality, You will need to share much of what you learn from this
1
exercise with group members individual therapists, so they can focus more in depth
on any distorted cognitions the children may have.
It is a good idea to separate group members somewhat during this exercise, so
that they do not copy off of each others* papers.
If a child in the group shows that she has no concept of how she is viewed by
others, or if her view is extremely distorted, then during the full group discussion ask
other members to share their views of that child. Make sure that this is done
sensitively and that you elicit a lot of positive comments.

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110 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

INSIDE THOUGHTS
AND FEELINGS

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Internal and External Boundaries Exercises 111

OUTSIDE THOUGHTS AND FEELINGS

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112 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Feelings/Thoughts Mask

GOAL

To learn about internal boundaries

AGES

5 through 9

TIME

45-60 minutes

PURPOSE

This exercise allows facilitators to assess the adaptive responses or coping

behaviors that group members use on a day-to-day basis, some of which may be
harmful to them over time. The exercise allows group members to identify their
feelings and thoughts and to recognize which ones are difficult for them to express;
it then gives them permission to express them.

DO THIS EXERCISE TO

• Help group members identify their own adaptive responses to trauma.

• Help group members make more positive behavior choices.
• Increase group members ability to understand that their thoughts and feel-
7

ings affect their behavior and actions.

• Give group members something concrete to lessen feelings of isolation and
give them visual images to remind them of what they are learning in group.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
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Internal and External Boundaries Exercises 113

DO NOT USE THIS EXERCISE WHEN

• Any group member has been ritualistically abused or masks were used during
the abuse.

WHAT YOU NEED

• Plain brown paper bags, one for each child, each large enough to fit over a
child's head (or you may substitute, for each child, two large paper plates
stapled together, with a Popsicle stick glued in between them)
• Markers, paints, and/or crayons
• Chalkboard and chalk or a large piece of paper
• Optional: glue, pipe cleaners, feathers, felt, fabric scraps

INSTRUCTIONS

Pass out one paper bag to each child and explain that they will be using the bags
to make masks with two faces. Talk with the group members about the kinds of
feelings and thoughts they are comfortable sharing with most people. Then ask
them what feelings and thoughts are harder to share with others, and ask whether
any of them have feelings or thoughts they haven't ever told to anyone. As part of
this discussion, generate a list of the feelings they feel comfortable sharing and a
list of those they don't. Do the same regarding thoughts. Write the lists up on the
chalkboard or on a large piece of paper that everyone can see. Following are some
examples of some very short lists:

Feelings Shared Feelings Not Shared Thoughts Shared Thoughts Not Shared
Happy Mad I like you. I'm ugly.
Sad Hate Nothing bothers me. I'm stupid.
Funny Embarrassed You're mean. No one likes me.
Goofy Scared I'm cool. I'm bad.
Lonely I want to hurt myself.

Encourage the children to take their time and do their best at making their own
two-sided masks. On one side, each child should depict the side of himself (the
feelings and thoughts) that he shows to other people; the other side should represent
the side of himself (the feelings and thoughts) that he keeps to himself and doesn't
usually share with anyone.

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114 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Discussion: O n c e the m a s k s are c o m p l e t e d , take time for all g r o u p m e m b e r s to

s h o w a n d talk about both sides o f their m a s k s . A s k t h e m to talk about w h y they
m a d e their m a s k s the w a y s they did. H a v e other group m e m b e r s ask questions and
p o i n t out similarities and differences b e t w e e n the m a s k s . A l s o , talk a b o u t w h y n o
o n e w a n t s to share all his feelings with everyone. A s k the children h o w they
d e t e r m i n e w h o is a safe person to share feelings with. H a v e t h e m n a m e the p e o p l e
t h e y trust a n d c a n go to w h e n they n e e d to share their feelings w i t h s o m e o n e .
E n c o u r a g e e a c h child to share his m a s k w i t h one of these p e o p l e d u r i n g the n e x t
w e e k a n d to share o n e feeling or thought h e has not shared before.

HINTS

We have found the first part of this exercise to be the key in making it a success.
Children need t o identify their feelings before they d o this exercise so that they can
determine w h a t feelings are okay to share with others, it is very useful to talk with
group members about w h a t they can do w h e n they feel sad, or mad, or w h e n they
have a n y other feelings. W h e n children do not know w h a t t o do w i t h their feelings
about the sexual abuse, or w h e n they d o not have someone to share their feelings
w i t h , it is helpful for them to hear other kids' suggestions, w e also encourage each
child t o choose one person he w o u l d be willing to go to with his feelings.
in one of our groups, w e worked w i t h a girl w h o had really suppressed her anger.
Making her mask helped her to recognize and begin expressing this anger once again.
Having access t o her anger allowed her t o feel more powerful and less victimized.

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Publications, Inc.
Internal and External Boundaries Exercises 115

Life Vest

GOAL

To learn about internal boundaries

AGES

6 through 18

TIME

30-45 minutes

PURPOSE

This exercise is a wonderful tool for teaching children h o w to c h o o s e w h a t they

will allow into their hearts. Each individual has the right to decide h o w she will
take in and respond to others comments about her and actions toward her. G r o u p
7

m e m b e r s learn to use their hearts (feelings), heads (thoughts), and h a n d s (actions)

to respond to others. This is all done with a powerful, imaginative, protective vest
that they c a n take with them anywhere.

DO THIS EXERCISE TO

• Increase the children's ability to define and express personal safety needs.
• Teach the children h o w to distinguish b e t w e e n constructive c o m m e n t s from
others and nonconstructive comments.
• Increase the children's ability to m a k e conscious behavioral choices.
• Increase the children's ability to identify, comprehend, m a n a g e , and express
thoughts and feelings appropriately.

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116 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• T h e r e is not enough time for the children to process the feelings it raises.
• You do not have two facilitators.

WHAT YOU NEED

Imagination!

INSTRUCTIONS

Part I: H a v e group m e m b e r s sit in a circle. Tell them that each of them is going
to put on the m o s t beautiful, magical, wonderful vest there is. Take a m o m e n t for
all the children to close their eyes and imagine what their vests look like. A s k
questions such as the following:

• W h a t color is your vest?

• A r e there any designs or pictures o n it?
• It is the m o s t comfortable vest in the world. W h a t is it m a d e of?

Tell group m e m b e r s that their vests are also very strong, and that nothing c a n
penetrate or p u s h through them. But notice, there is something extra special on each
vest. Why, it is a little zipped pocket right over the heart! D o e s e v e r y o n e see it? Put
y o u r h a n d o n that pocket. Yes, there it is!
Instruct the children to hold their vests out in front of them and admire them, and
then have them put their vests on very carefully. Once they are on, make sure they are
buttoned or zipped closed. Also, instruct everyone to check the pockets over their
hearts and make sure those are zipped closed too. Now have everyone open their eyes.

Part II: Explain that y o u are going to do s o m e role-plays with the vests on. T h e s e
vests will protect everybody and help them decide if they w a n t to take in w h a t
others say to them. A n y c o m m e n t a child does not w a n t to take in will just b o u n c e
right off the vest and back to the person w h o m a d e the c o m m e n t . T h e facilitators
then demonstrate h o w the life vest works:

First facilitator: You l o o k funny in b l u e shoes w i t h y e l l o w p o l k a dots.

Second facilitator: H m m m . . . H o w d o e s m y heart feel? It h u r t s . It d o e s n ' t l i k e
that c o m m e n t . . . . W h a t d o e s m y h e a d think? M y h e a d t h i n k s , Is w h a t s h e

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Internal and External Boundaries Exercises 117

is saying true for me? No, I don't think I look funny in these shoes, I like
t h e m . . . . So, what will my hands do? They want to push this comment away.
So I am going to keep the pocket zipped and let the comment bounce right
back to the person who made it. And F m going to say, "Well, maybe you
think they look funny but I don't. . . . I like them!"

The second facilitator continues by explaining the process she just went through:

So my heart, which is my feelings, was hurt. With my head, or thought, I

realized that I like these shoes. With my hands, or my actions, I had a choice
about what I wanted to say or do about this. I could have gotten all sad and let
the comment get inside me and feel terrible. Or I could have thought that
maybe she is right and then given up my shoes. But in this case I realized that
this is just her opinion. I have a different opinion. I like these shoes! Once I
realized that, I knew I did not have to let her comments into my pocket. I didn't
have to think like her. I also did not have to be mean to her. I could nicely, but
firmly, tell her how I felt.

Now the two facilitators switch roles. One says something mean to the other,
such as "You're mean." This time, while the second facilitator goes through the same
process of heart, head, and hands, she should realize that there is some truth to this
statement. She feels hurt and attacked at first, but then she thinks about the statement
and realizes that there have been times when she has been mean. So what does she
decide to do? She decides to say, "Gee, I guess I have done some mean things to
you. I'm sorry, I would like to be your friend." She should mention that she has
taken some of the comment into her pocket and then used it to help her be nicer.

Part III: Remind the children that they are wearing their vests. Now it is their
turn. Start with a facilitator making a positive comment to each child, such as "You are
really nice" or "I love how helpful you are in laying out the pillows when we come into
the room." Go through the process with each child by asking these questions:

• How does it feel in your heart when I say this to you? (Happy? Good? Scary?)
• What do you think in your head? ("It's true" or "I'm not really very nice.")
• Now, how do your hands want to respond? (They want to hide, or they want
to say thank you.)
• Okay, now, how would you respond back to me?

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118 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• Finally, is this a c o m m e n t y o u w a n t to open your pocket up for and let into

y o u r heart?

Part IV: N o w have a facilitator m a k e a negative c o m m e n t to e a c h child, but m a k e

sure that all c o m m e n t s are farfetched and clearly h a v e n o t h i n g to do w i t h the
children they're directed toward; for e x a m p l e , " W h e n y o u hiked to the top o f M o u n t
Everest y o u looked weird!" M a k e a different c o m m e n t to each child and see h o w
e a c h responds. F o r every c o m m e n t , go through the heart, h e a d , and h a n d process
w i t h the child. T h e n ask the child to decide if she wants to let the c o m m e n t into h e r
p o c k e t or h a v e it b o u n c e b a c k to the person w h o said it.

Part V: A s a h o m e w o r k assignment, tell the children to w e a r their vests all w e e k

and to practice using them. T h e following week, at check-in, h a v e each give
e x a m p l e s o f h o w she used her vest and explain w h a t she felt, thought, a n d did.

THERAPY GROUP ONLY: If there is time left in the session, before assigning
h o m e w o r k , do the exercise again, this time m a k i n g a mild n e g a t i v e statement to
e a c h child such as she m i g h t h e a r at school (e.g., "You act too silly" or " Y o u eat too
m u c h s u g a r " ) Let the children practice with these kinds of c o m m e n t s . P a y close
attention to w h e t h e r any statements are hitting too close too h o m e , causing with-
d r a w a l or acting out. If this happens, process with that child exactly h o w she is
feeling a n d h o w she can use her vest to protect herself.

HINTS

The children love this exercise, but younger ones can be extremely sensitive and
may take even the slightest negative statements to heart. W h e n w e were doing this
in a group recently, 6-year-old Amy looked crestfallen w h e n my comment to her was,
* % u are such a klu quiet I
responded, "Oh no, Amy. Do y o u have a bike and you've been falling off of itr She
nodded affirmatively w e immediately used that to say, "Use y o u r v e s t How do y o u
feel in y o u r heart?" and so on. She w e n t through the process and then I said, "See,
Amy? I had no idea y o u even had a bike. I totally made up that comment to sound
jerky, N o w y o u could have left here feeling miserable, b u t because o f y o u r vest y o u
were able to realize, 'Hey, r m not a klutz, r m Just learning h o w to ride my bike and
n
everyone falls off their bike w h e n they are first learning; She, more than anyone in
the group, understood how life vests work after t h a t She started becoming much
more assertive in group following this exercise.

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Internal and External Boundaries Exercises 119

Feeling Image

GOAL

To learn about internal boundaries

AGES

7 through 18

TIME

20-30 minutes

PURPOSE

This exercise helps group m e m b e r s to identify and develop visual i m a g e s o f the

feelings they h a v e related to the abuse. Understanding the m a g n i t u d e o f these
feelings is a preliminary step to learning h o w to m a n a g e them.

DO THIS EXERCISE TO

• H e l p facilitators assess group m e m b e r s ' adaptive coping styles.

• R e d u c e feelings of isolation and shame.
• Increase the children's ability to identify, comprehend, m a n a g e , and express
thoughts and feelings appropriately.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

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120 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

WHAT YOU NEED

• Writing paper
• Markers, crayons, or colored pencils

INSTRUCTIONS

Part I: Brainstorm a list of feelings that group members have about their sexual
abuse. Add your own ideas to the list during the brainstorming session. (Make sure
that feeling words such as guilty, embarrassed, happy, noticed, and important are
included.)

Part II: When a thorough list has been generated, help the children get to a quiet
place within themselves. Begin by having them lie down on their backs, far enough
from one another that they are not touching. Take the group members through
progressive relaxation to help them focus inward. Invite them to take three deep
breaths, and tell them that their bodies are relaxing more and more on each exhale.
Then instruct them to relax each body part, beginning with the feet, moving to each
leg, the bottom and pelvic area, up the torso, to the neck and head, through the
shoulders and then down the arms and through the hands—let the tension simply
melt away.
Then guide them to a quiet, safe place. Once they have found this place, ask
them to imagine a shape of any kind. Inform them that they will be communicating
with this shape. Instruct them to ask the shape about the feelings they had when
they were sexually abused, and how much of each feeling they had. For instance,
you might say, "Ask the shape to show you how much anger you felt. Notice and
remember how much space within the shape is filled up with anger." In the same
manner, go through each of the feelings brought up during the brainstorming
session. Ask the children to imagine different colors to represent their different
feelings. Then allow time for them to discover any other feelings that the shape
knows about, and to find out how much space these feelings fill.
Slowly end the guided imagery by counting backward from 10 to 1. As you are
doing so, instruct group members to become more present and connected to their
surroundings. Have them notice the carpet underneath them. Have them hear the
sounds of others. Encourage them to remember the shapes they envisioned, their
feelings, how big the feelings were, and what colors they were. As you finish
counting down to 1, tell them to slowly open their eyes and return to their seats.

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Internal and External Boundaries Exercises 121

Part III: Pass out paper and markers, crayons, or colored pencils to e v e r y o n e ,
and h a v e e a c h child d r a w a picture of his feeling i m a g e . W h e n g r o u p m e m b e r s h a v e
h a d e n o u g h t i m e for drawing, bring t h e m together to share their experiences. H a v e
group m e m b e r s and facilitators ask questions about the pictures a n d the feelings
they represent, s u c h as the following:

• W h a t do y o u think is the biggest feeling y o u h a v e ?

• D o y o u w a n t to lessen that feeling?
• W h a t could h e l p y o u to lessen it?
• Is there a feeling y o u w i s h y o u h a d m o r e of?
• W h a t c a n y o u d o to help y o u feel that feeling more?

HINTS

We have used this exercise near the beginning of group sessions and then again
near the end. This produces concrete images in w h i c h w e and group members can
see any changes in feelings that occurred during the weeks of group.
We have noticed that group members often draw triangles during this exercise.
The first time w e did it, five out of seven kids in the group drew triangles, and since
then that pattern has held. Other shapes are also used, however. For instance, Emiiy
drew a spiral-like shape and filled the center with guilt She left a lot o f blank space
toward t h e outer part of the spiral before she began t o fill the inner portion w i t h her
feelings. Generally, Emily had a hard time getting to her feelings; there were lots of
blanks before she could get there. Her core feeling was clearly guilt W e then were
able to help her view her guilt as a secondary gain she was using to prevent her from
having to feel other feelings. Once she felt safe enough to let g o o f her guilt, she w a s
able to identify and manage the other feelings underneath.
Kara drew an outline of a human figure as her shape, and filled in the different
body parts as the feelings she experienced w i t h the abuse. Arms represented a
helpless feeling, the feet and legs showed a nervous feeling, the head was timid, and
the breast level was shame and embarrassment Where her mouth w o u l d have been
was the feeling of pressure, and her lower abdomen w a s filled w i t h many feelings
she was as y e t unable to name (Kara often complained of stomaches). it would not
be unusual for a child drawing such a figure to have a litany o f somatic complaints,
especially stomachaches. Once Kara began to identify and express her feelings, her
stomachaches lessened.
If the children cannot lie still for the guided imagery, have them sit quietly in their
chairs, preferably w i t h their eyes closed. Turn out the lights if it will dim t h e room,
but not if it throws the room into complete darkness. Darkness is v e r y frightening for
many children w h o have been sexually abused during the night.

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122 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Encourage the children to draw the shapes they have visualized. T r y to seat them
in a w a y that prevents them from copying from one another's papers.
As a variation on this exercise, in a later session have group members revisualize
their feeling shapes. While they are doing so, have them visualize their positive
feelings taking up an increasing amount o f space in their shapes. Have them imagine
that their positive feelings have the power to diminish some of their other feelings,
such as guilt, revenge, hate, and loneliness. W h a t power do their positive feelings
have? Do they use laser guns or darts? Maybe they smother t h e negative feelings w i t h
hugs o r envelop them in love. During t h e guided imagery, state that the positive
feelings have more power and strength then the negative ones. Note that it is okay
to have negative feelings, but that by having a higher percentage of positive ones,
group members will feel more centered, clear, and happy. Tell group members that
the warmth of the positive feelings will surround them and lead t h e m to a healing
place.

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Internal and External Boundaries Exercises 123

Sentence Completion

GOALS

To learn about internal boundaries; to build self-esteem

AGES

6 through 18

TIME

5-20 minutes

PURPOSE

This exercise helps group m e m b e r s to identify and express their feelings regard-
ing the abuse, such as guilt, shame, and isolation. It can b e a quick o p e n i n g exercise
that e v e r y o n e does together in one large group to express one feeling, or it can b e
d o n e in pairs to allow the focus to b e m o r e in-depth, with an emphasis o n a variety
of emotions.

DO THIS EXERCISE TO

• Increase the children's capacity to identify, comprehend, m a n a g e , and express

thoughts and feelings appropriately.
• Decrease levels of fear, shame, and isolation.
• Identify emotions regarding the abuse.
• H a v e a quick lead-in or opening exercise to address a specific emotion.

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Publications, Inc.
124 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• You w a n t to do the expanded version and there are not e n o u g h facilitators to

ensure the small groups are staying on task.
• You h a v e a group with few talkers.

WHAT YOU NEED

• C h a l k b o a r d and chalk

INSTRUCTIONS

Short version: For older children, write on the chalkboard a sentence that y o u
w a n t e v e r y o n e to complete verbally. S o m e possibilities include the following:

• I feel guilty about the sexual abuse w h e n . . .

• T h e thing that m a k e s m e angriest about the abuse is . . .
• M y greatest concern about having b e e n sexually abused is . . .
• I a m m o s t scared a b o u t . . .
• I feel a s h a m e d because . . .
• W h e n I think about the abuse I w o n d e r . . .
• If only I h a d . . .
• I feel g o o d that I . . .
• I a m p r o u d of myself because . . .
• I feel it w a s m y fault because . . .
• T h e w a y I feel about the person w h o touched m e is . . .
• I f a n y o n e tries to abuse m e again, I . . .

H a v e e a c h group m e m b e r take a turn completing the sentence on the board. Repeat

this process for two or three sentences. For younger children w h o can't read, 6-8
years old, read aloud the sentences that y o u want them to complete.
Longer version: H a v e group m e m b e r s choose partners. W h e n e v e r y o n e is paired
off, ask the partners in each pair to designate one person A and the other B. Write
the sentence to b e completed o n the board, and tell the group that the A s h a v e 2
minutes to say the sentence over and over again to the B s , e a c h time ending the
sentence in a different way. For example, A might say, " I feel a s h a m e d because I

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Publications, Inc.
Internal and External Boundaries Exercises 125

didn't tell a n y o n e . I feel ashamed b e c a u s e this h a p p e n e d to m e . I feel a s h a m e d

b e c a u s e I liked s o m e o f the touch. I feel a s h a m e d b e c a u s e I accepted m o n e y from
him. I feel a s h a m e d b e c a u s e I k n e w it w a s h a p p e n i n g to m y sister a n d I d i d n ' t do
anything to stop it." Instruct the B s to listen quietly and n o d but n o t to talk. W h e n
the 2 m i n u t e s are up, say, " S w i t c h . " This time, the B s complete the s e n t e n c e w h i l e
the A s listen.
G o t h r o u g h this process with u p to three different sentence c o m p l e t i o n s at a
time. T h e n h a v e t h e pairs c o m e together again in the larger group a n d discuss w h a t
c a m e up for t h e m . D i d a n y o n e discover anything n e w about themselves? H o w does
it feel to a d m i t s o m e o f these feelings?

HINTS

This exercise is a great way to unblock feelings. T h e sentences focusing on shame

and seif-blame can bring forth previously undisclosed information, While doing this
exercise in a group of ours, 7-year-old Susie disclosed that she had touched her sister.
Also, 6-year-old jason admitted that his baby-sitter made him touch his sister. W h e n
information like this is revealed, group members become more animated and appear
much less traumatized. With the children's permission, w e shared t h e information
w i t h their individual therapists, w h o helped them work through the feelings even
more in their individual sessions.
The hardest part of this exercise is getting the group members t o stay w i t h i t
They tend to w a n t to supply only one ending t o any given sentence. Monitor the pairs
closely as they do the exercise and insist that they continue to t r y t o complete t h e
sentences. Tell them to just say the first things that come to their minds, even if those
things do not seem t o make sense. Some of the sentence completions may sound
off-the-wall, but by continuing t o try, the children may eventually reveal some real
feelings.

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Publications, Inc.
126 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Clay Faces

GOAL

To learn about internal boundaries

AGES

3 through 8

TIME

15-20 minutes

PURPOSE

This exercise helps group members to express their anger. It uses a physical and
visual w a y to help group members identify and express their emotions appropriately.

DO THIS EXERCISE TO

• Increase the children's ability to identify, comprehend, m a n a g e , and express

thoughts and feelings appropriately.
• Introduce the concept that thoughts and feelings create an internal interpre-
tation o f reality that affects behavior.
• H e l p group m e m b e r s articulate feelings they have toward their offenders.

DO NOT USE THIS EXERCISE WHEN

• Out-of-control m e m b e r s might hurt others b y throwing clay.

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Publications, Inc.
Internal and External Boundaries Exercises 127

• Clay m a y b e a problem to remove from carpets or other parts of the room.

• A n y group m e m b e r ' s anger tends to escalate rather than is released w h e n
expressed physically.
• You do not feel confident in helping a child w h o m a y b e heavily triggered. B e
aware that sometimes children can b e triggered b y the feel o f the clay, the
m o v e m e n t s o f shaping the clay, or the actual forms they create, w h i c h s o m e -
times remind t h e m of penises or other objects connected to the abuse. B e
attentive to trigger responses and help anyone w h o starts to w i t h d r a w or
b e c o m e too aggressive to verbalize her feelings.

WHAT YOU NEED

• W a r m m o d e l i n g clay that is pliable for little hands

• A large sheet of butcher paper or other protective covering for the floor
• Paper towels to w i p e hands

INSTRUCTIONS

Part I: Set up a w o r k space and seat the group m e m b e r s around that area. H a n d
each child a l u m p of clay. Begin b y taking a piece of clay of your o w n a n d m a k i n g
a face with it. W h e n y o u have m a d e your clay face, ask the group m e m b e r s to tell
y o u w h a t e m o t i o n is depicted on the face. T h e n h a v e them m a k e their o w n clay
faces s h o w i n g emotions. If they need m o r e structure, y o u can suggest e m o t i o n s they
m i g h t show, such as sad, happy, surprised, or angry.

Part II: Instruct group m e m b e r s to m a k e three faces that s h o w feelings they h a d

w h e n they w e r e touched. T h e n h a v e t h e m m a k e three faces s h o w i n g the feelings
they h a v e n o w about the touch.

Part III: Talk with the group m e m b e r s about the feelings they h a v e t o w a r d their
offenders. Tell t h e m they can m a k e anything they w a n t out of their clay that s h o w s
h o w they feel about the person w h o abused them. Explain that they m a y h a v e a
combination of feelings, like love, sadness, and anger, and that all of the feelings
they have t o w a r d their offenders are fine.

Notice and m a k e c o m m e n t s or ask questions about what they are m a k i n g .

E n c o u r a g e t h e m to show their feelings b y modeling examples. M a k e a sad clay face

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128 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

and, u s i n g y o u r voice, express the sadness y o u feel b y saying, " I feel sad y o u
t o u c h e d m e b e c a u s e m y life h a s felt so different ever since y o u did." T h e n add tears
to y o u r c l a y face or tear it up to s h o w w h a t y o u w a n t to do w i t h the sadness. T h i s
gives the children permission to do the s a m e . B y going first, y o u m a k e s u c h actions
less e m b a r r a s s i n g for them.
M a n y g r o u p m e m b e r s will express anger, so b e sure to talk w i t h t h e m a b o u t
a n g e r before they leave the d a y ' s session:

• H e l p t h e m clarify w h o they are angry with and h o w to express their anger in

appropriate ways.
• A s k g r o u p m e m b e r s for e x a m p l e s o f h o w to b e angry w i t h o u t hurting a n y o n e ,
i n c l u d i n g themselves.
• F i n d o u t w h o they go to w h e n they feel angry. S o m e t i m e s a child only feels
comfortable e n o u g h to b e consoled b y a pet or a stuffed animal. Help e a c h
child identify o n e adult or friend she can talk to.

HINTS

W e have had a lot of success with this exercise, especially w i t h children w h o are
developmentally unable to verbally express their feelings. It is especially important
to give these children plenty of time with the clay and lots of encouragement for
using their voices as part of their expression.
For younger children, it can be helpful if the facilitators roll out a bunch o f "snakes"
for t h e kids t o use as mouths and round balls to use as eyes.
One warning (especially w i t h boys): The children may w a n t t o throw the day. This
can get o u t o f hand very quickly. Therefore, allow smashing, squashing, flattening,
and pounding, but no throwing.
If any child is showing a lot o f negative emotions w h e n describing how she feels
about the abuse now, talk t o her about whether she feels stronger now. Help her t r y
to find one positive aspect to the aftermath of the abuse, For example, maybe it has
helped h e r t o have a closer relationship w t t caretaker. Be sure t o end t h e d a y s
session w i t h a positive, uplifting exercise or game.

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Internal and External Boundaries Exercises 129

Target of the Offender

GOAL

To learn about internal boundaries

AGES

4 through 18

TIME

10-15 m i n u t e s

PURPOSE

This exercise helps to reduce excessive anger, express repressed anger, a n d guide
misdirected anger. It is useful to reduce feelings o f s h a m e and internalization of
feelings.

DO THIS EXERCISE TO

• Encourage group members to identify, manage, and express anger appropriately.

DO NOT USE THIS EXERCISE WHEN

• A n y group m e m b e r s are in nonsupportive environments that could result in

severe repercussions for expressing anger.
• There is n o t e n o u g h time to process the exercise fully in group.

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130 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• A n y child in group feels n o anger toward the offender and w o u l d feel a n e e d

to pretend anger to feel included b y other members.

WHAT YOU NEED

• Paper
• M a r k e r s or crayons
• C l a y or water balloons
• L a r g e stuffed dolls or pillows

INSTRUCTIONS

Part I: H a v e group m e m b e r s use paper and markers or crayons to m a k e a n y

kinds o f targets they want to represent their offenders. A target m i g h t b e a picture
that looks like the person w h o touched the child, or it m i g h t b e silly or scary.
W h a t e v e r each child wants to d r a w is fine, as long as it represents the offender.
W h e n all group m e m b e r s h a v e finished making their targets, set up the target
range. Before any throwing or hitting of the targets begins, b e sure that everyone
u n d e r s t a n d s w h e r e to stand so as not to get hurt b y the other children's exuberance.
E n c o u r a g e the children to use their voices to help t h e m express their anger as
they t h r o w l u m p s of clay or water balloons at their targets. Let t h e m k n o w they c a n
yell anything, except for swear words.

If y o u are using dolls or pillows to hold the targets, h a v e group m e m b e r s take

turns. O n e at a time, have each person start b y pinning or taping her target picture onto
a doll or pillow. Then she can say or do anything she wants to the offender target.

Part II: Following the target practice, ask group members the following questions:

• D o y o u feel different?
• D i d it help y o u to get s o m e of your anger out?
• A r e y o u feeling less angry or m o r e angry n o w ?
• H o w do each of y o u express or s h o w y o u are angry? (Answers to this question
m a y provide y o u with n e w information about s o m e o f the group m e m b e r s
and h o w they m a y or m a y not need help dealing with their anger.)
• W h a t happens at h o m e w h e n y o u s h o w your anger?

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Internal and External Boundaries Exercises 131

End the exercise b y talking about healthy w a y s of expressing anger. S h a r e w i t h the

children s o m e ideas for w a y s they can express their anger that w o n ' t h u r t t h e m -
selves or others. S u g g e s t s o m e of the things that y o u do w h e n y o u are angry.

Part III: F o r h o m e w o r k , ask group m e m b e r s to pick one idea to try w h e n they

get m a d in the n e x t w e e k . Forewarn the m e m b e r s ' parents about this h o m e w o r k
and instruct t h e m to e n c o u r a g e their children to express their anger in safe w a y s .
T h e y m a y w a n t to allow their children to say that they are angry, or to ask for a
time-out to c a l m d o w n . Help the parents to understand that it is n o t safe for their
children to express their anger through swearing or hitting. B e sure to follow up on
this a s s i g n m e n t at the next group session.

HINTS

Clear limits are important for everyone's safety as well as for fairness, w h e n y o u
do this exercise. Some children will keep to the limits without any reminders, but
others will test the limits. Give any child w h o breaks the rules one reminder and then
remove her from the exercise if she cannot follow the directions in a safe manner.
When the child says that she feels she can act appropriately, allow her back in.
if there is a nearby park, or even a fence in back of the building, this can serve as
a good environment. Children really like using water balloons for this target exercise.
They are proud w h e n they hit their targets. Many times, group members have pointed
out how they really got their offenders w h e n their balloons blurred the colors, messed
up the images, and tore the paper. A sense of satisfaction and empowerment really
comes through. If using water balloons, w e usually do this activity o n a warm day,
just in case anyone g e t splattered with water. We haven't had any mishaps because
w e heavily emphasize waiting until everyone is out of the way and ready w i t h a n e w
balloon before throwing begins.
A variation o n this exercise is to use balloons filled with air as the targets, Have
the group members draw the faces of their offenders on the balloons. They can then
bat them around or pin or tape the balloons o n a large board and throw darts at
them. W h e n the children are allowed to draw whatever faces they want, many choose
to draw the looks their offenders had on their faces during the abuse.
W h e n y o u are using a large soft doll or pillow t o hold the targets, make sure that
y o u have t h e children stand in a line on one side of the room. Then have them take
turns, on the opposite side of the room, running up to the pillow and kicking,
smashing, throwing, or hitting it. Be sure that whatever they do is done well away
from those in line, so that other children do not get hurt.

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132 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

We have found, through our error, that it is best to let the parents of group
members k n o w ahead of time w h e n w e will be doing anger work. This applies in both
group and individual therapy. There have been a couple of times w h e n children have
gone home after one of these sessions w i t h a lot of anger, and their parents were
taken by surprise. Needless to say, w e heard about it later, w e modified the situation
by giving parents several warnings.

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Publications, Inc.
Internal and External Boundaries Exercises 133

Animal Boundaries

GOALS

To learn about internal and external boundaries; to learn to m a n a g e triggers

AGES

4 through 10

TIME

15-20 minutes

PURPOSE

This is a fun and nonthreatening technique to teach children that their thoughts,
feelings, and sensations affect their behavior. W h e n they understand this concept,
children recognize they h a v e more choice and control over their actions.

DO THIS EXERCISE TO

• Increase the children's ability to identify and express feelings appropriately.

• Increase the children's ability to identify sensations in the b o d y and to b e g i n
u n d e r s t a n d i n g w h a t the sensations mean.
• Teach h o w feelings and thoughts affect behavior.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

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134 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

WHAT YOU NEED

A large, comfortable room

INSTRUCTIONS

Part I: Instruct group m e m b e r s to close their eyes and i m a g i n e b e i n g an animal.

A s k the following questions, telling the children not to answer t h e m aloud, b u t to
picture the answers silently in their m i n d ' s eyes.

• H o w b i g is the animal?
• Is it generally a m e a n or friendly animal?
• W h a t are s o m e of the animal's strengths?
• W h a t does its b o d y feel like on the outside? Is it soft? H a r d ? Scaly?
• D o e s it h a v e big ears or little ears?
• W h a t do its face, eyes, and m o u t h look like?

Part II: A s k each child in turn to m o d e l with his b o d y h o w his animal w o u l d

react to the following situations. Act the situations out b y having o n e child play a
p e r s o n and the other play the animal he has imagined. T h e child acting as a person
should o n l y pretend to touch the "animal." A s k the child acting as the animal to
s h o w h o w h e would react if each of the following happened:

• Your fur w a s rubbed the w r o n g w a y ?

• S o m e o n e stepped on your tail?
• S o m e o n e petted y o u nicely?
• You w e r e scared? Lonely? H a p p y ? Hungry? A n g r y ? Excited? A s h a m e d ?
Goofy?

M a k e sure that y o u end the questioning on a positive feeling.

Part III: With the group as a whole, discuss the concept that h o w w e feel on the
inside affects h o w w e act on the outside. A s k group m e m b e r s h o w they act in each
of the following situations:

• T h e y are super hungry and haven't gotten to eat yet. (Are they whiny, cranky,
mean?)

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Internal and External Boundaries Exercises 135

• T h e y are tired b u t don't really w a n t to g o to b e d .

• T h e y feel e m b a r r a s s e d about s o m e t h i n g that just h a p p e n e d . ( A n e x a m p l e
m i g h t b e that a friend just said, " Y o u b u t t o n e d y o u r shirt all w r o n g ! " )

T h e n discuss b o u n d a r i e s b y explaining that w e use our w o r d s a n d b o d i e s to

express o u r b o u n d a r i e s to others. A s k questions such as the following:

• H o w did [group m e m b e r ] M a r y ' s animal tell the person she did n o t w a n t to

be p e t t e d ? D i d she hiss, or pull away, o r try to scratch?
• H o w a b o u t w h e n [group m e m b e r ] T o m m y ' s tail w a s stepped o n ?
• H o w w o u l d y o u s h o w y o u r b o u n d a r y if s o m e o n e h u g g e d y o u a n d y o u did
not w a n t to b e h u g g e d right then? W h a t w o r d s w o u l d y o u u s e ? W h a t w o u l d
y o u d o w i t h y o u r b o d y to s h o w that y o u did not w a n t to b e h u g g e d ?

N o w h a v e e v e r y b o d y stand up and, all together, pretend that s o m e o n e is h u g g i n g

t h e m w h e n t h e y d o n ' t w a n t to b e h u g g e d . H a v e e v e r y b o d y act out at the s a m e t i m e
w h a t they w o u l d do.

HINTS

Children love this exercise, but you have t o keep it moving and active. Do not spend
too much time talking, or y o u will lose them. Follow this exercise with t h e "Boundary
Line* or "Life Vest" exercise.
Remind the children that w h e n they are acting out their animals, they need t o
keep their animals in control. Some may use the play to get too aggressive toward
t h e persons w h o are "stepping on their tails/ This is a concrete w a y to remind them
that they are in control of their actions, if someone does get too rough after having
been instructed n o t to, play the animal for that child and let him play the person.
After role modeling h o w the animal can react in a safe fashion, have t h e child t r y
being t h e animal a g a i a If the animal is still too rough, let him know that this is not
a game he can play because others could get h u r t He is welcome to w a t c h and get
ideas from others o n how t o respond in a less harmful w a y After group, inform the
child's individual therapist so that therapist and child can work together t o address
the child's aggression.

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 136 GROUP WORK WITH SEXUALLY A B U S E D CHILDREN

Familiar Feelings

GOALS

To learn about internal boundaries; to build self-esteem

AGES

9 through 18

TIME

5-10 minutes (or assign as homework)

PURPOSE

Many children do not know how to identify their feelings. Often they know only
two feelings, "good" and "bad." This exercise gives children a vocabulary of
feelings so that they can better express themselves.

DO THIS EXERCISE TO

• Increase group members' ability to identify, comprehend, manage, and ex-

press thoughts and feelings appropriately.

DO NOT USE THIS EXERCISE WHEN

• Members of the group are not able to read at a fourth-grade level or above.

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Internal and External Boundaries Exercises 137

WHAT YOU NEED

• "Feelings" checklists
• Pens or pencils

INSTRUCTIONS

Pass out copies of the "Feelings" checklist to all group members. Take a few
minutes for each child to fill out her own checklist by putting check marks by all
the feelings she has had today. With the whole group, discuss the feelings each
person has had. Then ask some of the following questions:

• Did anyone express these feelings to others? If so, how?

• Was that an appropriate way?
• If not, what are some other ways to express those feelings more appropriately?

HINTS

This exercise is brief and works best w h e n it is repeated three to four times over
the length o f the group session, it is also a great opening exercise, because it gets
people talking about their lives.
You may w a n t to pick one emotion that a group member has expressed and ask
for further details. For example, if someone has marked that she has felt fearful, y o u
could ask, "Can y o u tell us w h a t y o u were fearful about?"
Copies of t h e checklist can also be sent home as homework. You can have the
group members fill o u t t h e checklists o n three different days and bring t h e m back in
the following week. This way, y o u can see if there are patterns t o the feelings that
individual children express.

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138 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Feelings

Keep track of how you are feeling by noting which of the following emotions you experience
each day
Aggressive Frightened Premenstrual
Agonized Frustrated Pressured
Amused Gossipv Prudish
Angry Greedy Puzzled
Apathetic Grieving Regretful
Apologetic Guilty Relieved
Arrogant Happv Resentful
Ashamed Helpful Sad
Bashful Homesick Satisfied
Blissful Hopeful Scheming
Boastful Horrified Seductive
Bored Hot Sheepish
Cautious Hungover Shocked
Cold Hurt Sick
Competitive Hysterical Skeptical
Concentrating Idiotic Smug
Confident Impressed Sophisticated
Confused Indifferent Sorry
Conniving Infatuated Successful
Contemptuous Innocent Sulky
Contented Interested Surly
Cranky Insecure Surprised
Creative Insignificant Suspicious
Curious Inspired Svmpathetic
Delighted Tealous Talkative
Demure Kind Tempted
Depressed Lazv Tender
Determined Loaded Thoughtful
Disappointed Lonelv Threatened
Disapproving Lovable Timid
Disbelieving Love-struck Tired
Disgusted Lustful Transcendent
Distasteful Martyred Triumphant
Domineering Meditative Turned on
Eager Mellow Two-faced
Eavesdropping Mischievous Undecided
Ecstatic Miserable Vulnerable
Efficient Nauseated Withdrawn
Egotistical Negative Worried
Embarrassed Nervous
Enraged Noble
Enthusiastic Nonchalant
Envious Nostalgic
Exasperated Obstinate
Exercised Optimistic
Exhausted Overworked
Expectant Pained
Fiendish Paranoid
Forgetful Passive
Frazzled Perplexed

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Internal and External Boundaries Exercises 139

Talking to the
Offender Psychodrama
(Therapy Group Only)

GOALS

To learn about internal boundaries; to build self-esteem and self-protection skills

AGES

5 through 18

TIME

20-30 minutes m i n i m u m (An hour or more can b e spent on this exercise w h e n

group m e m b e r s really get involved in it.)

PURPOSE

This exercise allows group m e m b e r s to voice unspoken thoughts and feelings

about their offenders without fear of retribution. It also helps t h e m to feel safe and
shows t h e m that they can think about their abusers without feeling afraid.

DO THIS EXERCISE TO

• Help group m e m b e r s appropriately direct repressed or displaced anger.

• Increase the children's capacity to separate the self from the abuser.
• Increase the children's capacity to place responsibility and accountability for
the abuse o n the appropriate persons.

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Publications, Inc.
140 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• Increase the children's ability to identify, comprehend, m a n a g e , and express

thoughts and feelings appropriately.
• R e d u c e feelings of guilt and self-blame.

DO NOT USE THIS EXERCISE WHEN

• A n y group m e m b e r has a strong tendency to dissociate.

• Trust is not well established in the group.
• T h e r e are too m a n y group m e m b e r s w h o will disrupt the exercise b y cracking
jokes, m a k i n g noises, or not taking others seriously.
• T h e r e is not enough time to complete the exercise.

WHAT YOU NEED

F o r y o u n g e r children, use props such as the following:

• Tape recorder with blank tapes
• Dress-up clothes
• Full-length mirror
• Dolls, puppets
• P h o t o g r a p h s or drawings of offenders
• Toy telephones

(Not all o f these materials are necessary, but children enjoy h a v i n g s o m e choices.)

INSTRUCTIONS

Part I: H a v e group m e m b e r s sit in a circle, and ask t h e m to imagine talking to

their offenders in a safe and comfortable situation. Suggest s o m e w a y s to m a k e the
situation safe and comfortable, including imagining that:

• T h e offender is in jail.
• T h e r e is a policeman watching.
• T h e offender is locked in a room where he can only hear y o u and cannot see
you.

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Internal and External Boundaries Exercises 141

• You are invisible and magic, so you can get away if he tries anything.

When everyone has imagined a safe setting, give group members a choice of
how they want to talk their offenders in the group. Tape recorders, dolls or puppets,
and dress-up clothes are especially useful for younger children. Children of all ages
can role-play talking to an empty chair, a doll offender, a facilitator playing the
offender, a picture of the person who abused them, or an offender on the telephone.
Before starting the dramas, set some ground rules. Let the group members know
that everyone will have a turn, and that no one is allowed to interrupt, unless they
are asked to help. This structure helps everyone to be more attentive. Ask for a
volunteer to begin talking to the offender in whatever way she chooses. Have each
person begin by describing the setting. For example:

• Are you outside or inside?

• Are you alone or with others?
• Is the offender standing or sitting?
• What is his posture like?
• What is the look on his face?
• What does his voice sound like?
• How far away is the offender in relation to you?
• What helps you know you are safe while doing this exercise?

Ask the group member to express her feelings and to tell the offender what she
wants from him, if anything. If she wishes, she can choose someone to play the
offender. She can then instruct the person chosen on how to respond as the offender
and can demonstrate how the offender stands or sits, how he sounds, his manner-
isms, and the like. The group member should then describe what she would like
from the offender—for example, the tone of voice he should use, if he should
apologize, whether he should be angry or conciliatory, and so on.
There may not be enough time for each child to talk to her offender in one group
session. If this is the situation, set aside time in the next session for the remainder
of the group members to take their turns.
We give group members paper and crayons or markers to draw pictures of their
offenders, then other pictures of their choice, while they wait for their turns.

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Publications, Inc.
142 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

Although we recommend this exercise for children ages 5 and older, we have used
it with 3- and 4-year-olds and had them dress up their offenders. During the role
model presented by the facilitators, the offender apologized to his victim. One of the
kids started clapping, and her face showed relief; everyone else then joined in the
clapping, in another group, a girl told the offender what she really thought of him:
"This guy is such a jerk."
This exercise offers material for some profound changes when used with teenag-
ers. One teenager who was talking to her offender was getting caught in a power
struggle until the offender began to soften. Then her defenses fell away and she
..sobbed............
Be aware that there may be times when you will have to stop the scenario and
take a child aside to help further process feelings that come up during this exercise.
Once, a teenager froze during this exercise and dissociated so severely that one of us
spent 15 minutes softly talking to her to help her feel safe enough to return, while
the other facilitator explained to the group about dissociation. When we were sure
she was ready the other group members took over her role-play so she could observe
it from the outside rather than being so involved in it
We have also used the technique of "doubling" when a group member has not
felt strong enough to stand up for herself. The "double* stands beside the group
member and states the feelings or thoughts that she thinks the member might want
to say to the offender. The member then repeats aloud any statements the double
makes that Fit for her. If that is too frightening, she simply lets the double do all the
talking for hen
Take note of children who have difficulty choosing situations in which they would
feel safe talking to their offenders. When a child has fears, take him aside and
encourage him to talk about these feelings. Help him discover what he can do to feel
safer, if he is able to articulate his needs and feelings clearly, this could become a
group discussion. On the other hand, he may need to explore these fears in individual
therapy
Notice, too, what situations children feel safe in and question them if those
situations dont seem safe to you. For example, a child may imagine herself approach-
ing the offenders home alone or carrying a knife with her. She needs to realize this
is fine to do in a role-play but in real life this could be a dangerous way to approach
him. If she approaches him alone she may be harmed further, either verbally or
physically.
We take time to brainstorm safe situations with the whole group, which teaches
them to ask for help and to trust that others can assist them in solving problems.

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Publications, Inc.
Internal and External Boundaries Exercises 143

My Own BASK Book

(Therapy Group Only)

GOALS

To understand the dynamics of sexual abuse; to learn about internal and external
boundaries

AGES

6 through 18

TIME

60-80 minutes (This exercise m a y b e done over two sessions.)

PURPOSE

This exercise helps children express their experiences with abuse at all levels.
U s i n g the B A S K (behavior, affect, sensation, and knowledge) model, it helps group
m e m b e r s understand their o w n reactions and begins the process o f shifting the
responsibility of the abuse to the offender.

DO THIS EXERCISE TO

• Increase the children's capacity to separate the self from the abuse / a b u s e r .
• Introduce the concept that thoughts and feelings create an internal interpre-
tation o f reality that affects behavior.

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Publications, Inc.
144 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• T h e r e is not enough time to do it thoroughly.

• T h e r e are not enough facilitators to give some focused t i m e to each group
member.

WHAT YOU NEED

• C o p i e s of " M y B o o k " pages

• M a r k e r s , pens, a n d / o r crayons

INSTRUCTIONS

Part I: S h o w the group m e m b e r s the different pages to " M y B o o k " and pass the
p a g e s out o n e at a time. For example, give everybody the first p a g e , " W h e n I w a s
touched, I thought in m y head," and have them write o n that p a g e whatever
thoughts they h a d b a c k w h e n they w e r e being abused. G i v e a few examples:

• I'm bad.
• N o o n e will like me.
• I hate h i m .
• H e thinks I ' m special.

H a v e e a c h person w o r k on her o w n page. A s the children w o r k , check on w h a t

each group m e m b e r is doing and give assistance as needed. S o m e children m a y
n e e d help with ideas about w h a t they thought. Others will need help with writing.
M a k e sure that each child writes d o w n m a n y thoughts, not just o n e or two.
A s the children complete the first p a g e of the book, pass out the next page, and
so on. U s i n g the B A S K model, the head is for thoughts or k n o w l e d g e , the heart is
for the affect or feelings, the stomach is for sensations or bodily feelings, and the
outline of the person represents behavior or action. Finally, the last p a g e is used to
identify the beliefs the child has developed about herself, such as " F m unlovable,"
"I'll n e v e r b e safe," or " I ' m b a d " (these are core negative beliefs).
W h e n the children have finished their b o o k s , give them p a p e r they can draw on
to m a k e covers.

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Publications, Inc.
Internal and External Boundaries Exercises 145

Part II: H a v e each person take a turn sharing her book. M a k e sure that e v e r y o n e
gives lots of praise! Encourage the children to share their books with their parents
or other caregivers.

HINTS

Have group members work with some space between them, otherwise they tend
to copy each other. If you have a group in which the members are hesitant to tell their
own stories, you can do this same exercise with them by having them guess how
Elizabeth was feeling instead (see the exercise "Elizabeth's Triggers;* in Chapter 10),
Often we choose to add pages to the BASK book, The books the children just
completed become their "Then" books, and we add the "Now* books, which include
pages such as the following:

• Now that I have told I t h i n k , . ,

• How when I think about the abuse I f e e l . . .
• How when 1 remember the touch, the places l feet it in my body a r e . , ,
• if anyone tried to touch rne again, I would , . .
• Now that l understand more about the abuse, I think that I am a person. [Use
many different adjectives,!
• The good things that have come out of all this are . . .

Give the children a lot of time to work on this exercise. When the books are
finished, it is worthwhile to try to bind them or put them in really nice report folders,
The children are very proud of their books. It is most effective to do this exercise
toward the last two-thirds of group. This work is likely to be a major step in the
children's recovery, and they will be able to look at their books time and time again,

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Publications, Inc.
146 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

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Publications, Inc.
Internal and External Boundaries Exercises 147

WHEN I W A S TOUCHED, I THOUGHT IN MY HEAD

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148 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

I FELT IN MY HEART...

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Internal and External Boundaries Exercises 149

THE SENSATIONS I FELT IN MY BODY WERE...

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150 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

WHAT I DID WAS...

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 Internal and External Boundaries Exercises 151

AND I DECIDED I WAS...

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152 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Lean on Me

GOAL

To learn about internal boundaries

AGES

9 through 18

TIME

10-20 minutes

PURPOSE

This exercise helps group m e m b e r s identify and define appropriate boundaries

in friendships and in romantic relationships. It helps them recognize h o w "healthy"
relationships include give-and-take b y both parties involved. T h e y learn h o w
exhausting and limiting a heavily dependent relationship can b e .

DO THIS EXERCISE TO

• Teach group m e m b e r s h o w to identify and practice healthy boundaries.

• A s s e s s the boundaries that group participants currently h a v e .
• D e m o n s t r a t e a concrete w a y of understanding dynamics in past and present
relationships.
• Increase the children's ability to m a k e conscious behavioral choices.

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Publications, Inc.
Internal and External Boundaries Exercises 153

DO NOT USE THIS EXERCISE WHEN

• A n y group m e m b e r is truly terrified o f touch.

• S o m e o n e in the group is on crutches or in leg braces and could b e physically
hurt easily. (You can modify the exercise b y doing it sitting down.)

WHAT YOU NEED

A clear, o p e n space

INSTRUCTIONS

Part I: H a v e group m e m b e r s choose partners, then h a v e each pair decide w h i c h

m e m b e r is A and w h i c h is B . H a v e the As stand close behind the B s , facing their
partners' b a c k s . A s k the pairs to imagine that they are sweeties and then h a v e the
As w r a p their a r m s around the Bs while the B s remain still. A s k the B s h o w this
position feels, b o t h physically and emotionally. Is there any discomfort or sense o f
uneasiness for a n y o n e ? Does anyone feel comfortable in this position? A s k the A s
the s a m e questions.

Part II: W h i l e the pairs are in the same position, instruct the A s to b e g i n to lean
on their partners. Instruct them to gradually lean more and more, until the B s are
holding as m u c h w e i g h t as they can. Then have t h e m stop and return to the original
position of standing behind their partners. A s k the Bs:

• Was the leaning okay?

• Did they feel needed because their partners were leaning on t h e m ?
• D o they feel strong enough to support another person fully?
• W h a t w o u l d it m e a n to support s o m e o n e fully—physically, emotionally, and
financially?
• H a s a n y o n e ever had this experience? W h a t did it feel like?
• W h a t w o u l d h a v e happened to A if B had tried to m o v e ?

N o w ask the As:

• H o w did it feel to lean so heavily on s o m e o n e else?

• Were y o u comfortable with it? W h y or w h y not?

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154 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• W o u l d y o u w a n t to b e in a position like this in a relationship?

• H a v e y o u ever been in this position before? If so, h o w w a s that for y o u ?

Part III: H a v e the partners stand facing each other. Instruct the B s to reach out
and take their partners arms and pull them toward them. Ask:
7

• H o w did that feel for the As?

• D i d y o u resist? W h y ?
• H o w d o the Bs feel about the A s responses to their pull?
7

Part IV: G a t h e r the As around y o u and privately instruct t h e m to resist B s pull.

R e t u r n to A s and Bs facing each other and again have B pull A ' s arm. Ask:

• W h a t h a p p e n s w h e n A resists? D o e s B pull harder?

• W h a t happens if B pulls harder?
• W h a t does this pulling exercise feel like for you?

Part V: H a v e the partners stand b a c k to b a c k and gently lean o n each other. N o w

ask:

• H o w is y o u r partner affected w h e n y o u m o v e ?
• W h a t d o y o u have to do to remain standing if your partner m o v e s ?
• [Directed to partners w h o m o v e d first] H o w did it feel to m o v e first?
• [To the other partner] H o w did it feel to have to m o v e in response to y o u r
partner's move?

Part VI: Return to a circle as a w h o l e group and discuss h o w these exercises are
alike and different from relationships the group m e m b e r s h a v e b e e n in. Discuss
w h a t m a k e s a relationship work. Is it really possible to h a v e a healthy, h a p p y
relationship if one person is always leaning on the other for support b u t cannot give
a n y b a c k ? H o w does it feel to always b e giving all the support? H o w m u c h can o n e
p e r s o n carry, and for h o w long?

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Publications, Inc.
Internal and External Boundaries Exercises 155

HINTS

This can be a very powerful exercise, Be sure to set safety guidelines in the
beginning so that no one gets hurt The number one guideline is that when someone
says "Stop/ you stopl
Following the exercise* take time to discuss relationships. Our teens have been
open to talking about their boyfriends and girlfriends. We often brainstorm lists of
how they might know if the people they are attracted to can both give and take
support
We had one group in which several girls did not mind having someone hanging
on them heavily. They kept saying that it helped them to feel loved and comfortable,
it was not until we had them partner up again and told them to try to move and get
things done while this dead weight was hanging on them that they began to
understand how such dependency can affect them and their partners.
We asked them to imagine a couple of scenarios: (a) There is an imaginary ball
and chain locked to their leg or (b) they are so dependent on someone else that they
can no longer make their own decisions regarding where to go, what to eat, or who
their friends are, We then discussed the following questions:

• How does it feel to be in this situation?

• What would happen to you if your partner got tired of alt that weight and found a
way to unlock the ball and chain and walk away? How would you feel then?

We discussed with them how untreated survivors of sexual abuse tend to be

either overly responsible or irresponsible, in relationship situations, past victims often
will become consumed by the fantasy of the ultimate relationship and play out the
role of either superwife or helpless victim. Neither is healthy. Those who act helpless
often end up in battering relationships, and those who play the superwife, the woman
who can do it all, often end up feeling resentful and unable to be truly intimate or
vulnerable with other persons. Both miss out on true love and connection with other
human beings.

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156 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

If You're Angry
and You Know It

GOALS

To learn about internal and external boundaries; to build self-esteem

AGES

4 through 9

TIME

10-15 minutes

PURPOSE

This exercise encourages children to recognize and express their anger in healthy
ways.

DO THIS EXERCISE TO

• Increase the children's capacity to value self and others.

• Increase the children's capacity to exert their will and desire effectively and
appropriately.
• Teach group m e m b e r s n e w w a y s to express their anger that w o n ' t hurt t h e m
or a n y o n e else.

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Publications, Inc.
Internal and External Boundaries Exercises 157

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

WHAT YOU NEED

N o special materials needed

INSTRUCTIONS

Part I: H a v e group m e m b e r s stand in a large circle with a fair a m o u n t of space

b e t w e e n them. Teach t h e m the words to the song:

If y o u ' r e a n g r y a n d y o u k n o w it, c l a p y o u r h a n d s , [clap h a n d s t w i c e ]

If y o u ' r e a n g r y a n d y o u k n o w it, clap y o u r h a n d s , [clap h a n d s t w i c e ]
If y o u ' r e a n g r y a n d y o u k n o w it, t h e n y o u r face will surely s h o w it.
If y o u ' r e a n g r y a n d y o u k n o w it, clap y o u r h a n d s , [clap h a n d s t w i c e ]

T h e song is s u n g to the same tune as " I f You're H a p p y and You K n o w It," w h i c h is

b a s e d on the traditional h y m n "Watch Your E y e s . " (If y o u aren't familiar w i t h " I f
You're H a p p y and You K n o w It," y o u can find it o n B o b M c G r a t h ' s a l b u m Sing
Along With Bob a n d on M a r c y M a r x e r ' s Jump Children. Or ask a r o u n d — s o m e o n e
y o u k n o w p r o b a b l y k n o w s the tune.)
Sing the s o n g through once to the group and then a second time w i t h the group
joining in. N o w give each group m e m b e r a chance to share a safe w a y of expressing
his anger. W h e n a child does not have an idea, m o v e o n to s o m e o n e else a n d c o m e
b a c k to the first child w h e n h e is ready.
A s e v e r y o n e sings the song, have them act out the ideas. For e x a m p l e , o n e child
m i g h t sing, " I f y o u ' r e angry and y o u k n o w it, stomp your feet." Start s t o m p i n g
around the r o o m and encourage everyone else to do the s a m e w h i l e singing.
Continue the song b y inserting other words that describe and demonstrate w a y s of
expressing anger. F o r example:

• P u n c h a pillow.
• S a y " I ' m mad!"

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158 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• G o for a bike ride.

• Take the d o g for a walk.

Part II: W h e n everyone has had a turn giving suggestions in the song, ask t h e m
to c h o o s e s o m e n e w w a y s to express anger in the u p c o m i n g w e e k . Talk about w h a t
things m a k e kids angry, such as the sexual abuse, not getting their way, a n d / o r a
sister, brother, or friend not sharing toys. Find out w h a t group m e m b e r s do and
w h o they g o to w h e n they feel angry.

HINTS

This song can be used to express any feeling-happy, sad, scared, or whatever. We
most often use it to help children learn to express their anger in safe ways. It goes
well with other exercises that allow them to express anger, such as "Target of the
Offender and Xiay Faces."

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
chapter
9

DYNAMICS OF
S E X U A L A B U S E EXERCISES

T h e dynamics of sexual abuse explain the emotional, psychological, and

physical impact of abuse on victims and, secondarily, on the lives of their families. What
occurs between an abuser and a victim is not a mutual or consensual act. It is, instead,
a personal transgression in which the abuser steps beyond personal boundaries, ignor-
ing the inner and outer reality of the person against whom he or she is offending.
Victims are children and adults, who are very definitely influenced and changed
by their experiences of abuse, often in very painful and negative ways and sometimes
for life. The dynamics of sexual abuse are very confusing to children. They need help
to understand what happened, how they coped with their experiences, and how to deal
with those experiences now. The group facilitator's fundamental and ongoing task is
to help children understand, define, and challenge the core dynamics of sexual abuse,
such as self blame and minimization or denial of their feelings about the abuse. ' T h e
Alligator River Story" and "Sexual Assault Continuum" are effective exercises to use
for this purpose.
Once the ambivalence and minimization have lessened, victims often question why
abusers abuse. Children's distorted thoughts about the abuse may become obvious to
facilitators at this point and generate discussion. For young children, it is easiest to
explain that abusers have a touching problem for which they need help. They cannot
stop it themselves. It is such a big problem that they touch even when they know that
the person they are touching feels terrible and does not want to be touched. All they
can think about is themselves, and no one else. It is helpful to praise the children at this
point in the explanation, to assist them in gaining an understanding that because they
told, their offenders may learn how to stop abusing others. Older children and their

159
160 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

parents can be given a more thorough explanation of how abusers are disconnected
from their own tender emotions and unable to connect with the experience of others.
In futile and compulsive attempts to overcome the emptiness and rage of disconnec-
tion, abusers use others for emotional ransom. Abusers experience and treat others as
objects that will gratify, obstruct, or threaten their needs and impulses. The checklist
in the exercise "Why People Sexually Abuse Kids" can help older children to under-
stand the dynamics of abuse.
The next step in helping children to understand the dynamics of abuse is to teach
them about the "grooming" process. By learning about grooming, children begin to
understand the feelings they have toward themselves, their offenders, and their non-
offending caregivers. Most child abuse is committed by someone known to the child:
an immediate family member or other relative, a caregiver, or a family friend. In most
instances of sexual abuse, a process of grooming occurs (Leberg, 1997; Way & Spieker,
1997, chap. 3). To groom is, by definition, "to train for a particular purpose" (Webster's
New World Dictionary, 197A). Children are groomed by abusers to gratify the offenders 7

own wishes. The grooming process usually begins with special attention or seduction.
A child is flattered and made to feel special by the abuser's attention, or is enticed with
an age-appropriate lure, which could be anything from candy to beer. These entice-
ments are then used to manipulate the child into performing some act for the abuser.
For example, the abuser may say to the child, "I won't tell your mother you drank beer
tonight if you give me a kiss." The child feels trapped and confused by the request, but,
fearing punishment, may concede. The abuser's demands increase over time, and when
seduction no longer works, the abuser will manipulate with threats. For instance, "If
your mother finds out about what you are doing with me, she will never forgive you."
Or "She will make me go to jail and I'll kill myself and it will be all your fault."
Seduction, deception, manipulation, and fear are the training tools used by the abuser.
Some of the exercises we use that teach about the grooming process are "The Butterfly
and the Spider," "Magic Tricks," and "Letter From Angie." Another exercise that helps
children identify how they were tricked or groomed by their offenders is "The Trick
Hat."
The process of grooming leads many victims to believe that they were willing
participants in the touch. Therefore, they believe that the abuse was their fault. Abusers
act shamelessly, leaving victims to carry shame that does not belong to them. Many
victims live their lives covered in this cloud of shame. They need help removing it and
returning it to the abuser. Exercises that address these issues include "Revised Cookie
Jar Tune," "Letter/Video to the Offender," and "Talking to the Offender Psychodrama."
Children also have confusion and strong feelings regarding the roles their nonof-
fending parents have played in relation to the abuse. Some parents knew the abuse was
happening. Others were engaged in abusive relationships where the abuser was vio-
lating both the parent and the child. Some parents were abusing drugs a n d / o r alcohol.
Other parents were unaware of the abuse, but the children were told otherwise by the
offender. Sometimes children believe that their parents should have known and should
have protected them.
Dynamics of Sexual Abuse Exercises 161

One exercise used in our therapy groups, "Letter/Video to Nonoffending Par-

e n t s ) , " is a dramatic and powerful recovery tool when combined with a letter of
response from the parent to the child. In the response letter, the parent takes appropri-
ate responsibility for the protection of the child, alleviating many of the child's feelings
and concerns. The response letter is written in the parent's therapy group and is
processed with the child in a family therapy session.
All of the group exercises in this chapter are designed to help children discover and
articulate what happened to them, how they were tricked or manipulated, and who is
responsible for the abuse. Helping children gain separation from the abuse allows them
to gain perspective and shift their belief from "I am the bad thing that happened" to "I
am me," "Abuse happened to me," "Here is how it happened," and "It is one of many
experiences I will have in my life."
162 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Letter From Angie

GOALS

To u n d e r s t a n d the dynamics o f sexual abuse; to build feelings o f trust and safety

AGES

8 t h r o u g h 10

TIME

10-20 minutes

PURPOSE

This exercise acts as a useful introduction and exploration o f the g r o o m i n g

process. It allows the group m e m b e r s to understand the concepts of g r o o m i n g
before applying them directly to themselves. We w o u l d like to thank Patricia
G o d l e m a n for bringing this exercise to us.

DO THIS EXERCISE TO

• Increase the children's capacity to separate the self from the a b u s e / a b u s e r .

• Increase the children's capacity to place responsibility and accountability
appropriately.
• Increase the children's capacity to b e vulnerable and to interact authentically.
• Increase the children's ability to put experiences and events in proper per-
spective, without minimizing or maximizing them.

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Publications, Inc.
Dynamics of Sexual Abuse Exercises 163

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

WHAT YOU NEED

• Copy of 'Tetter From Angie"

• Copies of the list of questions about the letter
• Pencils or pens

INSTRUCTIONS

Part I: H a v e the group sit together in a circle and explain that y o u are g o i n g to
read a letter t o d a y that is from a girl w h o is just finishing therapy. S h e w a n t e d to
write a letter to t h e m and asks that they listen to her words with their hearts and
not just their heads. R e a d Angie's letter aloud to the group.

Part II: Pass out the questionnaires about the letter and ask the group m e m b e r s
to answer the questions individually.

Part III: Invite everyone to c o m e b a c k together as a group and share their

responses to the questions.

HINTS

This exercise can be done at any time during the exploration of the grooming
process. Group members are usually genuinely curious about "Angie" and are inter-
ested in knowing how she is doing at die end of her therapy. They seem to identify
with her story and are quick at picking out the ways she was tricked and trapped.
Using the experiences of another person (as in this exercise) adds distance and safety,
allowing for quicker application of the lessons to themselves.
As the children discuss their answers to the questions about Angie, they begin
applying the same questions to their own situations without much, if any encour-
agement. Of course, not all groups do this smoothly so consider some possible
questions to help direct the group mem^^ For exam-
ple, you might ask:

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 164 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• How were you tricked?

• How was your family tricked?
• Who was responsible for the tricking?
• What made it hard for you to tell?
• How did someone find out about you being touched?

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Publications, Inc.
Dynamics of Sexual Abuse Exercises 165

Letter From Angie

January 2 5 , 1 9 9 6

Hi, my name is Angie and I am 13 years old and I want to tell you how I got
over feeling bad about being molested.
It all started when I was about 6 years old. I had an older brother, Brian, who
lived with his mom. He came to stay for about a week in the summer two times.
At first it was okay. He did things like climb a tree and throw me and my little
brother cherries. But one day he took me into my bedroom and started touching
me in my private parts. I was really confused. I didn't know what was happen-
ing. One day when he was touching me in my bedroom, my grandma came in
to say that dinner was ready When he heard her footsteps coming, he got up
from behind the bed, put me on the bed and pretended to be reading me stories.
I think nearly getting caught scared him and the touching stopped.
From that time on I was afraid to be around him and I didn't tell because I
wanted to protect my M o m and Dad from feeling bad. A couple of years later
someone from my church took advantage of me by touching me in my private
parts at my house again. I still couldn't tell, but later that year I finally told my
Mom.
She said, "Why didn't you tell m e ? " I thought she was real mad at me for
not telling but then I realized she was mad because I had been touched.
After that I went to counseling and learned that it's never your fault if you
get touched. It is always the person who decided to do the touching. I drew,
wrote stories, did this thing called eye movement therapy, and used talking to
understand my feelings. Then I met a bunch of other girls who had been touched
and we talked about what happened and realized it wasn't our fault. We also
learned how to protect ourselves. Now I've finished therapy and I have put the
memories behind me. In many ways I am a stronger person who can tell my
parents anything, stand up for myself at school, and now I have a lot of great
friends.
My wish for you, is for you to know that there is no reason to ever be
ashamed of what happened and that the bad memories, dreams, and feelings
will go away when you can talk about them. Always remember that you will
never be alone.

From Angie, a fellow survivor

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Publications, Inc.
166 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Questions Regarding Angie's Letter

How was Angie tricked?

How was her family tricked?

Who was responsible for the tricking?

Why do you think Angie didn't tell her grandmother what had just happened to
her?

What do you think helped Angie to tell her mom about being abused?

What do you think Angie was thinking when she was being touched?

How do you think Angie felt when she was being touched?

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Publications, Inc.
Dynamics of Sexual Abuse Exercises 167

The Butterfly and the Spider

GOAL

To understand the dynamics of sexual abuse

AGES

8 through 12

TIME

30 minutes

PURPOSE

This story can b e used as a tool at m a n y different points during discussion of

the abuse d y n a m i c s of grooming and responsibility for the abuse.

DO THIS EXERCISE TO

• H e l p group m e m b e r s understand and articulate the particular g r o o m i n g

d y n a m i c s u s e d b y their offenders.
• Increase the children's capacity to place responsibility and accountability
appropriately.
• Increase the children's capacity to separate the self from the a b u s e / a b u s e r .

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

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Publications, Inc.
168 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

WHAT YOU NEED

• C o p y of " T h e Butterfly and the Spider"

• Optional: writing paper and pens or pencils

INSTRUCTIONS

Before y o u read " T h e Butterfly and the Spider" to the group, gather the m e m b e r s
together and ask them to listen to the story with their hearts and not just their heads.
T h e n read the story aloud. Afterward, have the children answer s o m e questions
about the story, either b y writing their responses to or b y answering verbally. (If the
group m e m b e r s write their responses, follow this with a discussion.) For example,
y o u m i g h t ask:

• W h a t tricks did the spider use?

• H o w did the spider trap the butterfly?
• W h o w a s responsible for her getting stuck in the w e b ?
• W h a t is one w a y the offender tricked you?
• W h a t is one w a y the offender tricked your family?

T h i n k about the group dynamics before deciding w h i c h w a y y o u want to do

this exercise. S o m e groups do better writing responses to questions, whereas others
are fine responding verbally. If y o u h a v e a larger group, or any shy children in
group, h a v i n g t h e m write their responses initially can help b a l a n c e the participa-
tion.

HINTS

This exercise can be tension producing, which often winds group members up.
Make sure that there is time to do other winding-down activities after the story and
1
discussion. The "Personal Butterfly* exercise is a great follow-up. With a boys group,
you may need a more physical activity; such as "Let it All Out/Sound Train" (see
Chapter 6).

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Publications, Inc.
Dynamics of Sexual Abuse Exercises 169

The Butterfly and the Spider

(adapted by Patricia Godleman, MA, from a story in Davis, 1990)

Once upon a time there was a spider. As spiders do, this spider built a very
big web. He was determined to catch any unsuspecting flying thing—butterflies
or other insects unlucky enough to come within reach. Now, the spider knew
that insects need nectar from flowers, so he spun his web between two flowering
bushes. He then settled back to wait for something appealing to come by looking
for the sweet juicy nectar in the purple and pink flowers. He knew that he had
created a good trap.
The web was invisible to the eyes of most insects unless it was covered with
raindrops or morning dew; then it sparkled like jewels in the light. This made
the web even more dangerous, because unsuspecting insects would not see the
trap and the destruction it represented until it was too late. Sometimes insects
would see the spider, but, not understanding how spiders like to eat insects,
would fly directly into the trap of the web. Now, spiders wrap up their victims
and keep them alive until they are ready to use them, and this spider was no
different. He was proud of his web and felt no guilt at all about the way he lived
his life.
One day, a beautiful young butterfly happened by, flying from one colorful
flowering bush to another. The unsuspecting butterfly was attracted b y the
glistening web that sparkled in the sunlight, and suddenly was caught fast in
the spider's trap. Terrified, the butterfly tried to free herself, pulling and
twisting and fighting, but the more she moved, the tighter she was caught. The
spider counted on the terror of those he caught to make the prison of the web
even tighter.
Now a wise little red-and-black ladybug, who had learned about spiders
from experience, saw the trapped butterfly and decided to help her escape. The
spider, busily spinning on the other end of the web, was so sure that the butterfly
was helplessly trapped that he did not even hurry over to make sure that she
could not get away. Carefully, the ladybug flew near the butterfly and whis-
pered, "Stop fighting the web. That will only make it a tighter prison than ever."
"But I am so scared, and I feel so stupid. I don't believe I will ever be able
to get out of this sticky web," cried the butterfly.
"Then use your fear to give you power," the ladybug explained. "Under-
stand how the spider has tricked you and the web has trapped you and use your
mouth to free yourself. You have the power to be free."
So the butterfly took a few deep breaths, calmed herself down, and stopped
struggling against the web. Concentrating on what the ladybug had said, she
thought about how she had been trapped and the best way to free herself. She
used her creative brain, her clever mouth, and her whole body to escape. Once
she was free, she noticed that her wings were torn from being trapped in the
web. She worried that they would never heal and that everyone who saw her

(continued)

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Publications, Inc.
170 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

The Butterfly and the Spider (continued)

(adapted by Patricia Godleman, MA, from a story in Davis, 1990)

wings would know that she had been caught in the spider's web. She felt
ashamed and embarrassed and thought that all the other insects would blame
her for the spider's deceit. She even wondered if her family would be angry at
her for being tricked. But as she confided these feelings to the ladybug and was
able to talk things over with the wise old insect, she realized that she was
innocent and blameless. The ladybug reminded her that all butterflies need to
gather pollen to live and that spiders use that knowledge to trick and trap
unsuspecting insects.
As time went by, the butterfly was able to find a way to heal the hurt that
she had experienced because of the spider. Soon she was once again a strong,
beautiful butterfly who loved to fly from flower to flower to gather nectar. But
now as she flew she was aware of spiders and their traps, and she was proud
of her awareness, and in this way she continued to be free.

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Publications, Inc.
Dynamics of Sexual Abuse Exercises 171

Personal Butterfly

GOALS

To u n d e r s t a n d the dynamics of sexual abuse; to build self-esteem; to build

feelings of safety and trust

AGES

6 through 12

TIME

15-20 minutes

PURPOSE

This exercise helps group m e m b e r s to put their abuse in perspective and

e m p o w e r s them. It is a perfect follow-up to " T h e Butterfly and the Spider."

DO THIS EXERCISE TO

• Increase the children's capacity to separate the self from the abuser.
• Increase the children's capacity to desire, believe in, and h o l d h o p e for a
positive future.
• Increase the children's ability to put experiences and events in p r o p e r per-
spective, without minimizing or m a x i m i z i n g them.

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Publications, Inc.
172 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

WHAT YOU NEED

• F o l d e d pieces of paper, each with half a butterfly d r a w n o n it (so w h e n the

p a p e r is cut along the outline and then opened, it has the shape o f a full
butterfly)
• Blank paper
• F i n g e r paints or watercolors
• Glitter (optional)
• N e w s p r i n t or newspapers to protect the floor
• P a p e r towels

INSTRUCTIONS

Part I: If y o u are not doing this exercise as a follow-up to " T h e Butterfly and the
S p i d e r / b e g i n with a discussion about butterflies. (If y o u h a v e just finished " T h e
7

Butterfly and the Spider/ go on to Part II.) A s k group m e m b e r s w h a t they k n o w

7

about the metamorphosis process of the butterfly. Discuss the m a n y changes a

butterfly goes through. It starts out as a larva, b e c o m e s a caterpillar, builds a cocoon,
and then finally emerges from that cocoon as a beautiful, spirited butterfly w h o
lives a n d flies freely. E a c h growth experience affects the butterfly and m a k e s it
stronger, forming it into the wonderful spirit it is.

Part II: Before starting this part o f the exercise, spread newsprint or newspapers
to protect the floor in the area where y o u will b e working. H a v e e a c h child choose
a butterfly picture, or let them each d r a w half of a butterfly on a b l a n k piece of paper.
W h e n e v e r y o n e has a butterfly, h a v e the children fold their papers in half so that
the fold is w h e r e the middle of the butterfly would b e and the half butterfly is
showing.

H a v e the children paint the half of the butterfly that is s h o w i n g with multiple
colors. W h e n they h a v e painted that side, have them fold their papers over so that
the paint is transferred to the other half of the butterfly also. H a v e t h e m gently press
the halves together, then carefully pull the sides apart to reveal the w h o l e butterfly.

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Publications, Inc.
Dynamics of Sexual Abuse Exercises 173

T h e y can add m o r e paint after they open the butterfly up if they choose. Before the
paint dries, glitter can b e added as well.

Part III: W h i l e the butterflies are drying, h a v e each group m e m b e r describe, in

the first person, h o w she is like the butterfly. F o r example, " I a m like the butterfly
because I a m beautiful and I have changed a lot in m y lifetime."

W h e n the butterflies are dry, h a n g t h e m up in the room so e v e r y o n e c a n v i e w

them. T h e following week, at the close of group, send them h o m e w i t h the children
w h o m a d e them.

HINTS

Making the butterflies is a bonding experience that provides a good resolution to

the exercise "The Butterfly and the Spider." This will help the children ease their
tension after talking about their personal abuse issues,
When the children describe themselves as the butterfly; they probably will forget
to make their statements in the first person, insist that they do so~it makes the
exercise much more powerful when they describe themselves using the same positive
attributes that they assign to the butterfly
Bring extra copies of the sheets with half butterflies drawn on them and extra
blank paper Usually there is at least one group member who wants to try drawing
her own half of a butterfly. However, if you are short on time you may not want to
allow this. Some "artists" are perfectionists and take a long time to get their drawings
just right
it is nice for group members to have the option of completely creating their own
butterflies, This increases the potential for this exercise to build group members'
capacity to value themselves and others. Often, the children encourage and compli-
ment one another on the creativity and uniqueness that is expressed in their artwork.

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174 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Magic Tricks

GOAL

To understand the dynamics of sexual abuse

AGES

4 t h r o u g h 10

TIME

15-20 minutes

PURPOSE

This exercise is designed to help children gain an understanding o f the dynamics

of sexual abuse. Because of the element of magic and surprise, it is a very effective
teaching tool for y o u n g children. This exercise was brought to us b y a m o s t magical
intern, Margaret Vest.

DO THIS EXERCISE TO

• Increase the children's ability to separate the self from the a b u s e / a b u s e r .

• H e l p group m e m b e r s understand and articulate the particular grooming
d y n a m i c s used b y their offenders.
• Teach about the role of tricking and grooming in the d y n a m i c s of sexual abuse.
• Increase the children's capacity to place responsibility and accountability
appropriately.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Dynamics of Sexual Abuse Exercises 175

DO NOT USE THIS EXERCISE WHEN

• T h e abuse histories of any group m e m b e r s involve magic tricks.

WHAT YOU NEED

• T h r e e or four simple magic tricks or card tricks (can b e purchased at m o s t toy

stores for $2.00-$4.00)
• "Invisible p e n " set (optional)

INSTRUCTIONS

Before y o u d o this exercise in group, read through the directions for the m a g i c
tricks y o u h a v e purchased and practice the tricks enough times so that y o u r m a g i c
will b e really believable w h e n y o u do it for the children.

Part I: Perform the c a r d / m a g i c tricks with o n e child assisting y o u w h i l e other

group m e m b e r s observe. H a v e h i m guess the card, point to things—whatever the
trick requires. R e p e a t each trick as requested. Usually, w e perform the tricks with
each group m e m b e r , so that everyone can h a v e the experience o f b e i n g tricked.

Part II: After y o u h a v e performed the tricks several times, explain in detail h o w
each one w o r k s . U s e language that clearly s h o w s how, in performing the tricks, y o u
had information that the group m e m b e r s did not have. Then briefly discuss tricks
m o r e generally. Begin b y talking about h o w the tricks y o u have performed w e r e
harmless a n d fun. Explain h o w tricks fool people (note that tricksters h a v e infor-
mation and skills that others do not have, that tricksters m a y h a v e to practice and
train to pull off their tricks, and so on). Introduce the idea that there are other kinds
of tricks that are n o t fun and can hurt people. Talk about h o w p e o p l e w h o h a v e
b e e n sexually abused have been tricked, and h o w the people w h o tricked t h e m are
the ones w h o are responsible. Tricksters k n o w w h a t they are doing.

Part III (optional): W h e n the previous portion of the exercise is c o m p l e t e , y o u can

use an "invisible p e n " set to draw pictures with invisible ink. (Such p e n sets are
available at m a n y toy stores. T h e most c o m m o n one is called G h o s t Writer.) H a v e
the group m e m b e r s decode the pictures b y using the c o m p a n i o n marker. This
provides an opportunity for group m e m b e r s to b e in control of u n c o v e r i n g the trick.

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Publications, Inc.
176 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Part IV: If there is time and your group is not too rambunctious, discuss with
group members some of the ways in which they were tricked by their abusers.

HINTS

Boys' and y o u n g children's groups new have difficulty w i t h the discussion portion
of this exercise d u e to their relatively brief attention spans. This is a discussion that
m a y be revisited later as part of a different activity.
Young children really love magic tricks. This exercise is an easy w a y t o help them
understood the difference between good tricks and bad tricks. Some children may
even think o f bad tricks that are n o t abuse reiated-for example, mean tricks like
taking something away or telling someone they can have something and then saying,
"No, i tricked y o u . "
in therapy groups, this exercise can be easily followed by "The Trick Hat," which
focuses o n some specific ways that abusers trick children.

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Publications, Inc.
Dynamics of Sexual Abuse Exercises 177

The Trick Hat

(Therapy Group Only)

GOAL

To understand the dynamics of sexual abuse

AGES

4 through 8

TIME

10 m i n u t e s

PURPOSE

This exercise w o r k s as an introduction to talking about g r o o m i n g and as a w a y

to b e g i n the process of helping group m e m b e r s understand h o w their abusers
tricked them.

DO THIS EXERCISE TO

• Increase the children's ability to separate the self from the a b u s e / a b u s e r .

• Increase the children's capacity to place responsibility and accountability
appropriately.
• Help group m e m b e r s understand and articulate the particular g r o o m i n g
d y n a m i c s used b y their offenders.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
178 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• Any group member has a sexual abuse history that involved the use of magic.

WHAT YOU NEED

• Magician's hat
• Deck of jumbo playing cards
• Colored paper
• White paper
• Scissors
• Glue
• Pen or fine-tipped marker and colored markers

INSTRUCTIONS

Before the group session, take a large-sized deck of cards and cut pieces of
colored paper the size of the cards. On the pieces of paper, write some of the ways
that children are tricked by sexual abusers. Some examples:

Said my mom would get mad if I told.

Gave me candy
Let me have special time.
Bought me presents.
Said I was his "special girl."
Said he'd have to go away if I told.
Said Fd get in trouble if I told.
Said he would hurt my dog.

When you have about 15 ways that children are tricked written on the colored
pieces of paper, glue each of the pieces over the face of a playing card. (Be sure to
write the tricks first, and then glue them on. If you make a mistake writing a trick,
it is easier to start over with another piece of paper than to have to cover the card
again or peel off the mistake.)

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Dynamics of Sexual Abuse Exercises 179

Part I: In group, place the cards y o u h a v e created in the magician's hat. H a v e

each group m e m b e r take a turn drawing out a card, and have a facilitator read it
aloud. After each trick is read, ask if anyone in the group was tricked that way. G i v e
the group m e m b e r s a chance to respond either verbally or with a s h o w o f hands.
Leave the card out o f the hat and go on to the next group member. C o n t i n u e taking
turns picking cards out of the hat until all the cards h a v e been read.

Part II: Pass out markers and paper to everyone. Instruct the group m e m b e r s to
d r a w pictures of h o w they were tricked. W h e n their pictures are completed, h a v e
everyone c o m e b a c k into a circle and share w h a t they have drawn.

Write d o w n w h a t the group m e m b e r s describe about their pictures o n the

pictures themselves, because it m a y b e difficult to tell what they are trying to
c o m m u n i c a t e simply b y looking at their pictures. T h e y will often talk about abstract
things that are right on target. For example, o n e child said that her picture w a s about
a giraffe w h o got tricked b y an icky jellyfish that hurt and lied to the giraffe. S h e
w a s telling us h o w she w a s hurt and w a s lied to.

HINTS

Be sure to review the files of group members and cull any information they reveal
about grooming techniques that are specific to your group. For example, if you know
that one of the group members didnt tell about the abuse because she was worried
her brother would have to move away, use a similar scenario as one of the tricks on
your cards.
When writing up the tricks, keep in mind the age of your audience. Although
perpetrators can be quite explicit in their descriptions of how they will kill children's
pets or how they will be sent away be sure to avoid including graphic details on your

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180 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Questions and
Answers Box

GOALS

To build safety and trust; to understand the dynamics of sexual abuse

AGES

9 t h r o u g h 18

TIME

10 minutes to most of the group session (Time will vary d e p e n d i n g on h o w y o u

set up the exercise. Allow time to answer all the questions over the entire length of
an 8-15 w e e k group.)

PURPOSE

This exercise gives children a chance to ask embarrassing questions anony-

m o u s l y w h i l e encouraging discussion. This helps reduce feelings of s h a m e and
isolation.

DO THIS EXERCISE TO

• Correct misinformed beliefs regarding sexuality.

• A n s w e r questions group m e m b e r s m a y have regarding the m a n y n e w sys-
tems that have affected their lives since their abuse w a s disclosed ( m a y
include questions regarding the court system, supervised visitation, schools,
and more).

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Dynamics of Sexual Abuse Exercises 181

• Further assess the collective needs and direction o f the group.

• R e d u c e levels o f fear, shame, and isolation.
• Increase the children's capacity to place responsibility and accountability
appropriately.

DO NOT USE THIS EXERCISE WHEN

• G r o u p m e m b e r s are unable to sit still long e n o u g h for at least a 5-minute

discussion.

WHAT YOU NEED

• A shoe b o x or similar container

• Pencils
• Paper (all pieces should b e identical to protect anonymity)

INSTRUCTIONS

Part I: Set up the b o x for group members' questions ahead of time. Pass out pencils
and uniform pieces of paper so that questions can remain anonymous w h e n they are
being discussed later. Ask everyone to think of a couple of questions they have about
sexual abuse, about the group, or about anything that relates to sexuality.

W h e n e v e r y o n e h a s finished writing their questions, have t h e m deposit t h e m

in the b o x . Explain that time will be taken each w e e k to discuss the questions in the
b o x and that n e w questions can b e added during the following w e e k s .
I m m e d i a t e l y after introducing this exercise, y o u m a y w a n t to take s o m e t i m e to
discuss a few o f the questions, so that group m e m b e r s understand h o w the process
works. This m a y encourage them to think about additional questions for future
weeks. T h e timetable for answering the questions is up to you. W e h a v e b e g u n
group with o n e question from the b o x each week. In other groups w e h a v e set time
aside at the e n d of every two or three sessions to discuss some o f the questions.

Part II: C h o o s e s o m e o n e to draw a question from the b o x and read it aloud. A s k

others w h a t they think in response to the question. Encourage them to express their
opinions and to b e supportive of others' ideas.

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182 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

When we first began doing this exercise we made the mistake of not limiting the
questions to sexual assault or group process. We had many questions relating to
movies and more esoteric questions, like "What is time anyway?" By limiting the
questions to topics related to sexuality, sexual abuse, and systems, we got questions
such as "Could I have AIDS?" and "Am I sick if I liked the abuse?"

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Dynamics of Sexual Abuse Exercises 183

Revised Cookie Jar Tune

GOALS

To understand the dynamics of sexual abuse; to build self-esteem

AGES

3 through 8

TIME

4-10 m i n u t e s

PURPOSE

This exercise helps group members begin talking in a fun, safe w a y about b e i n g
touched. It is a first step toward placing responsibility for the abuse o n the perpe-
trator.

DO THIS EXERCISE TO

• R e d u c e self-blame for the abuse.

• Build self-esteem and group cohesiveness.
• E n c o u r a g e disclosure.
• R e d u c e feelings of isolation and lessen the children's sense of b e i n g different.

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184 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

There is no reason not to do this exercise, as long as you let group members
"pass" if they want to.

WHAT YOU NEED

No special materials needed

INSTRUCTIONS

This exercise uses a revised version of the hand-clap song "Who Stole the Cookie
From the Cookie Jar?" which goes like this:

Who stole the cookie from the cookie jar?

Joe stole the cookie from the cookie jar.
Who, me?
Yes, you.
Couldn't be.
Then who?
Mary stole the cookie from the cookie jar.

And so on. In this version, we have altered the words.

Have everyone sit in a circle. Start by demonstrating the hand motions before
adding the words. We use three beats: On the first beat everyone slaps their laps,
on the second beat all clap their hands, and on the third beat everyone snaps their
fingers. Continue the sequence. Once the children have the hand motions down,
sing the song using the following words:

Facilitator: Who touched [child's name] in her private parts?

Child: My [abuser's name or relationship; for example, my brother, my dad, my
uncle, or John] touched me in my private parts.
Group: Your [abuser's name or relationship] shouldn't have!
Facilitator: Who's fault was it when he [she] touched you that way?
Child: Not mine!

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Dynamics of Sexual Abuse Exercises 185

Group: N o t y o u r s !
Facilitator: T h e n w h o s e ?
Group and child together: H e r / m y [ a b u s e r ' s n a m e or r e l a t i o n s h i p ] t h a t ' s w h o !

Take turns so that each person in the group gets to sing (at least once) w h o touched
her. W h e n the kids k n o w the words well, they tend to just say t h e m o n their o w n
without help from a facilitator.

HINTS

Children greatly enjoy this exercise, as it helps them to feel powerful. They get
the whole group in unison making their offenders responsible for the abuse. Usually
they are clamoring for a turn, saying, "My turn, my turn next;* or "My brother touched
me too, so can i have two turns?* Young children love repetition, so repeat this exercise
several times throughout the group sessions,
Some children have been forced to touch but were not touched themselves.
Change the words to fit the situation-for example, "Who made Sammy touch him on
his private parts?"
Younger children probably cannot snap their fingers or keep the rhythm very well.
For children 4 and 5 years old, have everyone hold hands and swing their arms back
and forth, or just clap to the beat
Under special circumstances a child will occasionally join a group a week or two
after it has started. We had a 5-year-old girl in group who felt out of place and was
disruptive after joining 2 weeks late. A few weeks later we did this exercise. When it
came to her turn to say who touched her, she began to giggle and couldn't stop.
Pretty soon she had all of us laughing hysterically. Once the laughter subsided, she
proudly took her turn. She actively participated in and enjoyed group activities
through the remainder of the group sessions.
Another little girl who had been sexually abused by her mother learned this song
in group. Little Miranda's mother would never admit to the abuse, but that didnt stop
Miranda from singing this song during supervised visits with her mother*
The children in group will want the facilitators to sing the song about themselves,
and to share the names of the persons who touched them. Facilitators who do not
have sexual abuse histories should try to think of situations that involved uncomfort-
able touching so that they can join in also.

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186 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Why People Sexually

Abuse Kids

GOAL

To u n d e r s t a n d the dynamics of sexual abuse

AGES

7 t h r o u g h 18

TIME

20 m i n u t e s

PURPOSE

This exercise provides children with an opportunity to explore possible reasons

their offenders sexually abused them. This lessens their feelings o f responsibility,
self-blame, and shame, reverting accountability to the offender.

DO THIS EXERCISE TO

• R e d u c e the children's self-blame for their abuse.

• Further assess the children's perspectives regarding their abuse.
• H e l p group m e m b e r s better understand w h y they w e r e sexually abused.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
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Dynamics of Sexual Abuse Exercises 187

DO NOT USE THIS EXERCISE WHEN

• Group members cannot read.

WHAT YOU NEED

• Copies of the "Why People Sexually Abuse Kids" Checklist

• Pens or pencils

INSTRUCTIONS

Explain to the group that you want to know why they think people sexually
abuse children. Pass out copies of the checklist and encourage the children to take
time to fill them out with their own ideas about why adults sexually abuse children.
The only rule is that no one may write or say that the sexual assault happened
because of something he, the child, did. We instituted this rule to encourage group
members to take the first step toward realizing they did nothing to cause the abuse.
When everyone has finished filling out the checklists, bring the group back
together in a semicircle. Go over the items on the checklist one item at a time to find
out how each child responded. Ask for a show of hands after you read each
statement, then talk with the children about why they did or did not agree with that
particular choice.
Group members often suggest some motivations not included on the checklist.
Be sure to ask them to share their ideas with the rest of the group. These can often
generate good group discussions.

HINTS

To date, studies have revealed no single reason for sexual abuse. Many of the
items on our checklist come from ideas suggested by the children themselves. You
mgy choose to have your group members create their own checklist instead of making
copies of this one. Either way be sure to keep complete records of all the children's
responses, so that you can refer to them throughout your work with the group.
From this exercise we learn a lot about how group members' perceptions affect
their coping styles. We have often seen this exercise help group members to move
beyond self-blame, allowing them to hold their offenders accountable for the abuse.

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188 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

When a child consistently feels responsible for her abuse, it is important to explore
why she needs to hold on to these feelings so strongly. Possibly, it is her only sense
of control. Maybe she feels it is too hard to believe that someone she loves would
deliberately hurt her. The group process can be used to slowly chip away at these
self-destructive beliefs. Because the child has already established identification and
trust with other group members, the similar nature of the others' experiences and
their empathy reflected back to the child may allow her a sense of relief from the
burden of guilt

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Dynamics of Sexual Abuse Exercises 189

Why People Sexually Abuse Kids

Below is a list of reasons some adults sexually abuse children. Check as many
reasons as you think are true for the person who sexually abused you. Fill out one
checklist for each person who sexually abused you. Use the back if you need more
space.

Because h e / s h e wanted some fun out of me.

H e / s h e is going crazy.
H e / s h e might want to hurt kids.
H e / s h e is always drunk.
H e / s h e had been smoking marijuana and taking drugs.
It's what h i s / h e r family did when h e / s h e was young.
H e / s h e doesn't have any friends.
H e / s h e was sexually abused when h e / s h e was a kid.
H e / s h e doesn't think sexual abuse is wrong.
H e / s h e can do what h e / s h e wants to kids because h e / s h e is bigger
and stronger.
H e / s h e is out of control.
H e / s h e thought it was the way to teach me about sex.
H e / s h e thought this was the way to show me h e / s h e loves me.
H e / s h e did it to punish me.
I don't know.

Write any other reasons you think you were sexually abused below.

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190 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Letter/Video to the Offender

GOAL

To u n d e r s t a n d the dynamics of sexual abuse

AGES

5 t h r o u g h 18

TIME

O n e to t w o group sessions

PURPOSE

This exercise gives group m e m b e r s a safe place to express freely their emotions
about b e i n g abused. Hearing h o w others feel helps group m e m b e r s to admit m a n y
of their o w n "secret" emotions. Expect feelings of anger and the first lessening of
guilt.

DO THIS EXERCISE TO

• Increase the children's capacity to separate the self from the a b u s e / a b u s e r .

• Increase the children's ability to value self and others.
• H e l p the children to focus on identifying and expressing their emotions
appropriately.
• Increase the children's capacity to place responsibility and accountability
appropriately.
• Increase the children's ability to define and express personal needs.

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Dynamics of Sexual Abuse Exercises 191

DO NOT USE THIS EXERCISE WHEN

• You believe a group m e m b e r or a family m e m b e r m a y w a n t to send the letter

or video produced to get "revenge" or in hopes of getting an a p o l o g y back.
The letters and videos produced in this exercise are not to b e sent.

WHAT YOU NEED

• P e n s or pencils
• Writing p a p e r

Or
• Video c a m e r a

INSTRUCTIONS

Part I: A s k group m e m b e r s to write letters to their offenders. Explain that the

letters will not b e mailed, so they can write whatever comes to m i n d without
worrying about spelling or grammar. T h e letters can b e any length. (Note: This part
of the exercise can b e done as a h o m e w o r k assignment or in the group session. T h e
h o m e w o r k assignment w o r k s well for children 12 years old or under, b u t teenagers
are m o r e likely to get their letters written if y o u use group time. If the letters are
written in the group session, have the children sit w i d e l y separated from e a c h other
and write for 2 0 minutes.)

Children y o u n g e r than 9 often prefer to videotape their letters. If y o u d o n o t

h a v e access to a video camera, consider letting each child speak his letter into a tape
recorder and then y o u can transcribe it. We h a v e also divided into small g r o u p s and
h a d facilitators take dictation from one child at a time while the other children drew
pictures to illustrate their letters. If children 9 and older are having difficulty writing
their letters, y o u m a y w a n t to give them the questions b e l o w as a guide.
If y o u are videotaping letters, do a practice run one w e e k and then do the final
letters the next. T h e second time around, the letters will be far superior b e c a u s e the
children are m o r e familiar with the questions and the camera. It is best w h e n
videotaping to ask s o m e open-ended questions to help the children along. If they
h a v e difficulty answering these questions, ask m o r e specific ones. T h e y o u n g e r the
child, the simpler the questions need to be. S o m e sample questions are as follows:

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192 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• I f y o u k n e w y o u w o u l d b e totally safe and could say anything y o u wanted to

the person w h o touched you, w h a t would y o u w a n t to say?
• W h a t w e r e the feelings y o u felt w h e n y o u were being touched?
• W h a t w e r e y o u thinking w h e n y o u were being touched?
• W h a t w o u l d y o u like to h a p p e n to the person w h o touched y o u ?
• If y o u s a w the person w h o touched y o u again, what w o u l d y o u like to do or
say to h i m or her?
• Is there anything y o u wish the person w h o touched y o u w o u l d say to you?
• D o y o u h a v e any questions y o u w o u l d like to ask the person w h o touched
you?
• Is there anything else y o u w o u l d like to say?

Part II: H a v e the letters read aloud in group, either b y their authors or b y
individuals they choose to read for them. We also show the videos in group if time
allows. After each letter, allow time for group hugs, c o m m e n t s , or whatever is
n e e d e d . A l w a y s acknowledge the strength it takes to write such a letter.

THERAPY GROUP ONLY: Video letters to offenders often h a v e h u g e impacts on

nonoffending parents if the children are willing to have t h e m see the videos. In these
cases, w e s h o w the videos during family therapy sessions and only to nonoffending
parents w h o w e k n o w to b e supportive o f their children and also strong e n o u g h to
hear w h a t the children have to s a y

Other versions: Group m e m b e r s can also write letters to their nonoffending

parents or other caregivers. M a n y children w h o have been abused are angry at their
m o m s or other adults w h o they feel did not protect them. This is often true whether
these adults k n e w the abuse w a s happening or not (see the exercise " L e t t e r / V i d e o
to Nonoffending Parent[s]").
G r o u p m e m b e r s can also write to themselves. This is another version of the
exercise " T h e Parent Within" (see Chapter 7).

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Dynamics of Sexual Abuse Exercises 193

HINTS

Teenagers will often ask if they can swear in their letters, we tell them they can
in their first drafts, but then they need to do second drafts that have minimal swearing.
Children need to learn how to express their strong emotions in effective and appro-
priate ways so that others can hear what they have to say We found that without this
rule, group members can get into a swearing competition and the true meaning of
the letter can be lost
Do not send any of these letters. Usually abused children have many unresolved
issues with their offenders, and the sending of such letters may involve hidden
agendas and hurtful expectations. These letters can also be used in other damaging
ways, Once, a letter that a child wrote in one of our groups was sent to her offender,
her father, in the midst of a major custody battle between her parents, The letter
ended up in court as an example, according to the father, of the "hatred, anger, and
lies that Mom and the therapists were trying to put into the daughter's head." Luckily
his argument was not accepted and he did not win custody.
Parents and other caregivers may also find letter writing to be very helpful. During
the parent meetings, we often encourage adults to do this exercise on their own. We
tell them that we will read what they write if they want us to. When appropriate, we
recommend that they read their letters to their children during family therapy
sessions.

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194 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Samples of Letters to Group Members' Offenders

Cody,
I am writing this letter to you about what you did to me. I didn't appreciate
it. When it happened you made me feel guilty, like it was my fault. I was scared
too. I don't want you to get in trouble but if that's what happens you'll have to
suffer the consequences. But now I know it's not my fault and I feel better,
although I am glad you don't live with me.
Sincerely,
Ellen [age 11]

Dear Steve,
I hate you for what you did to me and you are a dummy, and a scum and
you are a chicken and I love you for a brother. And hate you for what you done
to me. Steve, you need help. Steve, I hate you for what you done and you need
to be punished. Steve, I hate you. Steve, you hurt me.
Love,
Abigail [age 11]

Dear Daddy,
I hate you very much. I don't love you anymore. I felt sad and not comfort-
able and more things. I don't like you anymore. I have more fun here. I don't
eat a lot of candy. I have new clothes that I picked out myself. I visit Grampa
every Thursday. You are a nincompoop. I do hate you very much. I have more
friends here. And I felt like jumping out the window when you abused me. I
hope you have fun in jail! You are a SON OF A BITCH! I hate you because you
touched me in my privates. And I felt mad. I know what you did to my sister,
you molested her. Don't do it anymore. You are a geek and you are a A-Hole.
Hate,
Susan [age 10]

Dear Joe,
I felt like it was my fault and it wasn't my fault 'cause you were the one who
was touching me. And I didn't like it at all and I told M o m and Dad because it
was a bad thing to do. And when you did that it made me mad.
Donald [age 7]

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Dynamics of Sexual Abuse Exercises 195

Sexual Assault Continuum

(Therapy Group Only)

GOALS

To learn to m a n a g e triggers; to understand the dynamics of sexual abuse

AGES

10 through 18

TIME

45-60 minutes

PURPOSE

This exercise helps to desensitize group m e m b e r s so that they are not alarmed
or triggered b y other participants' disclosures. Simultaneously, it gives participants
permission to disclose details about their abuse that they m a y n o t otherwise b e
willing to reveal. It also educates them to the "grooming process" (a subtler, m o r e
covert form o f abuse) and describes h o w s o m e offenders progressively desensitize
children and slowly increase their control over them. B e sure that group m e m b e r s
h a v e learned the " C e n t e r i n g " exercise (in Chapter 10) before doing this one.

DO THIS EXERCISE TO

• Help group m e m b e r s understand the covert and overt forms o f sexual abuse
and h o w o n e form m a y not be greater or lesser than the other in terms o f h o w
it affects the victim.

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196 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• B e g i n to decrease and desensitize trigger reactivity.

• Create a sense of safety that encourages disclosure of details of the abuse,
rather than keeping t h e m hidden b y a veil of shame.
• H e l p group m e m b e r s begin to m a n a g e trigger responses.

DO NOT USE THIS EXERCISE WHEN

• G r o u p m e m b e r s are under 10 years old. It is too triggering for t h e m and they

m a y learn about sexual acts w a y b e y o n d their previous experience.
• A n y group m e m b e r is triggered quite easily and has already displayed an
inability to m a n a g e triggers well.
• T h e r e is not enough time to process the continuum during the s a m e day's
session.
• G r o u p m e m b e r s have not yet learned the "Centering" exercise.

WHAT YOU NEED

• A chalkboard and chalk or a large piece of paper and a m a r k e r

INSTRUCTIONS

Part I: A s k group m e m b e r s to generate a list of all the things they think are sexual
abuse, from the subtlest to the m o s t overt. List all the things they say o n the
chalkboard or on a large piece of paper.

Part II: W h e n the brainstorming w i n d s down, explain that the group will b e
ranking all the different types o f abuse from the subtlest to the m o s t overt. D r a w a
long horizontal line across a clean writing surface and, using the brainstormed list,
ask the children w h i c h form of abuse mentioned is the subtlest. Write the answer
on the far left end of the line o n a diagonal, leaving plenty of r o o m for the other
answers. N o w ask the group to choose the most overt form of sexual abuse, and
write that answer on the far right end of the line. All the rest of the answers will fall
in b e t w e e n . If the group cannot agree on the placement of a specific form of abuse,
put it in t w o or three different areas, showing that there are n o right or w r o n g
answers.

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Dynamics of Sexual Abuse Exercises 197

Group m e m b e r s m a y need some help in coming up with s o m e o f the subtler

forms of sexual abuse. S o m e of these are not sexual abuse in and of themselves, but
they are forms of abuse if they have sexual overtones and if the recipients experience
discomfort and disrespect. A continuum might include the following abuses, from
subtlest to m o s t overt:

• Tickling s o m e o n e and not stopping w h e n asked

• Walking into the bathroom without knocking
• M a k i n g lewd c o m m e n t s about another's b o d y
• N u d e exposure that brings on discomfort
• Forcing s o m e o n e to view pornography or pornographic m o v i e s
• Forcing s o m e o n e to pose in the n u d e for photos or videos
• Forcing s o m e o n e to watch a person masturbate
• Forcing s o m e o n e to watch people being sexual
• Forcing s o m e o n e to touch someone else's private parts
• Touching a person on h i s / h e r private parts, m a k i n g that person feel u n c o m -
fortable
• Forced kissing using the tongue
• Forced oral sex
• Forced vaginal penetration (digital or penile)
• Forced anal penetration (digital or penile)
• Penetration with other objects (vegetable, bottles, sticks)
• Penetration with a w e a p o n
• Forced sex b y threatening with a w e a p o n
• G a n g rape
• H o m i c i d e after sexual abuse
• Suicide b e c a u s e of sexual abuse b y victim or offender

W h i l e doing this exercise, pay close attention to each group member. If a n y o n e

seems to b e dissociating or being triggered, attend to her immediately b y telling her
w h a t y o u are noticing in her actions or looks and asking her to talk about h o w she
is feeling. D o not m o v e on until you feel she is o k a y and able to focus in the present
time or is receiving one-on-one private attention from another facilitator.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
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198 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Part III: D o the "Centering" exercise to ensure that e v e r y o n e is in the present

time and able to b e focused in the r o o m after hearing the different forms o f abuse.
Afterward, ask group m e m b e r s the following questions:

• W h a t feelings surfaced while w e were doing the continuum?

• W h a t thoughts and feelings surfaced in relation to y o u r o w n abuse?
• Was a n y o n e in the group g r o o m e d b y an abuser w h o started with a subtle
form of abuse and slowly built to m o r e overt forms?
• Were s o m e of the subtler forms of abuse harder to deal w i t h than the m o r e
overt? If so, w h y ?
• Is there anything else y o u learned from doing this exercise?

HINTS

Make sure that the continuum includes the act of forcing someone to watch or
participate in making photographs, videotapes, and/or pornography, it is not unusual
for children who have been forced to be involved in such things not to admit it
Following this exercise, you may want to have each group member individually
draw the continuum of her own abuse. If you do so, then end that exercise either by
doing a guided imagery of a safe place or by having each child physically put her
continuum in a box marked "Then." Then have each draw a picture of her safe person
or place and put that picture in a box marked "Now,* This serves as a reminder that
the abuse is in the past and that the child is safe now.
We have found it interesting that many children find French kissing by their
abusers to be the most invasive aspect of the abuse. For some, that made them feel
more vulnerable then vaginal penetration.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Dynamics of Sexual Abuse Exercises 199

The Alligator River Story

GOALS

To build self-esteem; to understand the dynamics of sexual abuse

AGES

9 through 18

TIME

30-40 minutes

PURPOSE

This exercise leads to fascinating discussions that illustrate h o w pervasive

b l a m i n g the victim is in our society. Children, especially teenagers, see life as
black-and-white, with n o shades of gray. This exercise helps t h e m see the other
shades. In addition, it encourages individuals to w o r k cooperatively as a group. It
teaches t h e m to speak up for their o w n beliefs, yet listen to others and together c o m e
up with solutions that feel comfortable to all. T h e origins o f this exercise are
u n k n o w n ; w e do k n o w that it has been passed on for years from one rape crisis
center to another in the training of volunteers.

DO THIS EXERCISE TO

• Decrease feelings of self-blame and shame.

• Increase the children's ability to define and express personal safety needs.
• Increase the children's capacity to place accountability and responsibility
appropriately.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
200 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• T h e r e is not enough time for a full discussion.

• T h e r e is so m u c h competition a m o n g group m e m b e r s that cooperation is
unlikely.

WHAT YOU NEED

• C o p i e s of " T h e Alligator River S t o r y " with instructions for ranking

• P e n s or pencils

INSTRUCTIONS

Part I: P a s s out copies of " T h e Alligator River Story" to group m e m b e r s . Instruct

t h e m to read it to themselves and then individually rank the characters from 1 to 5,
with 1 b e i n g the most objectionable.

Part II: W h e n group m e m b e r s have completed their individual rankings, divide

the large group into smaller groups of 3-4 people. A s k the m e m b e r s of the small
groups to share their individual rankings, and then together reach an acceptable
group ranking. Encouraging discussion during this process can help individuals
explain their reasons for their rankings.

Part III: Return to the larger group and ask everyone to explain w h a t rankings
their small groups agreed u p o n and why.

Part IV: Encourage further discussion b y asking questions such as the following:

• W h a t if the situation w e r e different and Abigail lived in a city and w a s

hitchhiking?
• W h a t if Abigail had b e e n wearing a turtleneck and jeans?
• W h a t if Abigail had b e e n really drunk?
• Was Abigail tricked or manipulated in any way? D o e s that change h o w y o u
feel about her?
• D o e s Abigail have a right to b e sexy and to choose w h o she wants to have sex
with?

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Dynamics of Sexual Abuse Exercises 201

HINTS

Abigail is rarely last in the rankings and often comes in second. If, after the
discussion, group members still blame Abigail, chances are they still blame them-
selves. This was illustrated for us by a 10-year-old group member who consistently
expressed few effects from the sexual abuse. During this exercise she was adamant
that the assault was Abigail's fault After much arguing from other group members,
two issues became very clear. First, this girl blamed herself for the abuse she had
suffered. Second, she held on to the belief that sexual assault was the victim's fault
so that she could maintain the belief that she could prevent it from happening to her
again. This cognitive distortion functioned as a false sense of protection for her. By
being nice, not standing up for yourself, and not recognizing your right to protect
yourself, you can end up being revictimized.
Female group members are often confused by gender roles (e.g., the female role
expectation that females are viable only if they are always being nice). Therefore,
many have a hard time accepting Abigail's laughter over Gregory's being beaten up.
Facilitate a discussion about the ways people sometimes respond in the heat of crisis,
which can include laughter to release tension. Help them to remember or imagine
what it feels like not to be believed. Remind them that rape and molestation occur
when someone is manipulated or coerced into doing something sexual against her
will or consent Discuss what differences there are, if any, between Abigail's sexual
abuse and theirs.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
202 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

The Alligator River Story

After you read this story, privately rank the five characters from the most offensive
to the least objectionable.

Once upon a time, there was a woman named Abigail who was in love with
a man named Gregory. Gregory lived on the shore of the river. Abigail lived on
the opposite shore of the river. The river that separated the two lovers was
teeming with man-eating alligators. Abigail wanted to cross the river to be with
Gregory. Unfortunately, the bridge had been washed out, so she went to ask
Sinbad, a ferryboat captain, to take her across.
She was wearing a tight skirt and a low-cut blouse, because she wanted to
look sexy for Gregory. Sinbad said that he would take her across; however, the
look in his eyes frightened Abigail. So she went to her friend Ivan and explained
her plight to him. Ivan did not want to be involved at all in the situation. Abigail
felt that her only alternative was to take the ferry, even though she did not trust
Sinbad.
After the ferry left the shore, Sinbad told Abigail that he couldn't control
himself and had to go to bed with her. When Abigail refused, he threatened to
throw her overboard. He also said that if she complied he would deliver her
safely to the other side. Abigail was afraid of being eaten alive by the alligators,
and she didn't see any other alternative, so she did not resist Sinbad. Sinbad
delivered her to the shore where Gregory lived.
When Abigail told Gregory what had happened to her, he viewed her as
asking for it because of the way she was dressed. He saw her as unclean and
cast her aside with disdain. Heartsick and dejected, she turned to Slug, who was
a black belt in karate. Slug felt anger toward Gregory and compassion for
Abigail. He sought out Gregory and beat him brutally. Abigail was overjoyed
at the sight of Gregory getting his due. As the sun set on the horizon, Abigail
laughed at Gregory's fate.

Rank the five characters, making the most objectionable number 1:

1.
2.
3.
4.
5.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Dynamics of Sexual Abuse Exercises 203

Letter/Video to
Nonoffending Parent(s)
(Therapy Group Only)

GOALS

To understand the dynamics of abuse; to build self-esteem; to recognize b o u n d a -

ries; to learn to m a n a g e triggers; to build self-protection and feelings of safety and
trust

AGES

4 through 18

TIME

30 minutes in the first session; 20-30 minutes in the following session (Parts III
and I V are d o n e in individual therapy.)

PURPOSE

This exercise allows group m e m b e r s to express w h a t the abuse experience w a s

like for t h e m and w h a t they need from their nonoffending parents or other care-
givers for further protection. It helps group m e m b e r s to begin to place account-
ability and responsibility for the abuse with the appropriate persons. This exercise
helps to b o t h heal and improve relationships b e t w e e n abused children and their
nonoffending parents. T h e parents will w o r k with their own therapists o n letters to
their children.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
204 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO THIS EXERCISE TO

• R e d u c e levels of fear, shame, and isolation.

• Increase the children's capacity to b e vulnerable and to interact authentically.
• Increase the children's capacity to desire, believe in, and hold h o p e for a
positive future.
• Increase the children's capacity to separate the self from the a b u s e / a b u s e r .
• Increase the children's capacity to place responsibility and accountability
appropriately.
• Increase the children's ability to define and express personal safety needs.

DO NOT USE THIS EXERCISE WHEN

• A n y of the nonoffending parents or other caregivers are n o t receiving group

or individual therapy.
• A n y parents or other caregivers are unable to write their o w n letters to their
children in therapy and therefore will probably b e unable to b e supportive o f
their children.

WHAT YOU NEED

• C o p y o f "Questions for Children to A n s w e r Before Writing to Their Nonof-

fending P a r e n t s / C a r e g i v e r s "
• P a p e r and pens
• Video c a m e r a if desired (especially useful for y o u n g children's groups)

INSTRUCTIONS

Part I: Pass out pencils and paper. G o through the items on the "Questions for
C h i l d r e n " list one b y one, having m e m b e r s write d o w n their answers as y o u ask
the questions. After each question, ask one or two m e m b e r s to share w h a t they h a v e
written so that y o u are sure they are understanding the questions. A s k m o r e
clarifying questions if necessary. A s the children finish, give t h e m a choice (as a
group) w h e t h e r they want to put their answers into letter form for their parents or
if they w o u l d prefer to videotape their answers. Instruct them to spend the next
w e e k thinking about anything else they w a n t their parents to k n o w about the abuse
or about their feelings or thoughts regarding it.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Dynamics of Sexual Abuse Exercises 205

If the children in the group are too y o u n g to write, have t h e m a n s w e r the

questions orally. Simplify the questions so that they can understand them.

Part II: D o not do Part II until the following week. If y o u are v i d e o t a p i n g the
children's letters, h a v e the group m e m b e r s all on one side of the r o o m w i t h the
video camera and a chair set up on the other side. O n e b y one, h a v e each m e m b e r
sit in the chair and answer the questions while y o u videotape h i m . B e c a u s e the
children thought about their answers the w e e k before, they should b e able to a n s w e r
the questions easily. If a child leaves something out that h e mentioned the w e e k
before, y o u m a y w a n t to prompt him. Instruct those waiting their turns to sit quietly
and to b e attentive. You m a y want to let them color while they are waiting so they
do not get too restless. After each person finishes, applaud his efforts and allow the
group to share a n y positive comments.

For older children w h o have chosen to write letters, have them use their answers
from the previous w e e k to compose letters to their parents or other caregivers. G i v e
t h e m at least 20 minutes to do this. W h e n everyone is finished, h a v e each child read
his letter aloud to the group.

Part III: G i v e a c o p y of each child's letter or video to the individual a n d / o r group

therapist w o r k i n g with the child's parent. W e always have each parent v i e w the
letter or video o n c e in therapy without the child being present. This w a y the parent
has time to react authentically without worrying about h o w her reaction will affect
the child. T h e therapist can help the parent decide w h a t she w o u l d like to say to the
child later. Naturally, the parent should receive help to process any feelings the letter
or video brings up.

Part IV: This part is done with b o t h the parent's and the child's individual
therapists. T h e parent brings her letter to the child to the session, and the child's
letter or v i d e o is also brought in. T h e child usually goes first and either reads his
letter or s h o w s his video. T h e child can choose to have someone else read his letter
if he wishes, but the letter must b e read aloud. After this is completed, the parent
responds to the child, commenting on specifics in the letter and asking a n y clarify-
ing questions. This needs to be a very supportive interaction. T h e n the parent reads
her letter to the child. Afterward, the child gets to ask any further questions or to
clarify anything he is confused about. T h e session ends with the parent agreeing to
the w a y s she can help reduce the child's trigger responses a n d / o r concrete things
she can do to keep h i m safe.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
206 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

This is probably the most powerful and healing exercise we do. It is done when
children are far enough along in therapy that they are able to express themselves.
The parents must be willing to look at themselves and at the life choices they make
that affect their children. Parents often take on either all the blame and guilt for the
abuse or none of it at all. Children often do not express their needs and overprotect
their parents or blame the nonoffending parents for everything. This exercise helps
put the accountability and responsibility where it belongs and breaks down the
barriers that may have been built between the child and parent

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Dynamics of Sexual Abuse Exercises 207

Questions for Children to Answer Before Writing

to Their Nonoffending Parents/Caregivers

When asking the following questions, use group members' answers as

springboards to other questions. For example, if a child answers the question,
"What stopped you from telling your parents?" with "I didn't think I would be
believed," probe further, asking, "Why not?" and "Had you not been believed
about other things before?"

1. How did it become known that you were being sexually abused?
2. What stopped you from telling your parent (or other caregiver) about the abuse?
3. Had you tried to tell your parent before? If yes, what happened then?
4. Did your not telling have anything to do with feelings or thoughts you had
about yourself? Feelings or thoughts about the person touching you? Feelings
or thoughts about the parent who wasn't touching you? Can you describe those
feelings and thoughts?
5. When your parent did find out, what did she or he do that was helpful to you?
6. What did your parent do that was not helpful?
7. Did your parent believe you when you told?
8. Is there anything else you wish your parent had said or done?
9. Do you feel safe now? If not, what is it that makes you feel unsafe?
10. Is there anything your parent could do differently to help you feel safer? Do you
believe your parent is protective of you?
11. What are some of your triggers? How can your parent help you reduce how you
react to those triggers?
12. Would you tell your parent if something like this happened again? Why or why
not?
13. If some sort of abuse happened to you again, do you think your parent could
handle it in a supportive manner?
14. Is there anything else you have not said or that you think your parent should
know?

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
208 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Samples of Letters Written to Nonoffending Parents

Dear M o m [Stepmom] and Dad,

We are getting to tell you some things and it might be hard for you to hear
this but I will need you to get ahold of it and listen. (Fm not being mean.) I felt
if I told you, you would just tell me to stop lying to you. Stephanie and I felt if
we told anyone we would get in trouble, and not Bobby. Now I know that isn't
true and I know how I can tell you how I feel and I won't get in trouble.
I don't think it was you and I don't want to hurt you, but I thought that it
was all my fault and not Bobby's for drinking. But now I know that it was Bobby
who did it, not me.
I thank you for telling me that I didn't do it, but I still think it was my fault.
Thank you for being there for me. Here is some more about how I feel: I think I
feel safer around you than I would around anyone. I think of everything you
have done and I don't think I need anything anymore. I might need some time
with just you and Dad or just you or just Dad. I love you a lot.
This trigger doesn't have anything to do with you but I will like you to hear
this: It's when my mother doesn't give me any attention and you and Dad were
there for me in the summer. And when my mother asked me the question about
m y braces and not say "hi" or even give me a hug. I felt she hated me.
If this would happen again, I would tell you because I would know to and
not hold it in anymore. And if this happened again, I think that I could handle
it again because you have already been through it.
I love you and I am sorry that my own mother couldn't be there for me and
she was there for him. I love you and thank you.
Jordan [age 10]

Dear M o m ,
M o m it was hard for me to tell you because I thought you and "you know
who," Jerry, would get in a fight. Mom, you helped me after I told you. Mom,
you and Bill and Jane helped me. Thank you. Mom, I wish you had gone to the
police or called them at least. Mom, to be safe now, I need you to help me. I am
so scared that he is coming back to get me and my brother and you. If I tell you
it's important, I need you to listen and give me attention if you aren't busy, and
understand. I still get scared.
Sincerely,
Terry [age 12]

Dear M o m and John [Stepdad],

Hello. This is a letter to tell you two about things I need to tell you. (Mom),
the reason I didn't tell you right away is that I thought you wouldn't believe
me, get mad at me, or be very upset and not have time to sit down with me and
make sure I'm okay because you were so busy being happy and letting me do

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Dynamics of Sexual Abuse Exercises 209

Samples of Letters Written to Nonoffending Parents (continued)

anything I wanted. Also, I didn't tell you because I thought it was going to hurt
you a lot more and that I wasn't special enough to be listened to. The things that
you did was to let me stay out of school for 2 weeks with you. And also you
paid attention to me and I felt you were guarding me from all fears and enemies.
(John) The things that you didn't help me with is you two yelled at me. I
didn't feel trusted, protected, very insecure and like I just abused somebody
instead of them doing that to me.
(Mom and John) The things that I wish you never said or did was to yell at
me, put me down, and killing my ego, and self-esteem/confidence.
I don't want this letter to put down either John or Mom because I love you
both and now I'm happy, safe, secure, and still know that I can tell you guys
anything, most of the time.
(Mom) I do feel safe now. Thank you for believing me that this was going
on. The only triggers I have is seeing my offenders or somebody like them.
(John, Mom) I don't like to hear their names at all or anything about them.
So please don't ask questions, or say anything in my presence.
(Mom, John) If I was being abused again I wouldn't tell because how you
two acted with Mitchell,* and I don't want to lose any trust or feel different
about the way you two see me now. I don't think that I could go through this
again because I think I won't be supported.
All you two need to know is to not to say, or talk about my offenders in front
of me, and I would tell you two if I was being abused but you two yelled at me
and so now my whole opinion has been changed. Sorry.
Always,
Kaylee [age 15]
^Mitchell was someone Kaylee recently met who was "making advances to-
wards her." When she told her parents, they yelled at her.

Sample of a Letter Written by a Group (instead of individual letters)

Dear Mom, Dad, Grandma, Poppa, Aunt, Uncle, and Foster Mom,
We are writing this letter to tell you how we all felt about being touched,
what helped us, what was hard, and what we need from you to feel safe.
What made it hard to tell was:

1. I was blackmailed by my offender.

2. I was afraid my mom would be mad.
3. I was ashamed to tell the details of how he did it.
4. I felt icky and gross.
5. I was threatened not to tell.
6. My offender said he would tell my mom that I lied.

(continued)
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Publications, Inc.
210 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Samples of Letters Written to Nonoffending Parents (continued)

What helped me to tell was:

1. I didn't feel safe and I wanted to feel safe.

2. M y heart helped me listen to my inner voice.
3. I just needed to tell because it bothered me.
4. My real dad called.
5. Me saying to my mom that my dad touched me in my private parts and I said
he scared me badly so I told on him.

How my family helped me after I told was:

1. She told the whole family and said it wasn't my fault.

2. My family helped me by sending me to counseling.
3. I got into counseling.
4. I got to ride in a police car and go to a foster home.
5. My m o m told me how to tell on somebody if they touch me bad or if they
treated me meanly, I could say "NO!" and walk away, or tell an adult and
scream loudly.

What I wish my family had done differently was:

1. Not go upstairs so my brother would not do that.

2. Called the judge so we could talk.
3. I wished they would keep me away from the person who did it to me.
4. I wish the whole family had helped me.
5. Been with me and gave me security and safety and I could have been safer
at the time, and scared my dad away from me.

What I need from my family to be safe now is:

1. Lots of love and lots of protection.

2. I wish they would keep me safe and stay by me.
3. Security doors and know who the people who are coming in the house. Get
hard windows so nobody can break the window open and steal me. M o m
check in with me every 30 minutes. If there are people around me that she
doesn't know, only let safe people be around me.
4. To care for me more.
5. A security bubble that won't pop, and my dad being in jail.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
chapter 10
TRIGGER RESPONSE EXERCISES

Sexually abused children often experience negative trigger responses.

A trigger is any thought, feeling, or bodily sensation activated by a stimulus, causing
a temporary loss of current reality. This stimulus is a reminder of the abuse. Often a
stimulus is a sound, smell, sight, touch, or taste. Triggers usually happen so fast that
the child is not conscious of what is going on. Suddenly the child feels unsafe or anxious
but is not sure why. Children often respond dissociatively when triggered, therefore
most of the trigger exercises should be done in therapy groups only.
All people experience triggers, and triggers can be either positive or negative. For
example, imagine sitting in a car repair shop waiting for your car to be serviced when
a customer enters carrying a box of freshly baked cookies. With one sniff, you suddenly
feel warm and happy. You may or may not know why. You might recognize the smell
as chocolate chip cookies and suddenly have a memory of sitting in your grand-
mother's kitchen. For a few seconds you may feel like you are actually there. You may
not have noticed the smell of cookies on a conscious level, but still you were transported
momentarily to your grandmother's kitchen. This is a positive trigger response.
A negative or traumatic trigger evokes responses that are mentally, emotionally, or
physically distressing. Children who have been sexually abused sometimes experience
traumatic trigger responses in the form of vivid intrusive thoughts, images, and
sensations. These interpretations and responses are symbolic reminders of the abuse.
When children are triggered by something that represents an aspect of the abuse,
they can temporarily lose touch with their present reality. They often feel as if the
abusive events are actually taking place in present time. They react to triggers in a
conditioned manner and usually have no conscious control over their responses. For
instance, imagine a child who was often abused by an alcoholic father. Drunk and out
of control, he would stumble into her room, slamming the door closed behind him.
With the abuser behind bars, the child has been safe for 2 years. One day, she is coloring
211
212 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

quite contentedly on the living room floor when she hears the sound of a door banging
shut. Suddenly, she is running out of the living room straight to her bedroom to hide
beneath her bed. This child just experienced a negative trigger response. The sound of
the slamming door caused her to lose touch with time and reexperience the feelings of
terror she felt while being abused.
Due to the intrusive and disintegrating nature of traumatic triggering, children
develop defensive coping mechanisms to deal with the recurrence of such experiences.
Often they cope by avoiding thoughts and feelings that relate specifically to the abuse.
However, these defensive measures often compound the issues rather than resolve
them and create more problems than they solve. It is not unusual for some children to
try to protect themselves against traumatic thoughts and feelings by regressing to
earlier behaviors, such as thumb sucking, clinging, or wanting to be cradled in a
parent's lap. Other children may exhibit fearful or phobic behaviors, such as throwing
themselves on the floor and screaming to avoid going outside to the backyard, where
the abuse occurred. One child we worked with had been abused while watching the
TV show Barney. He anxiously avoided watching the program and would rip up any
advertising he saw of Barney products. For some children the feeling of anxiety alone
is an unconscious reminder of abuse. At the slightest hint of anxiety, children may act
out, using harmful coping strategies to avoid these feelings. Still other children may
act out aggressively, fighting with their siblings at home or with their peers at school.
Childrens' particular coping strategies may vary, but the goal is the same. They want
to feel safe and secure and to avoid feelings of powerlessness, fear, and anxiety
The group exercises in this chapter are designed to help children regain a sense of
control and safety over the involuntary and intrusive nature of trigger responses.
Utilizing the BASK concept (see the introduction to this volume as well as Chapter 8)
with the exercises in this chapter, children can be taught what triggers are ("101 Dalma-
tians"), how to identify their own triggers ("Triggered Memories"), and how to manage
experiencing triggers by bringing themselves into present reality ("Centering").
Trigger Response Exercises 213

101 Dalmatians

GOAL

To learn about triggers

AGES

4 through 12

TIME

20 minutes

PURPOSE

This exercise is an introduction to the definition of triggers. It is d o n e in a

nonthreatening w a y with a story that most children already know. A g a i n , w e w o u l d
like to thank Patricia G o d l e m a n , w h o recognized 202 Dalmatians as the perfect story
to use w h e n introducing the concept of triggers.

DO THIS EXERCISE TO

• Increase the children's understanding and articulation of trigger reactions.

• C o n t i n u e to identify and express the internal and external triggers that result
in reactive coping behaviors.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

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Publications, Inc.
214 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

WHAT YOU NEED

• A short, well-illustrated picture-book version of 202 Dalmatians

• Paper
• P e n s and pencils

INSTRUCTIONS

Part I: Explain to the group w h a t a trigger is (see the e x a m p l e in Part I o f

"Elizabeth's Triggers"). Then read 202 Dalmatians aloud to the group, showing the
illustrations as y o u go.

Part II: W h e n y o u finish the story, pass out paper and pencils and ask the group
m e m b e r s to write d o w n anything they think might trigger the p u p p i e s after their
b a d experiences with Cruella DeVille. R e m i n d them to think of triggers the puppies
m i g h t feel, see, hear, or smell. F o r example:

• Black and white hair

• F u r coats
• Smell o f s m o k e
• Feel of cold snow
• S o u n d of m o v i n g trucks
• S o u n d o f the T V

Part III: H a v e each child share the triggers she thought of with the group. T h e n
ask the group m e m b e r s to guess:

• H o w d o the puppies feel w h e n they are being triggered?

• W h a t thoughts go through the puppies' heads w h e n they are being triggered?

Part IV: A s k the group m e m b e r s to write down some things they think m i g h t
help comfort the puppies w h e n they are being triggered. S o m e examples:

• Tell their m o m or dad.

• Tell their n a n n y
• Lie in their p u p p y baskets.

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Publications, Inc.
Trigger Response Exercises 215

• Listen to R o g e r play piano music.

• Notice they are n o w safe.
• C u d d l e with the other puppies.

A s k the group m e m b e r s to share their answers with each other.

HINTS

Obviously, younger children are not able to do the writing part of this exercise,
but they will happily express their ideas aloud in response to questions. Young
children have a hard time grasping the concept of triggers. They may confuse a trigger
response with being tricked. Help them understand how to be conscious of their
feelings by listening to their and minds. Explain that their bodies and their
minds let them know when they are being triggered. For example, "When my mom
says we get to go to the toy store, 1 want to burst with happiness and then scream
and yell and jump up and down, Thats because l remember that I had so much fun
there the last time. My memory of going there triggers all these feelings and thoughts
inside me. These are nice triggers." Or. "When my mother says we're going to fly on
the airplane, 1 can feel the pressure in my ears, and l think, 'Oh, I might not be safe;
and then I feel ail sleepy because 1 was so bored the last time we flew This time
when Mommy told me about flying, memories and thought were triggered and i
didnt feel that great."
This exercise is a good introduction to triggers. Because it does not involve the
abuse that the children experienced, it allows them to more fully understand the
concept of triggers. When doing this exercise, do not ask the group members about
how they were triggered when they were abused. Leave that discussion for another
week, or they will be too overwhelmed.

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Publications, Inc.
216 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Elizabeth's Triggers
(Therapy Group Only)

GOAL

To learn about triggers

AGES

6 through 12

TIME

15-20 minutes

PURPOSE

This exercise helps group m e m b e r s begin to look at triggers b y using a third-

p e r s o n perspective. T h e children learn to n a m e Elizabeth's triggers and, b y doing
so, b e g i n to identify their own.

DO THIS EXERCISE TO

• B e g i n to identify personal triggers.

• Increase the children's understanding and articulation of trigger reactions.
• H e l p the children identify and express the internal and external triggers that
result in reactive coping behaviors.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Trigger Response Exercises 217

DO NOT USE THIS EXERCISE WHEN

• There are any vulnerable children in group w h o m a y adopt Elizabeth's story

as their own.

WHAT YOU NEED

• C o p y of "Elizabeth's Story"
• Copies o f "Elizabeth's Triggers" worksheet
• Pens or pencils

INSTRUCTIONS

Part I: Begin b y explaining to the group w h a t triggers are: T h e y are reminders

of experiences. N o t e that w h e n w e are reminded of experiences, this s o m e t i m e s
brings b a c k old thoughts or feelings. Give an e x a m p l e of a good trigger, such as the
following:

Imagine y o u r m o m tells y o u that y o u get to b u y a n e w puppy. I m a g i n e y o u go

to s o m e o n e ' s h o u s e and there is a b o x of puppies there. O n e little b r o w n furry
p u p p y j u m p s right out of the b o x and c o m e s over to you and gives y o u a b i g
kiss o n the face. Two years later, w h e n your p u p p y has grown big, y o u still
might get triggered from that time y o u picked her up. These positive triggers
remind y o u of thoughts and feelings y o u had w h e n you first m e t her. For
example, w h e n e v e r y o u see a little p u p p y it reminds y o u of that first t i m e y o u
saw y o u r p u p p y and y o u feel all w a r m inside. That is a positive trigger. O r
every time y o u get a wet lick on your face y o u remember the first t i m e she
kissed y o u . A g a i n , m a y b e it gives y o u a tingly feeling on y o u r face and the
feeling m a k e s y o u w a n t to h u g someone. T h e kiss is the trigger a n d y o u r
feelings and behaviors are h o w y o u react to that trigger. M a y b e w h e n e v e r an
animal c o m e s to you, y o u might think, " I ' m nice, animals like m e . " You then
had a positive thought pop into your head because of being triggered b y a g o o d
memory.

T h e n give an e x a m p l e of a negative trigger, such as the following:

Imagine that y o u h a v e the flu and are lying on the couch. You h a v e a fever and
feel terrible. You are watching T V and a commercial comes on and s h o w s a big

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
218 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

greasy h a m b u r g e r with lots of cheese. You look at it and y o u h a v e to go throw

up. Now, it is possible that a year or two later, y o u m a y see that s a m e
c o m m e r c i a l and feel nauseated, like y o u want to throw up. It is not that y o u
are sick now. It is simply that without realizing it, y o u h a v e b e e n triggered and
y o u r b o d y and mind are reminded of those old feelings that n e v e r got healed
inside you. Until they are healed, this trigger might keep happening. Recog-
nizing a trigger can help y o u to have a choice about h o w to take care of yourself
w h e n y o u feel or remember the abuse.

Part II: R e a d "Elizabeth's S t o r y " aloud to the group and ask group m e m b e r s to
be a w a r e o f w h a t might trigger Elizabeth. Instruct them to think about w h a t feelings
and thoughts might get triggered for her later in life.

Part III: After y o u finish the story, pass out copies of the "Elizabeth's Triggers"
w o r k s h e e t and have group m e m b e r s write d o w n individually any triggers they
think Elizabeth might have from U n c l e Tim's actions. H a v e t h e m include the
feelings a n d thoughts she m i g h t h a v e as she is being triggered.

Part IV: A l s o on the worksheet, h a v e them write d o w n anything that m i g h t

comfort Elizabeth w h e n she is being triggered.

Part V: H a v e the children c o m e b a c k together as a group and h a v e each m e m b e r

share the triggers she wrote d o w n and the ways she thinks that Elizabeth can
comfort herself.

HINTS

Pay dose attention to each members thoughts and feelings about Elizabeth's
story, because they will probably express what most fits the child's own. Group
members will probably have a hard time coming up with thoughts, so you may need
to help them with this. Ask them what Elizabeth might have been thinking about
herself when her uncle was touching her. Was it Tarn so stupid* or 1 wish I could
make him stop*? (in other words, T m helpless"?) The thoughts mentioned will help
you to identify the core beliefs of each group member, and thus help you to
understand what coping mechanisms each uses to try to make her core beliefs a
reality
After doing this exercise, group members usually have a much easier time
identifying their own triggers.

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Publications, Inc.
Trigger Response Exercises 219

Elizabeth's Story

Seven-year-old Elizabeth had lots of friends and loved school. Her m o m and
dad worked during the day but they spent lots of time with her at night and on
Saturdays and Sundays. Once in a while, when they went out, her m o m and dad
would invite Uncle Tim to baby-sit Elizabeth. Uncle Tim was not really her
uncle, but the family had known him since Elizabeth was just 2 years old. He
lived near them and he loved kids. He taught Elizabeth how to ride her bike
and taught her how to roller-skate down at the roller rink.
Elizabeth's m o m and dad used to tell all their friends how lucky they were
to have Uncle Tim around. They felt good knowing that there was another adult
in Elizabeth's life. She loved him and loved talking to him. He was like a
member of their family and joined them for all their holidays, including birth-
days. Once a year, Elizabeth's mom and dad would go away for two or three
days and Uncle Tim would take care of Elizabeth.
When Elizabeth turned 7, Uncle Tim started acting kind of weird. He hugged
Elizabeth in a way that made her feel yucky. He kept wanting her to sit on his
lap when he read her stories, but she did not like the way he touched her chest
while he was reading. One time he tried to kiss her on her lips. She remembered
he had this faraway look in his eyes and his breath smelled liked peppermint.
She turned her head really quickly and so he kissed her cheek instead. It was a
really wet kiss.
Sometimes, Uncle Tim acted just like he used to. He would be really goofy
and lots of fun. But one day something really weird happened. Elizabeth's m o m
and dad had gone to the movies and Uncle Tim was taking care of her. She went
to sleep and woke up feeling someone touching her back and forth on her
private parts. She knew it was Uncle Tim because her night-light was on and
when she opened her eyes a tiny bit she could see his flannel shirt. She felt really
scared and didn't know what to do, so she kept her eyes shut and pretended
she was sleeping. She was hoping that if she didn't move, he would go away.
Then he kissed her cheek and she could feel his mustache tickling her. Still
pretending she was asleep, she turned around and curled up into a little ball.
He got up then, but right before he left the room he said, "You're my special
girl. Don't tell anyone, this is our special secret."
The next day, when she woke up, she thought maybe she had been dreaming.
She didn't see Uncle Tim for a few days, but when she did her stomach started
to hurt. He baby-sat her one more time and came into her room again. Once
more she pretended she was asleep. She hated the sound of his breathing and
couldn't stand how he kept shaking the bed.
The next day she told her parents about Uncle Tim. Her mom started to cry,
but she also hugged Elizabeth and told her she was glad she had told. Her m o m
and dad told her that Uncle Tim would never baby-sit for them again and that
they would not even let him in the house again.
(continued)

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Publications, Inc.
220 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Elizabeth's Story (continued)

This confused Elizabeth a little bit because she really liked Uncle Tim most
of the time. She just didn't like him doing that touching stuff. But then she was
kind of relieved she didn't have to see him because she knew if she did, then
her stomach would start feeling weird again.
She didn't tell many of her friends what happened because she was kind of
embarrassed by it. Then she got to be in a group with all these other kids who
all had similar things happen to them. She was so glad she wasn't the only one!
The group was super fun and it lasted for lots of weeks. When it was over she
didn't feel so bad anymore.
She still isn't positive why Uncle Tim did what he did. She is glad he won't
be able to do it to her anymore.

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Publications, Inc.
Trigger Response Exercises 221

In the columns below, write d o w n Elizabeth's triggers, her feelings and thoughts
w h e n she h a s the triggers and h o w she can find comfort w h e n she is triggered.

Elizabeth's Triggers

Triggers Feelings and Thoughts Comforts

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Publications, Inc.
222 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Centering

GOALS

To learn about internal boundaries; to learn to m a n a g e triggers; to build self-

protection skills

AGES

5 through 18

TIME

10 m i n u t e s

PURPOSE

This exercise presents a technique that is essential for all sexually abused
children to learn. It teaches children h o w to bring themselves b a c k to present time
w h e n they are being triggered or experiencing flashbacks in relation to the abuse.

DO THIS EXERCISE TO

• D e c r e a s e dissociative behavior w h e n abuse is mentioned.

• H e l p the children identify and express the internal and external triggers that
result in reactive coping behaviors.
• D e c r e a s e trigger reactivity.
• Increase the children's ability to m a n a g e trigger responses.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Trigger Response Exercises 223

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise. However, if anyone in the group has
a cold or is feeling ill, use a different past experience then one of r e m e m b e r i n g an
illness.

WHAT YOU NEED

N o special materials needed

INSTRUCTIONS

Part I: H a v e group m e m b e r s sit in a circle, and explain to them that this exercise
can b e used a n y t i m e and anyplace. Tell them that y o u are going to teach t h e m h o w
to keep themselves aware, focused, and in the "here and n o w " w h e n they w a n t to
be. A s k t h e m if they daydream often, or suddenly h a v e b a d m e m o r i e s about the
abuse and feel like they are reexperiencing it. This simple exercise will help t h e m
better m a n a g e those times.

Part II: H a v e everyone close their eyes and think about a time they h a d the flu
or a really b a d cold. Tell them to r e m e m b e r h o w they felt, saying, " F o r a few
m o m e n t s let yourself feel the illness." T h e n ask:

• Is y o u r h e a d full or stuffy?
• H o w does y o u r stomach feel?
• D o y o u h a v e a fever?

N o w tell t h e m y o u are going to bring t h e m b a c k to present time. All they need

to do is keep their eyes closed and follow y o u r instructions. T h e y are to a n s w e r y o u r
questions in their heads, not aloud. S a y the following to them:

• I w a n t y o u to say in your head, " I a m not sick. I a m r e m e m b e r i n g a time that

w a s long ago. I a m safe and healthy now."
• Notice y o u r body. Feel your feet on the floor. Notice the w e i g h t of y o u r arms
and w h a t y o u r arms are touching. Notice your b a c k and bottom. Feel the parts
of the chair, floor, or pillow your b o d y has contact with.

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224 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• W h a t are the sounds y o u hear? D o y o u hear the sound of birds outside or the
rustling m o v e m e n t of y o u r friends near you?
• N o t i c e the temperature. D o y o u feel w a r m or cool?
• D o y o u feel any sensations on your body, like a cool breeze or the soft feel of
y o u r shirt?
• O p e n y o u r eyes and look around. W h a t colors do y o u see? W h a t pictures or
drawings are on the wall? Notice the room y o u are in and w h o is around you.
• A g a i n , say to yourself, " I a m safe and healthy. I a m not sick. I w a s remember-
ing a time w h e n I w a s sick but n o w I a m not. That w a s then and this is now."
• N o w take a deep breath and really feel yourself being present in this room.

Part III: Discuss w h a t this experience w a s like for e v e r y b o d y to do. Were they
able to c o m e b a c k to the here and n o w ? Explain that w h e n they are reexperiencing
the abuse, they can do this exercise to bring themselves to the present. T h e m a i n
things they n e e d to remember to tell themselves are these:

• I a m safe now.
• T h a t w a s then, this is now.
• I can use all of m y senses—sight, sound, smell, touch, and taste—to b r i n g
m y s e l f b a c k to the here and now.
• I a m safe.

Part IV: A s h o m e w o r k , h a v e group m e m b e r s practice centering during the next

w e e k . F o l l o w up in the next group session to support and e n c o u r a g e t h e m in
practicing centering.

HINTS

Once you have introduced this exercise, use it often in group. Whenever you notice
a child withdrawing or dissociating, use it Use it if the children are becoming very
distracted or inattentive. The more practice they have with centering, the greater the
likelihood that they will use it automatically if they begin to use this technique daily,
they will have a much easier time managing triggers; they will be able to experience
the world as it happens and participate in it more fully

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Publications, Inc.
Trigger Response Exercises 225

Drawing Where Molested

(Therapy Group Only)

GOALS

To learn to m a n a g e triggers; to build feelings o f safety and trust; to learn about

internal boundaries

AGES

5 through 12

TIME

15-20 minutes

PURPOSE

D r a w i n g the locations where they were molested can help to desensitize group
m e m b e r s and m a k e it easier for them to talk about their abuse. T h e d r a w i n g s also
help the facilitators as well as group m e m b e r s begin to identify s o m e o f the
children's trigger points regarding the abuse.

DO THIS EXERCISE TO

• R e d u c e levels of fear, shame, and isolation.

• Begin to increase the children's ability to identify and m a n a g e trigger re-
sponses.

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Publications, Inc.
226 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• T h e r e has been n o previous discussion of m a n a g e m e n t a n d containment o f

triggers. M a n y children will b e triggered b y doing this exercise. D o one of the
earlier trigger exercises first, so they understand the concept.

WHAT YOU NEED

• D r a w i n g paper
• M a r k e r s , crayons, or colored pencils

INSTRUCTIONS

Part I: H a v e group m e m b e r s find comfortable places in the r o o m where they

will n o t b e disturbed or distracted. T h e y can lie d o w n and y o u c a n lower the lights
as long as it is not too dark. Tell them that y o u will b e leading t h e m in a guided
i m a g e r y exercise. H a v e them close their eyes and begin to focus o n their breathing.
L e a d t h e m through a brief progressive relaxation and then ask t h e m to r e m e m b e r
a place w h e r e they were sexually abused. Remind them that they are safe, that this
is o n l y a m e m o r y and nothing can hurt them here in this room.
Tell t h e m , w h e n they can imagine the place where they w e r e sexually abused,
to let themselves continue to relax and notice what that place looks like. A s k
questions such as the following:

• W h a t is it like there?
• Is it inside or outside?
• A r e there any furnishings or other objects around?
• A r e there people or animals there?
• W h a t time of day is it?
• If the place is inside, are there any w i n d o w s or doors? If so, can y o u see
outside?
• W h a t else can y o u see?
• Is it h o t or cold out?
• D o y o u notice any smells or noises?

C o n t i n u e to remind them that no one is going to hurt them, that the m e m o r i e s

are from the past and they are safe now. Reassure them that if they do not feel safe

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Trigger Response Exercises 227

now, y o u will d o everything y o u can to help t h e m feel safe. E n c o u r a g e t h e m to

r e m e m b e r everything they can about the places where their abuse h a p p e n e d . A s k
t h e m to c o m e b a c k to the group room with as m u c h of this m e m o r y as they can.

Part II: A s group m e m b e r s return from the guided imagery exercise, h a v e t h e m

immediately start drawing the places where they were abused, and include any
sensory descriptions. F o r example, a child m i g h t d r a w his b e d r o o m in the d a r k with
s n o w outside of the house. A s group m e m b e r s complete this task, invite t h e m to
c o m e b a c k into a circle to discuss their drawings with the group. W h i l e they share
their drawings, h a v e group members state w h a t objects or sensory m e m o r i e s they
h a v e d r a w n in their pictures trigger them now. You m a y need to ask s o m e very
specific questions to elicit this information. F o r example, y o u m i g h t say, "Y notice
y o u drew a spider in the corner. D o y o u h a v e any big feelings or thoughts w h e n
y o u see spiders n o w ? "

Part III: E n d the day's session with a centering exercise. H a v e the children notice
the colors in the r o o m , feel their bodies touching the floor or their chairs, notice the
air in the r o o m and h o w it smells. H a v e the group m e m b e r s say to themselves, " I
a m safe now. I w a s abused back then, but this is now. I a m safe now." This will help
t h e m stay in the present and not get lost in the memories triggered b y their
drawings.

HINTS

It is important to take notes about the children's triggers during the discussion
part of this exercise so that you can help them identify when they are being triggered
in the future. Give group members the power to decide how much they feel
comfortable sharing about their abuse. Ask each group member's permission before
you allow other participants to ask him questions about his abuse and where it took
place.
The places the children remember while doing this exercise may be where they
were abused once or repeatedly Their reactions to these memories can vary greatly
Pay close attention to how the children describe these places and what occurred
there. Ask them how thinking about these memories again makes them feet Be
certain they feel all right before they leave the group setting, With older children,
encourage them to exchange phone numbers. Make certain that younger children
have some adult to talk to at home if the need arises, Also, inform the children's

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228 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

parents or other caregivers about this exercise so they can be supportive after the
children leave the safety of the group setting.
In a recent teen group, two members drew pictures and described their triggers
in the following ways. Jody drew an open field behind a school and car exhaust at
night She said she had her eyes closed or looked at the stars. She reported not
remembering any sounds, except the voice of the man who raped her. She mentioned
these images and memories, saying that they brought up more and more anger. She
commented that she is "realizing it is wrong and he's responsible/' She stated she
doesnt feel sad anymore, just angry at "the system" (which let him go). Beth drew
pictures of two houses she had lived in. She reported that the abuse took place in
"every room of the house." She stated that she is bothered when she sees others
with hair or a similar walk or run as her brother. Beth remembers the cologne he
wore, in her old house, there was always someone else at home when she was
abused. She would crawl out her window onto a roof and her brother would come
f

and get her there and abuse her. She said that now she is afraid of heights.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Trigger Response Exercises 229

Triggered Memories
(Therapy Group Only)

GOALS

To learn to m a n a g e triggers; to learn about internal and external b o u n d a r i e s

AGES

4 through 18

TIME

20-30 minutes

PURPOSE

Sexual abuse survivors often have m e m o r i e s of their abuse restimulated or

triggered b y something in their environments. Suddenly they are reliving the
experience, b u t they don't k n o w why. B y learning to identify the triggers, survivors
learn w a y s to increase their ability to m a n a g e these automatic responses. F o r
example, they learn to stay in the present time and consciously recognize the
stimulus that has triggered them.

DO THIS EXERCISE TO

• Decrease dissociative behavior w h e n abuse is mentioned.

• Help the children identify and express the internal and external triggers that
result in reactive coping behaviors.
• Decrease trigger reactivity.

Grotsky Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
230 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• Increase the children's ability to m a n a g e trigger responses.

DO NOT USE THIS EXERCISE WHEN

• T h e group has not had lengthy discussions of triggers and has not done
previous exercises concerning triggers. (Group m e m b e r s m u s t already under-
stand that triggers can b e positive and negative.)
• T h e group has not previously done the exercises " 1 0 1 D a l m a t i a n s / "Eliza-
7

b e t h ' s T r i g g e r s / ' a n d / o r " D r a w i n g W h e r e Molested."

• G r o u p m e m b e r s dissociate to such a degree w h e n they are triggered that it is
difficult to bring them b a c k to the present.

WHAT YOU NEED

• D r a w i n g paper
• C r a y o n s or markers

INSTRUCTIONS

Part I: R e v i e w with the group what triggers are and h a v e group m e m b e r s share
a few e x a m p l e s to m a k e sure they understand the concept. T h e n ask all the children
to d r a w o n their o w n pieces o f paper all the things that trigger m e m o r i e s of the
abuse for them. R e m i n d t h e m to include sights, smells, objects, feelings, touches,
and tastes.

Part II: H a v e each person share her drawing with the group a n d talk about each
of h e r triggers. Find out if there are any triggers that can b e taken care of immedi-
ately. In other words, if a child's trigger is a teddy bear or a pillow, y o u can talk to
the parents about getting rid of such objects so they do not act as constant reminders
of the abuse. M a y b e the child should b e m o v e d to a different b e d r o o m , or an award
that says she is "special" removed from the wall. Most triggers are not taken care
of so easily, however; they can include such things as colors and odors (such as the
smell of cigarettes).

Part III: D o a guided imagery with the children. With older groups, y o u can have
t h e m lie on the floor, close their eyes, and relax. With younger children you m i g h t

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Publications, Inc.
Trigger Response Exercises 231

w a n t to h a v e t h e m stay in their chairs with their eyes shut. H a v e t h e m take three

deep breaths to relax themselves. A s k t h e m to imagine all of the tension leaving
their bodies each time they exhale. D o not spend a lot o f time on relaxation, as y o u
w a n t t h e m to stay s o m e w h a t in the here and now.

H a v e t h e m i m a g i n e one of their triggers. A s k t h e m to respond to the following

questions and instructions in silence:

• H o w do y o u feel as y o u experience this trigger?

• H o w does y o u r b o d y feel?
• Is any part of your b o d y tight?
• H o w is y o u r breathing? N o w breathe slow and e a s y [Lead t h e m b y saying,
slowly, "In, out, and again, in, out." D o this two or three times.] K e e p
breathing slowly while experiencing the trigger. Relax your b o d y e v e n while
y o u see the trigger in your mind. You can relax every muscle in y o u r body.
K e e p breathing and relaxing.
• N o w look at that trigger and k n o w it can't hurt you.
• S a y to yourself, "You can't hurt m e . I a m okay. I a m strong. I a m n o t b e i n g
sexually abused now. I a m right here in a r o o m with other p e o p l e and I a m
safe. I a m all right. I a m breathing, I a m relaxed, and I a m safe."
• K n o w that y o u can do this anytime y o u see or feel a trigger. Just breathe, relax,
and stay in the present.
• B e aware o f w h e r e y o u are and tell yourself over and over again that y o u are
okay.

Slowly b r i n g t h e m b a c k to the room, telling them, in sequence:

• Feel the carpet underneath you.

• Notice w h a t parts of your b o d y are touching the floor.
• H e a r the s o u n d s in the room.
• Feel the air temperature.
• W h e n y o u are ready, open your eyes and look around the room.

Part IV: Tell t h e m that their h o m e w o r k assignment is to practice this exercise

during the w e e k . W h e n e v e r they feel scared, or "triggered," they are to talk to
themselves about being in the present and tell themselves that they are okay. Ideally,
they'll b e in situations where they can do the entire imagery.

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232 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

A good follow-up exercise to this one is "My safety and Comforts" (see Chapter 11).
Keep a close eye on group members while they are doing their drawings and make
sure they stay in the present If anyone appears to need help staying in the present,
talk to her about what she is feeling in her body and where she is feeling it, and
remind her that she is safe now. Tell her to look around and to name the different
people in the room. Repeat over and over again, "The abuse was then, this is now.
You are safe now. Look around. Feel yourself in the room. You are safe." (Use this
technique only when you are sure the child is not currently in an abusive situation.)
While doing this exercise, 7-year-old Carrie drew the basement where her brother
used to abuse her. She drew it as a very stark place with a bare iightbuib, stacks of
boxes, a Ping-Pong table, spiders, and a pull-out couch. She hated to go down to the
basement. After doing this exercise, she decided to reclaim the basement as her own.
She went down there, added pillows and stuffed animals she liked, moved things
around, and made it into a comfortable room for herself.
Sometimes the drawings of triggers give hints of ritualistic or sadistic abuse, if
arry child's drawing has a lot of religious symbols, masks, snakes, or animals being
hurt, consider this a red flag and make sure that the child is also in individual
counseling. Beth, a 4-year-old, constantly drew blood in all her pictures. Every person
was bleeding and her pages would be covered with splotches and smears of red
representing blood. The pictures were too frightening for the other children, in an
effort to not alienate her and unduly frighten the other children, the facilitators chose
not to have the children share their drawings with the entire group, instead, they
went to the children individually and had them share their drawings with the
facilitators only

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Trigger Response Exercises 233

Samples of Children's Triggers

Guy with long hair

Guys named Ron
His brother
His family
If anyone brings up the subject of sexual abuse
Going to group
People asking me why I have to go to counseling
Christy [age 9]

Blond hair
Yelling
A laugh like his
Thinking about it
Hearing his name mentioned
Beaded necklaces
Being under my bed
Seeing pictures or movies where people kiss or have sex
Katherine [age 10]

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Publications, Inc.
234 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

How We
Sabotage Ourselves

GOALS

To learn to m a n a g e triggers; to learn about internal boundaries; to build self-

esteem

AGES

9 t h r o u g h 18

TIME

60-90 minutes

PURPOSE

Children w h o have been abused often engage in behaviors that result in their
hurting themselves. M a n y of t h e m h a v e learned to act helpless, w h i c h can set t h e m
up to b e revictimized. This exercise helps group m e m b e r s identify their o w n
self-destructive behaviors and teaches t h e m to choose healthier ones as substitutes.

DO THIS EXERCISE TO

• Increase the children's capacity to m a k e conscious behavioral choices.

• H e l p the children recognize h o w they keep themselves in a victim's role.
• Build self-empowerment and social skills.
• B e g i n to decrease and m a n a g e trigger reactivity.

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Trigger Response Exercises 235

DO NOT USE THIS EXERCISE WHEN

• There is n o t e n o u g h time to complete it adequately.

WHAT YOU NEED

• C o p i e s of the " S a b o t a g e " checklist

• Pencils
• C h a l k b o a r d and chalk

INSTRUCTIONS

Part I: Pass out copies of the " S a b o t a g e " checklist and have group m e m b e r s fill
t h e m out individually. T h e n ask t h e m to go b a c k over their checklists a n d put
asterisks b y the three sabotaging behaviors they do most often.

Part II: H a v e each m e m b e r read her asterisked behaviors to the large group.
Write d o w n the behaviors she mentions as part of a general list on the chalkboard.
Role-play t w o or three of the behaviors that m o s t group m e m b e r s use. F o r e x a m p l e ,
if m a n y m e m b e r s p o u t and whine, m a k e up a role-play such as the following: " M a r y
wants to spend time with Ellen, but Ellen has already m a d e plans to b e with
Jennifer." H a v e group m e m b e r s play Ellen and Mary. H a v e M a r y ask Ellen to play
with her and, w h e n Ellen says she can't, h a v e M a r y pout and w h i n e . Notice w h a t
Ellen does then. After the role-play, ask the child w h o played Ellen h o w she felt
w h e n M a r y reacted that way. A s k the child w h o played M a r y h o w she felt w h e n
she w a s pouting and whining. W h a t feelings w a s she trying to express?

Part III: R e p e a t the role-play, but this time ask for volunteers to play M a r y and
h a v e t h e m c o m e up with healthier w a y s to respond. For e x a m p l e , o n e person
playing M a r y m a y say, " G e e , would it b e all right if I joined y o u and Jennifer?"
A n o t h e r m i g h t say, " C a n w e m a k e plans to play together another d a y ? " After each
of these role-plays, h a v e the players c o m m e n t on h o w they w e r e affected b y the
responses.

C o n t i n u e the role-plays with the other two sabotaging behaviors m o s t c o m m o n

to the group m e m b e r s .

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236 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Part IV: A s k each group m e m b e r to n a m e one behavior that she will w o r k on

c h a n g i n g during the next week. Instruct each to choose one b e h a v i o r she w o u l d
like other group m e m b e r s to "call her o n " w h e n they notice her d o i n g it. M a k e sure
that y o u follow up on this assignment during the next session.

HINTS

Ask group members to fill out the "Sabotage" checklists as honestly as possible.
They should not talk with others while they are doing so.
During the role-plgys, it may be difficult for some group members to stay in their
roles. You may want to play a character in the initial role-play to help demonstrate
how to play a role and how to stay in it
This exercise can help group members take responsibility for their own behaviors,
Katie, a 12-year-old, used to complain each week about how she never felt included
with her friends and how they did not like her as much as they liked each other. After
this exercise, she realized that whenever she walked with them she was always one
or two steps behind and that she never initiated contact with them. Instead, she
would wait for them to call her. Her homework assignment from this exercise was to
walk right in line with them and to initiate an activity with one of her friends. She
returned the following week and reported gleefully that her friends had been thrilled
she initiated something, and for the first time she Felt included with them.

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Publications, Inc.
Trigger Response Exercises 237

Sabotage

Place a check mark by any of the behaviors that you do. You do not need to turn
this paper in when you are done with it. We will ask you to share some of your answers
with the group. Please be as honest as you can. You will not have to share anything you
do not want to share.

I get sick a lot.

I skip out of school.
I don't do my homework.
I say mean things to other people.
If someone is getting too close to me, I start a fight.
When I am angry, I cry instead.
I get high using alcohol, illegal drugs, or prescription medication.
I don't stay friends with anyone very long.
I feel like an outsider, like I never fit in with anyone.
I feel sorry for myself a lot.
I hang around people who say mean things to me and put me down
a lot.
I don't take anything seriously. I make jokes about everything and act
like a clown.
I blame other people when things don't go right for me.
I'm kind of negative and criticize other people a fair amount.
I always think it is my fault whenever something goes wrong.
I don't let people know how I feel.
I hardly ever feel angry.
I skip meals almost every day.
I hardly ever get enough sleep.
I keep myself super busy.
I'm always late for school and appointments.
I sleep too much.
I'm always tired.
I eat a lot of junk food.
When I don't get what I want, I pout and whine a lot.
I act tough even when I'm feeling hurt.
If I'm mad about something, I just withdraw. I go to my room or I just
won't talk.

(continued)

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238 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Sabotage

If I am feeling hurt or angry, I hit, kick, or punch others.

I tease other people a lot.
I yell a lot when I am angry or hurt.
[For girls] I flirt or act really silly and giggly around boys or men.
[For boys] I talk about girls all the time and try to kiss them and get
sexual with them as fast as I can.
[For girls] I wear clothes that look pretty sexy or that show a lot of my
body.
I eat whenever I am feeling mad or hurt.
I act like I don't care or like nothing bothers me, like I'll say, "No big
deal," even though it might be.
I have sex with others I don't really love.
I don't join any clubs or groups or try to meet friends.
I wait for others to come to me to say they want to be friends.
I'm really stubborn and won't give in.
I always seem to be in some sort of crisis.
I tell lies.
I spend a lot of time figuring out ways to get back at people who have
hurt me or made me mad.
I feel jealous a lot.
Others (write them below):

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Publications, Inc.
Trigger Response Exercises 239

Secret Soliloquy
(Therapy Group Only)

GOALS

To learn to m a n a g e triggers; to build feelings of trust and safety; to learn about

internal boundaries

AGES

9 through 18

TIME

20 minutes (if only sharing two to three secrets per week)

PURPOSE

Children w h o h a v e b e e n sexually abused often have parts o f the a b u s e they

never share b e c a u s e they feel so humiliated or scared about them. This p s y c h o -
d r a m a exercise attempts to set up a safe w a y for t h e m to air those secrets without
b e i n g identified. This helps children feel accepted b y seeing that others can under-
stand them. This in turn reduces their sense o f s h a m e and often reduces their trigger
response pattern. (We adapted this very intense and powerful exercise from one
that w e learned at a psychodrama w o r k s h o p in Eugene, Oregon, that w a s led b y
A n n Taylor.)

DO THIS EXERCISE TO

• E n c o u r a g e further disclosure b y group m e m b e r s y o u suspect are withholding

major parts of their stories.

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240 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• R e d u c e levels of fear, shame, and isolation.

• Increase feelings of safety.
• Increase the children's capacity to value themselves and others.
• Further assess the safety of group members.
• Identify, m a n a g e , and reduce trigger responses.

DO NOT USE THIS EXERCISE WHEN

• You believe s o m e group m e m b e r s m a y m a k e fun of the secrets or b a d g e r

others to reveal which secrets belong to them.
• T h e r e is not enough time to do the exercise fully.

WHAT YOU NEED

• A s h o e b o x or similar container
• M a t c h i n g paper and pens for everybody

INSTRUCTIONS

Part I: A s k the group m e m b e r s to take a few minutes to think about one aspect
of their abuse they h a v e never told anyone. This could b e s o m e t h i n g that h a p p e n e d
to t h e m or something they were forced to do to s o m e b o d y else. It m a y b e a feeling
they h a v e about themselves, the abuse, or the offender. It could b e that they are still
b e i n g abused.

A s k t h e m to write d o w n their secrets about themselves or their families, but not

to p u t their n a m e s on the papers. E m p h a s i z e to the group m e m b e r s that they are
not to guess w h o s e secret is w h o s e , and explain that they are revealing these secrets
so they will n o longer b e burdened b y them. Even the m o s t embarrassing, humili-
ating, shameful secret can c o m e up here. In fact, chances are that s o m e o n e else has
the s a m e secret. N o one will b e asked to talk about his o w n secret. Point out that
e v e r y o n e h a s the same color and size of paper and the s a m e color pens, so they can't
identify w h o s e secret is whose. A s k all group m e m b e r s to fold their papers in the
s a m e way, and demonstrate exactly h o w y o u w a n t the papers folded.

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Trigger Response Exercises 241

G i v e the group 2 minutes to write d o w n their secrets. Tell them to write clearly,
so that s o m e o n e else can easily read w h a t they h a v e written. H a v e e a c h p e r s o n write
only one secret. W h e n they are done, h a v e t h e m place their folded papers in a b o x
with e v e r y o n e else's.

Part II: M i x up all the folded papers and h a v e each person pick o n e out o f the
container. If a n y o n e picks his o w n secret, have h i m put it b a c k and pick another
one. (If the last p e r s o n picks his own, h a v e the group return all the secrets to the
container and start the process over again.)

A s k for a volunteer w h o is willing to start. T h e volunteer is to read the secret he

has picked from the b o x as if it were his own. T h e n he is to "soliloquize"—that is,
talk about h o w h e feels regarding this secret. F o r example, the secret J o h n h a s picked
says, " M y father put his penis in m y m o u t h and m a d e m e suck on it." J o h n reads
that aloud and then continues, "It w a s really gross. I wanted to throw up. I feel so
ashamed, I can't believe I did that " Thus J o h n talks as if the secret h a p p e n e d to
him.
If a n y o n e gets stuck, a facilitator or another m e m b e r of the group can " d o u b l e "
for him. T h e double can stand behind h i m and act like the secret h a p p e n e d to h i m
and begin to soliloquize. If the group gets a good feel for h o w to double, then a n y o n e
can double for the person soliloquizing at any time (say his feelings and then sit
d o w n ) . This encourages a lot of m e m b e r s to share h o w it feels to h a v e a particular
secret. In addition, through doubling, the person w h o s e secret it is m a y feel safe
e n o u g h to talk about it anonymously. T h r o u g h this exercise, each p e r s o n also gets
to see h o w c o m m o n l y shared his feelings are.
If the secrets are quite heavy, y o u m a y w a n t to do only two or three in a session.
After every t w o or three soliloquized secrets, stop to process the feelings in the
group. Ask:

• A r e there any c o m m e n t s ?
• D o any o f y o u feel like this too?
• Did a n y of these secrets particularly hit h o m e for you?

Part III: Tell group m e m b e r s that they are w e l c o m e to share their secrets in future
group sessions, b u t n o one is expected to.

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242 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

if anyone starts trying to guess whose secrets are whose, even jokingly, intervene
immediately. Remind him that this is a safe place, and part of feeling safe means
knowing that you will not be laughed at, put down Judged, or identified against your
will.
Once during this exercise we discovered that one of the teens in our group was
suicidal. Just talking about her secret relieved some of the pressure for her.
Usually, this exercise reveals further details of the children's abuse. You may have
group members who say they do not have any secrets. Stress to them that virtually
everyone has at least one thought or feeling he has never shared, it may be "I don't
like tile way my body looks," or "f think most girls are ugly." Everyone has at least one
thought or feeling that he has not shared with others. Tell them they must come up
with something.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
chapter
11

H E A L T H Y B O D Y IMAGE A N D
SELF-PROTECTION EXERCISES

A body can become a frightening, dangerous, and powerful reality for

a sexually abused child. Because it is "the body" that seems to attract the abuser's
attention (threats, touches, tricks, violations, and manipulations), it is "the b o d y " that
a child learns to fear and wishes to escape, control, or use to defend against the abuse.
Children's developing ideas and images about themselves and others are shaped
largely by their relationships. Abusive relationships confuse and distort a child's
self-image. The dynamics of sexual abuse often negatively influence children's ideas
about who they are, how they look and feel, and how others view them.
Healthy body image and self-protection exercises are used to correct these distorted
images and to give children a better sense of their bodies and themselves. These
exercises are designed to help children create self-images that are not defined solely in
relation to their sexual abuse. This requires guidance, support, and encouragement.
The reality of abuse forces many children to choose coping behaviors that, over
time, can cause further harm to them and keep them isolated from others. Not all
children respond in the same ways to being sexually abused. In our experience, some
of the ways sexually abused children cope with their negative body images include the
following:

• Developing strong contempt for their bodies: Children who view their bodies with contempt
see their bodies as having betrayed them, especially if they became aroused during their
abuse experiences. They may blame themselves for the abuse and believe it is the fault of
their bodies' shape or allure. These children may physically harm themselves by being
very accident-prone or by cutting on themselves. As they get older, they may develop

243
244 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

eating disorders. They may try to hide their bodies with layers of clothes or try to blend
into the background by constricting their activities and participation in social situations.
• Dissociating from the reality of their bodies: Many sexually abused children basically feel
numb from the neck down. Often they will not feel pleasure or pain. They may ignore parts
of their bodies that feel too threatening. These children may not be very physically active.
As they get older, they may be asexual, simply having little or no sexual desire.
• Acting out sexually and aggressively toward others: In an attempt to master their feelings of
vulnerability and powerlessness, some children may try to control and overpower others.
• Exhibiting seductive behavior in an attempt to increase their desirability to others: Sexually
abused children who act seductively believe they are objects of desire and display learned
exhibitionistic and sexualized behavior with peers and adults. These children may be
confused by the negative responses they receive for their behavior. Sexualized children
often seek attention and admiration in place of intimacy.

Most children who have been sexually abused on an ongoing basis fear intimacy
because it increases the possibility of exposure and vulnerability. When children who
have been abused learn to separate what happened to them from how they coped and
who they are, their true nature and potential may be developed.
Through their introduction to the "Body Bill of Rights," sexually abused children
learn their most basic rights and responsibilities concerning their bodies. For many of
these children, these are brand-new concepts.
It is important for sexually abused children to develop clearer and more realistic
views of their bodies. Exercises that can help them do this include "Body Rights and
Responsibilities" and "Body Tracing."
Once the children have more realistic views of themselves, they recognize their
rights to physical and emotional protection. This enables them to assert their bounda-
ries with strength and conviction. It is then much easier for them to learn and practice
self-protection skills and to believe that they have a right and responsibility to express
their needs in a clear and direct manner.
Healthy Body Image and Self-Protection Exercises 245

Body Rights
and Responsibilities

GOALS

To build self-protection skills and healthy sexuality; to learn about internal

boundaries

AGES

9 through 12

TIME

20-40 minutes (depending on the size of the group)

PURPOSE

This exercise helps children identify w a y s they can nurture and comfort them-
selves. It also reinforces the concept that they h a v e the right to protect a n d care for
their bodies.

DO THIS EXERCISE TO

• Introduce the concept of the rights and responsibilities of h a v i n g a b o d y to

protect and nurture.
• Introduce the concept that thoughts and feelings create an internal interpre-
tation o f reality that affects behavior.
• Increase the children's ability to m a k e conscious behavioral choices.
• Increase the children's ability to define and express personal needs.

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246 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise.

WHAT YOU NEED

• C o p i e s of the " B o d y Bill o f R i g h t s "

• Paper
• P e n s or pencils
• C o l o r e d markers

INSTRUCTIONS

Part I: H a v e everyone sit together in a circle for a brainstorm and discussion o f

w h a t it m e a n s to have a b o d y and w h a t rights and responsibilities go with having
a body.

Part II: Pass out copies of the " B o d y Bill of Rights" to all group m e m b e r s , along
with b l a n k p a p e r and pens or pencils. R e v i e w each right and responsibility on the
" B o d y Bill o f Rights," and then ask the group m e m b e r s to m a k e lists o f the personal
things they do to take care of their bodies. For example, in response to the right to
decide w h o can and cannot touch your body, Susie could write d o w n that she uses
h e r v o i c e to say, "No! I don't w a n t y o u to touch m e . " In response to the right to feel
b o d i l y sensations such as pain, sexual arousal, and comfort, A n n a m i g h t write, " I
laugh w h e n m y little brother tickles m e " or " I cried w h e n I fell off m y b i k e and h u r t
m y k n e e last w e e k . " Regarding the responsibility to understand y o u r b o d y ' s basic
needs for a healthy diet, good hygiene, exercise, and safe sex, D a v i d m a y write, " I
eat cereal a n d bananas for breakfast because it feels good in m y tummy."

Part III: H a v e each child d r a w a picture, using the markers, that illustrates o n e
of the things from her list that she does or has done. Tell the children to think of
specific e x a m p l e s that are in response to one of the rights o n the " B o d y Bill of
Rights."

Part IV: W h e n everyone has completed their tasks, invite the group to c o m e b a c k
into a circle. In turn, have all group m e m b e r s share their drawings and their
personal lists.

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Healthy Body Image and Self-Protection Exercises 247

HftfTS

Often, one or more group members will have difficulty thinking of specific ways
they take care o f their bodies. You can make suggestions or ask them questions to
help stimulate ideas.
This exercise c a n help children begin t o recognize and regain a sense o f personal
power and awareness of their o w n bodies.

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248 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Body Bill of Rights

H a v i n g a b o d y m e a n s there are rights and responsibilities that g o w i t h
it:

• T h e r i g h t to exist a n d o c c u p y s p a c e

• T h e r i g h t to d e c i d e w h o c a n a n d c a n n o t t o u c h y o u r b o d y

• T h e r i g h t to d e t e r m i n e h o w y o u r b o d y c a n b e t o u c h e d

• T h e r i g h t to c h a n g e y o u r m i n d a b o u t b y w h o m , how, a n d w h e n y o u r
b o d y m a y be touched

• T h e r i g h t to protect a n d defend y o u r b o d y against h a r m

• T h e r i g h t to feel b o d i l y r e a c t i o n s s u c h as pain, s e x u a l arousal, a n d

comfort

• T h e r e s p o n s i b i l i t y to e x p r e s s directly y o u r n e e d s a n d w a n t s r e g a r d i n g
your body

• T h e r e s p o n s i b i l i t y to u n d e r s t a n d y o u r b o d y ' s b a s i c n e e d s for a h e a l t h y
diet, g o o d h y g i e n e , exercise, a n d safe sex

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Healthy Body Image and Self-Protection Exercises 249

My Safety and Comforts

GOALS

To build self-protection skills and healthy b o d y image; to learn about internal

boundaries

AGES

5 through 12

TIME

20-40 minutes (depending on group size)

PURPOSE

This exercise encourages children to develop self-soothing behavior; to increase

a feeling of safety in their lives. Sexually abused children often live in a constant
state of fear, vulnerability, a n d / o r anxiety. This exercise begins to replace negative
stimuli associated w i t h the abuse with positive stimuli that induce thoughts of
safety and protection.

DO THIS EXERCISE TO

• Introduce the concept that thoughts and feelings create an internal interpre-
tation of reality that affects behavior.
• Increase the children's ability to identify, comprehend, m a n a g e , and express
thoughts and feelings appropriately.
• Increase the children's ability to define and express personal safety needs.

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250 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise.

WHAT YOU NEED

• C o p i e s of the "Things That M a k e M e Feel Safe" worksheet

• P e n s or pencils

INSTRUCTIONS

E x p l a i n to the group that each of t h e m will b e making his o w n list of things that
help h i m feel safe in his life. Pass out copies of the "Things That M a k e M e Feel Safe"
worksheet, along with pens or pencils, so the children can write their answers.
G o a r o u n d the circle and allow all group m e m b e r s to fill in each b l a n k on the
worksheet. Encourage the children to write d o w n (or, for those w h o are younger,
to draw) their endings to the statements. Items that m a k e t h e m feel safe m i g h t
include certain clothes, favorite b o o k s , or animals. A n i m a l s c a n include pets or
stuffed or imaginary animals. Things they can look at to help t h e m feel safe m a y
include a picture of s o m e o n e they love and trust or a sunset. If y o u h a v e extra time,
let group m e m b e r s ask s o m e of their o w n questions. For e x a m p l e , " W h a t [person,
place, or thing] m a k e s y o u feel safe?"

HINTS

in one of our girls' groups, jody asked the question, "What food makes you feel
safer We added this to the list. This gave us an opportunity to talk about the
drawback of relying on food for comfort In such a discussion it is important to go
back to the "Body Bill of Rights" and emphasize that eating food is part of the body's
basic needs for health and nutrition, not for gaining emotiona! comfort. Other
questions you can ask group members to promote further discussion about this topic
include the following:

• Have you used food for comfort?

# what were the circumstances?
• How do you feel after eating for comfort?
• What else could to do to comfort yourself?

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Healthy Body Image and Self-Protection Exercises 251

Be sure to include the children's completed "Things That Make Me Feel Safe"
worksheets in their final group packets at closure. Unless their offenders have been
sentenced to serve time in prison, many children who have been abused have
difficulty feeling safe. Encourage them, with their parents or other caregivers, to
gather some of the safe things from their lists and keep them in their rooms to enable
them to sleep more restfully
This exercise can be modified and used with younger children. It is fun to be
creative in imagining what helps the children feel safe. A few of the ideas that we
have tried include the following:

• Different smelly things to pass around for them to smell (e.g., vanilla extract, suntan
lotion, chalk)
• Recordings of different sounds for them to listen to (e.g., someone singing, the sound
of a flute, children's voices, laughter)
• Various materials for them to touch (e.g., suede, cotton blanket, velveteen)

Usually, young children can tell you places that make them feel safe or animals
that help them feel safe. Have them draw pictures using one color that makes them
feel safe. Or have them draw pictures of people, places, or things that they could took
at and feel safe.

Samples of Some Things That Help Children Feel Safe

Smell: Perfume
Safe activity: Talk on the phone
Sound: Listening to the radio
Taste: Taco salad
Touch: White cotton sweater
Colors: Blue and white
See: Pictures of friends
Lisa [age 9]

Smell: Ocean air

Taste: Chocolate
Touch: My fuzzy teddy bear
Sound: Little kids laughing
Sight: Woods
Colors: Green and purple
Place: Anywhere with friends
Janine [age 13]

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252 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Things That Make Me Feel Safe

The place that makes me feel safe is:

The smell that makes me feel safe is:

The animal that makes me feel safe is:

The sound that makes me feel safe is:

The thing that I can touch that makes me feel safe is:

The color that makes me feel safe is:

The thing that I can look at that makes me feel safe is:

The food that makes me feel safe is:

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Healthy Body Image and Self-Protection Exercises 253

Healing Image

GOALS

To build self-protection skills and healthy sexuality; to learn about external

boundaries; to build self-esteem

AGES

9 through 18

TIME

30-40 minutes

PURPOSE

This exercise gives participants a sense of p o w e r and hope that assists t h e m in

their recovery w o r k from the sexual abuse. It is adapted from an i m a g e r y exercise
in M a r t y R o s s m a n ' s b o o k Healing Yourself: A Step-by-Step Program for Better Health
Through Imagery (1987).

DO THIS EXERCISE TO

• Give participants a sense of inner strength and a stronger core self-image.

• Create an i m a g e of what it looks like and feels like to b e healthy again.
• R e d u c e and desensitize trigger reactivity.

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254 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT DO THIS EXERCISE WHEN

• T h e r e are group m e m b e r s w h o dissociate easily and w o u l d h a v e difficulty

maintaining awareness and attachment to their present surroundings follow-
ing the exercise.

WHAT YOU NEED

• Paper
• Pastels, paints and paintbrushes, or markers

INSTRUCTIONS

Tell the group y o u will do a guided imagery exercise with t h e m , and explain
that i m a g e r y is not the s a m e for any t w o people. Tell them, "It's e a s y enough. All
y o u h a v e to do is use your i m a g i n a t i o n s / ' H a v e group m e m b e r s spread out in the
r o o m and ask t h e m to get comfortable w h e r e they will not b e distracted b y anyone
else.
B e g i n w i t h a progressive relaxation to help group m e m b e r s focus inward. T h e n
lead t h e m to an inner place of deep relaxation and healing. H e r e is an e x a m p l e of
a healing i m a g e r y exercise:

To b e c o m e m o r e relaxed, go to a place in your m i n d that's filled with great

beauty, peacefulness, and security . . . a place that feels safe a n d beautiful and
healing to you. It m a y b e a place that's real or imagined. Take a few m o m e n t s
to look around this place and feel m o r e comfortable here. Find a spot w h e r e
y o u feel m o s t relaxed, centered, and quiet in this place. . . . B e c o m e c a l m and
comfortable here.
W h e n y o u are ready, n o t i c e a n y p r o b l e m y o u are h a v i n g b e c a u s e o f t h e
s e x u a l assault. . . . It m i g h t b e h o w y o u feel or h o w y o u r b o d y feels. . . .
S i m p l y p u t y o u r attention there, s t a y i n g c o m p l e t e l y c a l m , n o n e e d to
w o r r y . . . y o u are safe now. . . . A l l o w an i m a g e to c o m e to y o u that
r e p r e s e n t s this p r o b l e m . . . . It m i g h t b e different from w h a t y o u e x p e c t or
it m i g h t b e familiar. . . . J u s t a l l o w it to b e w h a t e v e r c o m e s u p . . . . L e t it
b e c o m e c l e a r e r and clearer. . . . O b s e r v e it carefully.

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Healthy Body Image and Self-Protection Exercises 255

E x p l o r e this i m a g e from as close or as far a w a y as y o u feel c o m f o r t -

able. . . . Try o b s e r v i n g it carefully from different p e r s p e c t i v e s . . . . D o n ' t try
to c h a n g e i t . . . j u s t n o t i c e w h a t c a t c h e s y o u r attention.
W h a t s e e m s to b e the m a t t e r w i t h this i m a g e ? . . . H o w d o e s this i m a g e
s y m b o l i z e t h e p r o b l e m ? . . . W h e n y o u k n o w this, let a n o t h e r i m a g e a p p e a r
that r e p r e s e n t s t h e solution, the h e a l i n g o f this p r o b l e m . . . . A g a i n , let t h e
i m a g e arise w i t h o u t a n y effort . . . a n d a l l o w it to b e c o m e c l e a r e r a n d
clearer. . . . W a t c h it closely from different a n g l e s . . . . H o w d o e s this i m a g e
represent healing?
H o l d this i m a g e in y o u r m i n d . . . n o w recall the first i m a g e n e x t to it
H o w d o t h e y differ? . . . H o w do t h e y relate to e a c h other? . . . O b s e r v e t h e m
carefully.
N o w m a k e o n e i m a g e . . . the h e a l i n g i m a g e . . . . L e t the h e a l i n g i m a g e
t a k e u p m o r e a n d m o r e space. . . . L e t it c h a n g e the o t h e r i m a g e o f t h e
p r o b l e m into t h e h e a l i n g i m a g e . . . . D o this in w h a t e v e r w a y w o r k s for
you S t a y r e l a x e d a n d c o m f o r t a b l e . H o l d t h e h e a l i n g i m a g e in y o u r m i n d
a n d k n o w t h a t y o u c a n h a v e this i m a g e a n y t i m e y o u think a b o u t it Each
t i m e y o u i m a g i n e this h e a l i n g i m a g e y o u b e c o m e stronger a n d h e a l t h i e r
You c a n r e m e m b e r it a n y t i m e .
N o w i m a g i n e y o u r s e l f s l o w l y c o m i n g b a c k to this r o o m . B e g i n c o m i n g
b a c k o n e step at a t i m e . . . as I c o u n t from o n e to ten. . . . S t a y in a r e l a x e d
state. . . . O n e , t w o . . . just b e g i n n i n g to m o v e , . . . three, . . . feeling c o m -
fortable, . . . four, five, . . . halfway to the r o o m , . . . six, . . . r e m e m b e r i n g
w h a t w a s i m p o r t a n t to y o u from this imagery, . . . seven, . . . feeling m o r e
a w a k e , . . . e i g h t , . . . y o u r eyelids m i g h t b e feeling lighter, . . . n i n e , . . .
feeling b e t t e r t h a n b e f o r e , . . . t e n , . . . fully a w a k e , o p e n i n g y o u r e y e s , a n d
b a c k in this r o o m .

H a v e group m e m b e r s immediately get drawing or painting materials and b e g i n

creating the healing images they had. W h e n all h a v e completed their i m a g e s , c o m e
b a c k together as a group and talk about the images. A s k each person, as the group
m e m b e r s share, w h a t kinds of feelings she h a d with each of the i m a g e s a n d h o w
she is feeling now. G i v e group m e m b e r s a chance to ask one another questions.

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256 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

Generally, children are able to use their imaginations and visualize images very
easily. There are times, however, when children's fears make it difficult for them to
feel comfortable enough to close their eyes, In these cases, take time and explain
the imagery process step by step. Have any children who feel scared choose places
in the room near friends or a facilitator. Encourage them to try closing their eyes, and
if it still feels too hard, give them permission to open their eyes at any time. Encourage
them to do the imagery even if they need to keep their eyes open.
In the past, we have used the image of going down some stairs as a way of
deepening relaxation to assist in creating healing imagery We stopped doing this,
however, when a little girl in group was triggered by the image of the bottom of the
stairs. She had been abused in the downstairs of a house when she was very young.
We now try to limit and use only very general image suggestions when children have
difficulty imagining a safe place. For example, you might suggest that they imagine
their favorite place or what their favorite place might look like, or a place that they
have always wanted to go.
The images that get created during this exercise can be used throughout the
remainder of the group sessions. You may also want to repeat this exercise in a later
group session, especially if anyone has difficulty creating a healing image. This
exercise also provides a good baseline for assessing how victimized the group
members still feel from the sexual assault
1
In one of our girls groups, Jessica's healing image was of talking with her offender
and asking him why he had abused her, She held this image in her mind, and though
she had difficulty confronting him in group role-plays, she was finally able to confront
him in individual therapy a year later.
Andrea's healing image was an image of her body as a chalice overflowing. This
contrasted greatly to the emptiness and loss she felt after finally realizing her
perpetrator had manipulated her into believing that she was his girlfriend. This was
a long process for Andrea, and this healing image helped to reinforce her strength.

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Healthy Body Image and Self-Protection Exercises 257

Body Tracing

GOALS

To build self-protection skills, healthy sexuality, and good b o d y i m a g e

AGES

4 through 6

TIME

20-30 minutes

PURPOSE

This exercise helps to introduce group m e m b e r s to the concepts of identifying

personal boundaries, being aware of their o w n bodies and bodily sensations, while
learning to express themselves regarding touch they like and do n o t like.

DO THIS EXERCISE TO

• C o n t i n u e to reinforce the children's ability to define and express personal

safety needs.
• Define age-appropriate sexual behavior.
• Introduce the concept of the rights and responsibilities of h a v i n g a b o d y to
protect and nurture.

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258 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• A n y child in the group is hypersensitive to any form of touch. F o r such a child,

y o u c a n modify the exercise: Let her k n o w her b o d y w o n ' t b e touched at all.
If she still feels too uncomfortable, give her the option of d r a w i n g an outline
of h e r b o d y freehand. This w a y she does not have to lie o n the paper, w h i c h
m a y b e too vulnerable a position for her.

WHAT YOU NEED

• Roll e n d of newsprint (available at m o s t newspaper printing offices)

• C o l o r e d markers

INSTRUCTIONS

Before group starts, measure and cut newsprint in lengths that are as long as the
tallest group member.

Part I: Let group m e m b e r s k n o w that y o u will b e tracing around their bodies.

H a v e e a c h child decide w h a t feels m o s t comfortable to her, either lying d o w n on
the n e w s p r i n t with her face toward the ceiling or standing w i t h her b a c k against
newsprint that is hanging on the wall. Also, encourage each child to choose her
favorite color for y o u to trace with.

W h i l e y o u m a k e a tracing on the newsprint around each child's body, talk to her

to b e sure she is comfortable. A s k her to tell y o u to stop if the m a r k e r is tickling her
or if she doesn't w a n t y o u to trace around any part of her. D o not trace close to the
child's genital area. D r a w to slightly above her knees on the inside o f her legs, and
later, after h e r b o d y is fully traced and she is off the paper, y o u can fill this part in
freehand. B y talking to the child during the tracing and e n c o u r a g i n g her to state
h o w she is feeling, y o u help her to focus her awareness on her b o d y and her personal
safety needs.

Part II: Explain to the group m e m b e r s that they will b e using a color code to
indicate their personal safety needs related to the different areas of their bodies.
H a v e t h e m color the tracings of their bodies with green, red, yellow, and blue
according to the following key:

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Healthy Body Image and Self-Protection Exercises 259

• Green: All areas that I like to b e touched.

• Red: All parts of m y b o d y I don't like to b e touched.
• Yellow: T h e parts of m y b o d y that I don't care if I a m touched.
• Blue: T h e parts of m y b o d y only I can touch.

H a n g the tracings on the wall and h a v e the children color them according to the
color key. A s they w o r k o n their drawings, talk with them about the specific areas
they like or don't like to h a v e touched and why.

HINTS

It is helpful with children in this age group to remind them what the different
colors mean, because they will just keep coloring with whatever color they are using
if you don't provide some gentle nudging.
Often, we follow this exercise with a hand or foot massage that children do
together in pairs. This heips reinforce appropriate touch and a gentle approach to
nurturing their bodies, ff you decide to do such massage and you are using hand
lotion, have a facilitator put it in the group members* hands or supervise it very closely.
Many young children will get too much lotion if they are allowed to squeeze it into
their hands themselves. Naturally you should not use lotions or oils if any kinds of
lubricants were used during the abuse of any of the children in group.

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260 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Safety Plan

GOALS

To build self-protection skills and healthy sexuality; to learn about internal

boundaries

AGES

6 through 12

TIME

15 minutes

PURPOSE

This exercise helps children think about their safety and actively identify adults
they c a n confide in. It also encourages them to ask for help w h e n they need it.

DO THIS EXERCISE TO

• Reinforce the concept of the rights and responsibilities of h a v i n g a b o d y to

protect and nurture.
• Increase the children's ability to m a k e conscious behavioral choices.
• Increase the children's ability to define and express personal safety needs.

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

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Healthy Body Image and Self-Protection Exercises 261

WHAT YOU NEED

• Paper
• Pencils or pens

INSTRUCTIONS

Part I: A s a group, discuss what the children w o u l d do if they n e e d e d help and

did not feel safe. A s k t h e m to think of three things they could do. G i v e t h e m a few
minutes to c o m e u p with their o w n ideas about w a y s they could get help. H e r e are
s o m e suggestions that c a m e from some of our group members:

• G o to the n e i g h b o r ' s house.

• Call the police.
• G o into a store.
• Call a friend.
• Call y o u r parents.
• G o to the school counselor.
• Call y o u r counselor.
• Talk to y o u r teacher.

Part II: H a v e each child write d o w n the n a m e s of three people h e w o u l d go to

if h e n e e d e d help. If a child cannot c o m e up with three names, contact his individual
counselor so that the child can also w o r k on safety issues in his individual sessions.

HINTS

The trauma of sexual abuse often leaves children feeling unsafe, which can put
them at further risk. This very simple and straightforward exercise takes only a few
minutes to do in a group, yet it gives tremendous strength in resources and ideas to
children in need. Talking about what to do when they need help gets them thinking
and feeling confident enough to choose consciously to protect themselves.
During this discussion, consider whether you believe that the children in the group
would really do what they are suggesting. To help strengthen their self-protective
skills, you may wish to follow this exercise with "Prevention Skits/ When children
seem less capable of self-protection (e.g., they have difficulty knowing what to do if

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262 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

they need help, or who to ask for help, or they hesitate to believe that anyone would
help them), practice prevention skills repeatedly with them. Encourage them by
recognizing their strengths and their uniqueness. Help educate the other aduits in
their lives to praise and encourage them as well This allows the children more
chances to feel stronger and more confident about themselves. We also suggest to
the parents of group members that their children need to feel strong in their bodies
as well as their minds, various activities-such as ballet, gymnastics, and martial
arts-can help create this feeling, depending upon the child's interests.
After doing this exercise we often assign homework for the children to do before
the next weeks group. We instruct them to ask someone for help during the week
and report back about it in group next week. Usually group members do the
homework or during group they think of something that happened where they
needed to ask for help.

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Healthy Body Image and Self-Protection Exercises 263

Simon Says and I Say

GOALS

To build self-protection skills; to build self-esteem

AGES

5 through 11

TIME

5-15 minutes

PURPOSE

In this exercise, group m e m b e r s play S i m o n Says with an assertive twist added.

Children learn that it is o k a y to say n o even w h e n playing a fun g a m e .

DO THIS EXERCISE TO

• Increase the children's capacity to value self.

• Increase the children's capacity to assert their will and desire appropriately
and effectively.
• Decrease restlessness in the group.

DO NOT DO THIS EXERCISE WHEN

• S o m e group m e m b e r s are not respectful of others' boundaries, so they will

not accept " n o . "

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264 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

• Too many of the group members will play only if they can be Simon and would
refuse to follow other Simons.

WHAT YOU NEED

No special materials needed

INSTRUCTIONS

Explain that the group is going to play a version of Simon Says that is played
just like the original, but with one exception: When Simon asks you to do something
that you do not want to, you can say no, and you don't have to do it.
To begin, pick a group member to play Simon. Instruct everyone else in the
group to follow what Simon tells them to do as long as he says, "Simon says." If he
tells you to do something without preceding his command with "Simon says," then
you are not to do anything. If you do what he says and he hasn't said "Simon says,"
then you are out. The last person left wins.

HINTS

When we play this game in group, we often say no to one of Simon's commands
early in the game to model being assertive. Group members soon follow our lead.
We have had children in groups who will participate only if they can lead. To help
such children move from a place of control, make it clear that the first one to lead
will be the one who is quiet and paying attention. The next one to lead will be the
one who wins the first game, so you must be playing in order to get a chance to be
Simon, If someone wins more than once, we have her choose somebody else who
hasn't had a turn yet and who is participating. She can then have the control of
choosing whether she wants to play or not.
Maddie, a 6-year-old, was not feeling comfortable in group. She appeared shy and
nervous and the other children were finding it hard to get to know her. When it was
her turn to be Simon, we supported and encouraged her to give it a try. She was great
at i t She came up with many fun, outlandish moves and switched from one move to
another so fast that she kept fooling people as Simon. Everyone was laughing and
engaged. This helped build her self-esteem, and she started to be more talkative in
group.

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Publications, Inc.
Healthy Body Image and Self-Protection Exercises 265

Prevention Skits
(Therapy Group Only)

GOALS

To build self-protection skills and healthy sexuality

AGES

4 through 11

TIME

45 minutes

PURPOSE

Often children w h o h a v e b e e n victimized in the past are at high risk for

revictimization. It is vital to practice specific prevention techniques with them.
These skits, w h i c h are divided up according to age groups, are useful for such
practice.

DO THIS EXERCISE TO

• Reinforce the concept of the rights and responsibilities of having a b o d y to

protect and nurture.
• Increase the children's ability to define and express personal safety needs.
• Build the children's self-protection skills.
• E m p o w e r the children to feel confident enough to act consciously and appro-
priately.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
266 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

• A n y group m e m b e r tends to dissociate as a coping style. Stop the exercise if

a child begins to dissociate or feels genuinely frightened.

WHAT YOU NEED

• Dress-up clothes (optional)

I N S T R U C T I O N S

Part I: Explain that everyone in group will b e doing role-plays about different
situations that could happen in real life. T h e y will have a chance to practice various
w a y s of protecting themselves. Let h e m k n o w that if at anytime a n y o n e is feeling
scared and wants the role-play to stop, she should just say so. Stay alert and
attentive to h o w the children are doing and initiate asking others for help if y o u
sense s o m e o n e is having trouble.

Part II: Pick a role-play from s o m e of the examples that follow. T h e facilitators
should d o o n e role-play first as an e x a m p l e for the group. A s y o u act out the
role-play and c o m e to the point in it where y o u need to assert yourself for
self-protection, turn to the group m e m b e r s and ask them for suggestions o n w h a t
y o u could say in order to stay safe. W h e n the group m e m b e r s h a v e a sense of the
exercise, c h o o s e a small group to act out the same or a different prevention skit.
Take turns so that each group m e m b e r has several chances to practice defining and
expressing her personal safety needs in the skits. W h e n s o m e o n e doing a role-play
gets stuck, h a v e her ask the rest of the group for ideas to help her. If y o u run short
of role-plays, ask the group m e m b e r s for s o m e of their ideas.

Vary the role-plays according to the ages of the group m e m b e r s . Following are
s o m e prevention skit ideas grouped for children ages 4 - 5 , 5 - 7 , and 8-11. ( S o m e skits
for teenagers are described in the exercise "Date Rape.")

S o m e e x a m p l e s of role-plays for 4- to 5-year-olds:

• You are at the park with your friend. A stranger comes up to y o u and wants
y o u to help h i m find his dog. W h a t do you do?

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Publications, Inc.
Healthy Body Image and Self-Protection Exercises 267

• You are at the park with a friend and her older brother. S o m e o n e offers y o u
c a n d y to c o m e with him. W h a t do y o u do?
• You and y o u r friend's brother are playing together. H e wants to touch y o u in
the private parts. You really like h i m and y o u want h i m to b e y o u r friend.
W h a t do y o u do?
• You are at child care and are playing house. A child asks y o u to pull d o w n
y o u r pants. W h a t do y o u do?

With little children (4-5 years old), y o u act out more fantasy than simple
role-plays. F o r e x a m p l e , everyone w o u l d pretend to b e kids playing in the p a r k and
one of the therapists w o u l d approach the group to try and trick a child. T h e other
therapist and other group m e m b e r s w o u l d help that child stay safe.

S o m e e x a m p l e s of role-plays for 5- to 7-year-olds:

• You just h a d a special dinner that your m o m m a d e for her favorite brother,
y o u r U n c l e Tim. W h e n your m o m tells y o u it's time for b e d , U n c l e Tim
volunteers to tell y o u a bedtime story. A s U n c l e Tim is telling the story, he is
also playing tickle. A t first it's fun, but then U n c l e Tim tries to tickle y o u d o w n
your pants. W h a t do y o u do?
• You are 7 and your friend Jason is 9. Today y o u are playing in y o u r room.
Jason w a n t s to play doctor, and he tells y o u to take off all y o u r clothes, so he
can see if y o u are sick. You say no. H e calls y o u a b a b y and says h e doesn't
w a n t to play with y o u anymore. W h a t do y o u do?
• You go to the c o m e r store with a friend to b u y s o m e candy. You see h e r slip
s o m e into her pocket. W h a t do y o u do?

T h e following role-play, also suitable for 5- to 7-year-olds, is d o n e in t w o parts.

In the first part children learn that they need to ask their parents or other caregivers
for permission to g o to someone's house. In the second part, they learn w h a t to do
w h e n s o m e o n e starts playing a g a m e that they do not like.

• (a) Mr. Garrison is your school bus driver. All the kids like h i m . S o m e t i m e s
he gives special treats and even invites s o m e kids over to see his n e w puppies.
Today h e invites y o u over and y o u love puppies. W h a t do y o u do? (b) After
y o u get permission, y o u go to Mr. Garrison's house. You're holding a p u p p y
and Mr. Garrison pretends he is a p u p p y and playfully tries to lick y o u r face.
T h e n h e acts like he has a p u p p y p a w and he touches y o u in y o u r private

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Publications, Inc.
268 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

parts. H e says that this is a very special g a m e and that he m a y e v e n give y o u

a p u p p y after the g a m e is over. W h a t do y o u do?

S o m e e x a m p l e s of role-plays for 8- to 11-year-olds:

• You get h o m e and your m o m isn't there. You don't h a v e a k e y and a strange
m a n is lurking around y o u r n e i g h b o r ' s yard. W h a t d o y o u do?
• You are sitting at a b u s stop and a cute boy, w h o is the older brother of a
classmate, stops b y in his car and asks y o u to go for a ride w i t h h i m . W h a t do
y o u do?
• You are at the mall and s o m e o n e keeps standing too close to you. W h e n y o u
b a c k u p they get closer. W h a t do y o u do?
• You are staying the night at a friend's house and she wants y o u to drink s o m e
alcohol with her. You see her take it out of her parents' liquor cabinet, and
w h e n y o u say no she keeps pressuring you. W h a t do y o u do?
• A friend of your parents' keeps putting his arm around and y o u don't like it.
W h a t do y o u do?
• Your sister c a m e h o m e drunk and wants y o u to lie to y o u r parents and says
she'll get in trouble if y o u don't keep the secret. W h a t do y o u do?

Part III: Return to the large group to discuss what w o r k e d and w h a t did not
w o r k in the role-plays. H a v e each person tell what she did before w h e n she w a s
touched, then h a v e her state w h a t she w o u l d do n o w if s o m e o n e tried to manipulate
her.

HINTS

When acting out the role-plays, be especially sensitive to how the children are
responding, if anyone is having a particularly difficult time, or appears to be shutting
down, pull her out of the role-play immediately She may be getting triggered and so
may be reexperiencing her own abuse, .
The most effective tools we can teach children in doing these role-plays is to say,
"NOP and "I am going to tell* These responses need to be stressed over and over
again. Studies have shown that offenders will not hurt children who they believe will
tell on them. For children who have disclosed their abuse in the past and havent been
believed, strongly encourage them to keep telling. Ask them to make lists of the people
they trust and could tell if they weren't believed by the first person they told.

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Publications, Inc.
Healthy Body Image and Self-Protection Exercises 269

Another effective way for children to avoid victimization is to scream. Screaming

"Firer catches people's attention and they usually respond quickly If a child screams,
"Help, this stranger is hurting me," others are more likely to get involved, because the
person threatening the child is a stranger, not a family member Naturally, encourag-
ing children to run away from potential offenders is important And of course you
should be sure they know how to call 911.
when doing these skits with younger children, we often alter some of the
role-plays so that the touch is good. This helps them learn to discern between safe
and unsafe touch. For example, a baby-sitter may ask a child if he would like to sit
on her lap while she reads him a story The baby-sitter may put her arm gently around
the child's waist or lightly touch his arm. No "bad" touch is intended. When the
children are acting this skit out, keep checking with them to see if they feel
rt
comfortable or if they are feeling "uh-oh feelings.

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Publications, Inc.
270 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Date Rape

GOAL

To build self-protection skills

AGES

12 through 18

TIME

60-90 minutes

PURPOSE

A c q u a i n t a n c e or date rape is extremely c o m m o n , and children w h o have b e e n

previously abused are even m o r e susceptible to this form of victimization. T h e focus
o n date rape in this exercise is intended to prevent further abuse and to help teens
recognize w h e t h e r they have b e e n exploited in their o w n dating experiences.

DO THIS EXERCISE TO

• Reinforce the concept of the rights and responsibilities of h a v i n g a b o d y to

protect and nurture.
• Increase the children's ability to define and express personal safety needs.
• B u i l d group m e m b e r s ' self-protection skills.
• E m p o w e r the children to feel confident enough to act consciously and appro-
priately.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
Healthy Body Image and Self-Protection Exercises 271

DO NOT USE THIS EXERCISE WHEN

• You suspect someone in the group has recently been date raped. (Instead of
doing this as a group exercise, discuss your concerns with the group member's
individual therapist.)

WHAT YOU NEED

• No Easy Answers videotape (optional; available from the Illusion Theater, 528
Hennepin Ave., Ste. 704, Minneapolis, MN 55403)

INSTRUCTIONS

Part I: Have group members brainstorm the definition of rape or sexual moles-
tation. When summarizing, make sure the final explanation includes "being coerced
or manipulating into doing something sexual that makes you feel uncomfortable."

Part II: Have group members brainstorm situations in which they have felt they
were manipulated sexually. Ask them what sort of "lines" or "tricks" were used.

Part III: Discuss the following questions with the group:

• How do you feel when you are being manipulated?

• What are the feelings inside you?
• Where do you feel it in your body?
• What thoughts go through your head when you are being manipulated?

Part IV: The facilitators now role-play a potentially dangerous situation. We like
using this one, which we have adapted from the No Easy Answers video (see above).
One facilitator plays Frank and the other is Susan. The facilitators set the scene:
Frank and Susan are on their first date. They just went to dinner and a movie. Frank
paid for both of their dinners. They have been having a really good time. They now
decide to drive around and talk for a while. Frank takes Susan to "his favorite spot"
and parks the car. They are fairly isolated from any main roads, although there are
a couple of other cars parked around there too.

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272 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

N o w b e g i n the role-play. Frank starts to " c o m e o n " to Susan. S h e is uncomfort-

able. A l t h o u g h she likes him, she wants to k n o w h i m better before getting "in-
v o l v e d . " S h e doesn't even w a n t to kiss h i m yet. A s Frank c o m e s o n to Susan, the
facilitator playing Susan asks group m e m b e r s for advice o n w h a t she should do.
She tries out their suggestions and F r a n k responds to each one o f them. Afterward,
h a v e a discussion as to w h a t w o r k e d and w h a t did not. W h y did s o m e suggestions
w o r k better than others?

Part V: N o w h a v e group m e m b e r s participate in role-playing. H a v e them think

of situations they h a v e found themselves in or are concerned about. H a v e t h e m
rehearse b o t h serious and outrageous responses to give t h e m the chance to risk
s o m e t h i n g they w o u l d never do otherwise. M a k e sure that o n e o f the scenarios
p l a y e d out includes both people being drunk or stoned.

Part VI: You m a y consider bringing in a self-defense instructor at this point.

P e o p l e w h o specialize in self-defense often have simple hints to give group m e m -
bers that will help build their confidence. O n e simple hint is, if y o u can hit y o u r
attacker in the eyes or the nose, it m a y give you enough time to get away. This can
lead to a discussion about when it would feel okay for group members to use physical
force to get away from someone. These are important questions to consider:

• W h i c h is worse, hurting s o m e o n e else or getting hurt?

• Is b e i n g forced or coerced into doing something sexual hurtful to yourself?

HINTS

One of the reasons date rape is so prevalent is that girls are afraid to make a scene
and are also afraid to hurt boys* feelings. In the role-plays, have girls practice making
a scene. Also, have them rehearse telling a guy, *i am not afraid to tell others that
you are sexually abusive/ The willingness to tell seems to be the best protection
there is.
Haw group members practice using the "broken record** technique rather than
snappy comebacks. By not getting involved in a war of words and just repeating
yourself over and over again, a person wilt take you seriously and know you are not
willing to play any games. For example, when Frank says, "Ah, c'mon, Susan, what's
the big deal? 1 just want to kiss you," she should respond, "But 1 dont want to kiss."
He might then say, "Why are you acting like such a body?" Her response: "I dont want

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Healthy Body Image and Self-Protection Exercises 273

1
to kiss/ Frank says, "Cmon, lets just practice one time/' Susan's response: "I dont
want to kiss/
Explain to group members that the sooner they say something in an uncomfort-
able situation, the easier it is to stop it Make it clear that each of them has to decide
for herself what feels comfortable and what does not Maybe kissing Frank is fine but
fondling isn't Maybe a group member has made love before but does not want to
anymore. Everyone has a right to choose who she wants to be with and what she
feels comfortable doing.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
chapter
12

Closing Exercises

E a c h group session and every group series ends with closure. Closure
is a transitional process. It is a way to celebrate and summarize each child's efforts and
achievements. It is a time to plan for the future, prepare for the next experience, and
say good-bye.
Closure helps to make group a more tangible experience for children. It creates an
opportunity for them to learn how to acknowledge their progress. It teaches them how
to value what they have learned about themselves and how to use the skills they have
acquired to ensure their future safety. To reinforce what children have learned, positive
comments are often made to children during closing exercises, such as "Mickey knows
who to ask and how to ask for help when he does not feel safe" and "Zac has learned
what some of his triggers are and knows how to make himself present." These affirma-
tions both support and encourage children in continuing to make healthy choices.
Summarizing the children's progress also enables them to gain perspective on their
abuse. When children understand that abuse is an experience with a beginning, a
middle, and an end, it is easier for them to trust in their present safety and to find hope
for the future.
"Completion of Group Ceremony" is one exercise we use to acknowledge children's
successes. This exercise offers the opportunity for family members to share in celebrat-
ing their children's progress and completion of group and for the children to take home
concrete reminders of their accomplishments. Another closure exercise, "Debriefing
and Evaluating Group," is used to review concepts often introduced to children for the
first time in group. This process may be useful for revisiting and reinforcing ideas such
as the rights and responsibilities of having a body to protect and nurture. This exercise
also serves as a review of the entire group process, starting from the children's thoughts
and feelings when they arrived the first day to their thoughts and feelings on this day
275
276 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

of closure. This reinforces the concept of "then" and "now" and that life is an ever-
changing process.
Part of group closure includes developing a plan for the future of each child. Most
group members will continue to have contact with individual therapists. Some might
benefit from additional group experience or from family therapy. The group facilita-
tors' review and evaluation of a child's progress is integral to the success of the
individual therapist's treatment plan. What the facilitators share about the child's
progress in group will also help the individual therapist to determine the length of time
and the modality of treatment most appropriate for the child.
As group draws to a close, some children will naturally become more inquisitive
about when they will be finished with their therapy. The facilitators can inform them
that they will contact their individual therapists and tell them about how well they did
in group, which will help their therapists decide how much longer therapy will be
needed. Other children who are further from completion may be anxious about group
ending. They should be supported and encouraged to both recognize and rely on the
resources they still have available in their lives, such as grandparents, their individual
therapists, school counselors, and caseworkers. This also may be a time for children to
exchange phone numbers, so that they can retain connections with one another.
For children who are not continuing in individual therapy after completing group,
it is especially important that the facilitators review the resources they have available
if the need arises. The facilitators can discuss with these children who they feel
comfortable going to for help and what they can do if they need help feeling safe in the
future. The facilitators should also make sure to offer themselves as resources, particu-
larly to children who have few others to rely on.
Closure helps children to feel complete about what they have accomplished in
group. It teaches them to contain their issues, and it helps them to make the transition
back into their lives, with direction and goals for a positive future.
Closing Exercises 277

Wishes

GOALS

To provide closure; to build self-esteem

AGES

3 through 18

TIME

10-15 minutes

PURPOSE

This exercise helps group members to leave group with positive feelings about
themselves and e a c h other, and to hold on to a sense of future.

DO THIS EXERCISE TO

• Increase the children's capacity to desire, believe in, and hold h o p e for a
positive future.
• E n d group o n a positive note and leave the children feeling connected with
the other m e m b e r s .

DO NOT USE THIS EXERCISE WHEN

There is n o reason not to do this exercise.

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Publications, Inc.
278 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

WHAT YOU NEED

• Colorful individual sheets of paper

INSTRUCTIONS

H a v e the group sit in a circle and choose someone to go first. T h e n , going around
the circle, h a v e each m e m b e r give that person a wish for the future, such as " I w i s h
that y o u are safe with your brother," " I wish that y o u keep y o u r great laugh," or " I
wish that y o u can see h o w wonderful y o u are to b e with." E a c h p e r s o n then takes
a turn at receiving wishes. A s the wishes are spoken to each, a facilitator should
write t h e m d o w n on a colored piece o f paper for the individual to keep.

HINTS

If you late the group members know about this exercise a week in advance, they
may think about their wishes ahead of time and the wishes may be more profound.
This is a quick, short, positive exercise that can also be used as a filler during any
other session.

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Publications, Inc.
Closing Exercises 279

Debriefing and
Evaluating Group

GOAL

To provide closure

AGES

4 through 18

TIME

10 minutes

PURPOSE

This exercise allows the group m e m b e r s to review and evaluate w h a t t h e y h a v e

learned in group over the weeks. It also encourages the transition of group m e m b e r s
from d e p e n d i n g o n each other to meeting n e w people and feeling c o n n e c t e d to the
"outside" world.

DO THIS EXERCISE TO

• R e v i e w the learning and growth that h a v e taken place in group.

• Facilitate closure of group.
• Help group m e m b e r s transition from group to m o v i n g on.
• Restate the children's accountability for their o w n behaviors, feelings, and
thoughts a n d the offenders' responsibility for the abuse.

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280 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise (just keep it short).

WHAT YOU NEED

• C h a l k b o a r d and chalk or large piece of paper and marker

INSTRUCTIONS

Part I: R e v i e w s o m e of the exercises y o u have done during the group sessions

and highlight the general themes. A s k the group members:

• D o y o u remember w h e n y o u walked into group on the first day? H o w did

y o u feel?
• W h a t w e r e s o m e of the g a m e s w e did that first day to get to k n o w one another?
• D i d a n y of those g a m e s help y o u to feel safer in group and less nervous?
• W h a t else did w e do that helped y o u feel safer?
• D o y o u remember w h e n w e first started talking about the touch? H o w did
y o u feel then?
• H o w d o y o u feel n o w w h e n w e talk about it?
• W h e n y o u first c a m e to group, did y o u think the touch w a s y o u r fault? D o
y o u still think that? If not, w h o s e fault is it?
• W h a t else did w e do in group that helped you?

THERAPY GROUP ONLY: A d d these questions:

• R e m e m b e r w h e n w e talked about triggers? W h a t can y o u do w h e n y o u are

b e i n g triggered to b e b a c k here in the present time?

Part II: In all groups, brainstorm with group members:

• W h a t w a s the best part of group?

• W h a t w o u l d have m a d e group better?
• In w h a t w a y s are y o u different n o w from w h e n y o u c a m e here the first w e e k ?

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Closing Exercises 281

HIHTS

While reviewing the group exercises, include the objectives o f trust and safety,
understanding triggers, boundary setting, accountability for the abuse, and so o n .
w h e n asking w h a t group members teamed, feel free to add y o u r o w n observations;
for example, "Katy, w h e n y o u first came, remember h o w y o u used to hide under a
pillow and w o u l d n o t talk to anyone? Then y o u teamed t o ask for w h a t y o u needed.
Instead o f hiding under the pillow y o u learned to state, 1 would like some attention"
or Talking about this makes me feel y u c k y inside.* Then w e Knew h o w to help y o u .
l hope y o u keep asking for w h a t y o u need so others can understand."
Keep this review short, especially for younger children. The members will be
excited because it is the last day of group and y o u will probably be doing some form
of party or celebration. Therefore, their attention spans will be short.

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282 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

Completion of
Group Ceremony

GOAL

To p r o v i d e closure

AGES

4 t h r o u g h 18

TIME

25 minutes

PURPOSE

This closing exercise highlights and honors the significance of the children's
c o m p l e t i n g the group. Parents and other caregivers should also b e included in the
c e r e m o n y as long as each group m e m b e r has s o m e o n e w h o can attend it. (This
exercise w o r k s well w h e n preceded b y "Debriefing and Evaluating Group.")

DO THIS EXERCISE TO

• B r i n g conscious closure to the end of group.

• Celebrate the accomplishments that the children h a v e m a d e in group.

DO NOT USE THIS EXERCISE WHEN

T h e r e is n o reason not to do this exercise.

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Publications, Inc.
Closing Exercises 283

WHAT YOU NEED

• Preprinted personalized certificates for all group m e m b e r s (These certificates

are m a d e in advance after facilitators h a v e brainstormed e a c h m e m b e r ' s
strengths. T h e s e strengths are printed on the certificates along with general
statements regarding the completion of group. Examples of s o m e certificates
follow this exercise.)

INSTRUCTIONS

Part I: A s k the children's parents or other caregivers in advance to c o m e up with

mental lists o f things they are proud of about their children w h o are in group. Let
group m e m b e r s k n o w that their parents will b e joining them for a few m o m e n t s in
this session.

Part II: H a v e the parents c o m e into the r o o m and sit next to their children. Stand
up and present a s u m m a r y of group and w h a t the children h a v e learned d u r i n g the
past few w e e k s . T h e n , one b y one, call each child up to the front of the r o o m to
receive her certificate. A s each child is called up, ask her parent to share w i t h her
the things about the child that she is proud of. F o l l o w this b y reading aloud to the
group the personalized statements about the child on the child's certificate. T h e n
h a n d the certificate to the child and shake her hand. Everyone then a p p l a u d s as the
child returns to her seat, and the process continues for the next child.

Part III: W h e n all of the certificates h a v e been passed out, join with the group
m e m b e r s in the middle of the circle to do a chant. (Practice the chant before the
parents c o m e in, so group m e m b e r s are prepared for it.) Chants that w e h a v e used
in the past include "Hey, h e y we're really great!" " W e feel, w e think, w e share, w e ' r e
strong!" and " W e like us!" Choose just one chant and have the group repeat it at
least five times, getting louder each time. Finish b y having e v e r y o n e share a big
round of applause. A t this point, have the parents leave the room.

Part IV: To celebrate group completion further, w e end the session with a party.
Pizza and soda p o p are usually the popular requests. (We ask the group about pizza
toppings and dietary restrictions the w e e k before.) If the parents h a v e agreed, this
is also a g o o d time for children to exchange p h o n e numbers.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
284 GROUP WORK WITH SEXUALLY ABUSED CHILDREN

HINTS

When making the certificates, make sure you spell the children's names correctly
We make our certificates on our computer. Most paper stores, office supply stores,
and copy centers have papers with fancy borders that can be used as certificates.
Some parents have a difficult time giving compliments to their children and often
will qualify everything they say. Help them to give clear positive statements, if a
parent makes disparaging remarks, such as Tin proud she got through group, 1 just
1
wish she wouldn't wear those awful colors; you can protect the child and teach the
parent by stating, *r think those colors look great on her. They are fun and bright. It
sounds like you and your daughter have different tastes in clothing, let's get back to
other things you are proud of. Stay positive."
Teenagers may not want their parents at the celebration. Check with teen group
members the week before to give them a choice of whether to have their parents at
the ceremony or not Remind them that parents will be there for only 10 or 15
minutes.

Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage
Publications, Inc.
285
Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage Publications, Inc.
286
Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage Publications, Inc.
287
Grotsky, Camerer, and Damiano, Group Work With Sexually Abused Children. Copyright 2000, Sage Publications, Inc.
 APPENDIX:
SAMPLE GROUP OUTLINES

Preschool Support Group

(8 weeks, 60-minute sessions)

Weekl

Goal: Safety and trust

"Ball Toss" to learn each others' names and other general information (use a teddy bear for
a ball)
"Safety Rules"
" Y e s / N o / M a y b e Continuum"
"My Own Safe Place"
A story about safety or building friendships and snack

Week 2

Goals: Safety and trust; self-esteem

"Ball Toss" to relearn names and say one thing you like about yourself
Review safety rules
"Group M a s c o t "
"London Bridge"
Draw a picture of yourself big and strong
Story about feeling good about yourself and snack

289
290 GROUP WORK WITH SEXUALLY A B U S E D CHILDREN

Week 3

Goals: Self-esteem and boundaries (identifying feelings)

"Ball Toss" using questions about general feelings
"Animal Boundaries"
"If You're Angry and You Know It" (using all feelings)
Draw pictures of feelings you feel sometimes (happy, mad, sad, confused)
Story about feelings and snack

Week 4

Goals: Boundaries (feelings about the abuse); dynamics of abuse

"Ball Toss" with questions about feelings about the abuse
"Revised Cookie Jar Tune"
" Y e s / N o / M a y b e Continuum" with feelings about the abuse
"Magic Tricks"
Draw a picture of your feelings about being touched
Story about being tricked and snack

Week 5

Goals: Triggers; dynamics of abuse

"Ball Toss" with an explanation of triggers first; then each give an example of a positive
and a negative trigger unrelated to abuse
Read 101 Dalmatians (a short version)
Draw a picture of a safe place
"Revised Cookie Jar Tune"

Week 6

Goal: Boundaries (regarding feelings about the offender)

"Ball Toss" with questions about triggers they have and ways they can center themselves
"Clay Faces"
"Boundary Line"
"London Bridge"
"Let It All O u t / S o u n d Train"

Week 7

Goals: Self-protection; healthy body image

"Ball Toss" about parts of your body you like
"Simon Says and I Say"
"Safety Plan"
Story about self-protection or body image and snack
Appendix 291

Week 8

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony"
"Friendship Medals" while eating and partying

Preschool Therapy Group

(8 weeks, 60-minute sessions)

Weekl

Goal: Safety and trust

"Ball Toss" to learn each others' names and other general information (use a teddy bear for
a ball)
"Safety Rules"
" Y e s / N o / M a y b e Continuum"
"My Own Safe Place"
A story about safety or building friendships and snack

Week 2

Goals: Safety and trust; self-esteem

"Ball Toss" to relearn names and say one thing you like about yourself
Review safety rules
"Group Mascot"
"London Bridge"
Story about feeling good about yourself and snack

Week 3

Goals: Self-esteem; boundaries (identifying feelings)

"Ball Toss" using questions about general feelings
"Animal Boundaries"
"If You're Angry and You Know It" (using all feelings)
Draw pictures of feelings you feel sometimes (happy, mad, sad, confused)
Story about feelings and snack

Week 4

Goals: Boundaries (feelings about the abuse); dynamics of abuse

"Ball Toss" with questions about feelings about the abuse
"Revised Cookie Jar Tune"
292 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

" Y e s / N o / M a y b e Continuum" with feelings about the abuse

"Magic Tricks"
"The Trick Hat"
Story about being tricked and snack

Week 5

Goals: Triggers; dynamics of abuse

"Ball Toss" with an explanation of triggers first, then each give an example of a positive
and a negative trigger unrelated to abuse
Read 101 Dalmatians (a short version); discuss how the puppies might be triggered later in
life (eat a snack during the story)
"Drawing Where Molested"
"Centering"
"Revised Cookie Jar Tune"

Week 6

Goals: Boundaries (regarding feelings about the offender)

"Ball Toss" with questions about triggers they have and ways they can center themselves
"Clay Faces"
"Boundary Line"
"Talking to the Offender Psychodrama"
Eat a snack
"Let It All O u t / S o u n d Train"

Week 7

Goals: Self-protection; healthy body image

"Ball Toss" about parts of your body you like
"Prevention Skits"
"Simon Says and I Say"
"Safety Plan"
Story about self-protection or body image and snack

Week 8

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony"
"Friendship Medals" while eating and partying
Appendix 293

1
Boys Support Group
(8 weeks, 90-minute sessions)

Weekl

Goal: Safety and trust

"Imaginary Object" to learn each others' names and other general information
"Safety Rules" (while eating snack)
"Group Mascot"
" M y O w n Safe Place"
Tag (if you have enough room) or Red L i g h t / G r e e n Light

Week 2

Goals: Safety and trust; self-esteem

"Ball Toss" to relearn names and say one thing you like about yourself
Quick review of safety rules
" Y e s / N o / M a y b e Continuum"
Draw a picture of yourself big and strong (snack while drawing)
Discussion of the power of our thoughts (postive thoughts help us feel and be stronger)
Fun closing game, such as Telephone, Freeze Tag, or Duck, Duck, Goose

Week 3

Goals: Self-esteem; boundaries (identifying feelings)

"Ball Toss" using general questions about identifying feelings
" Y e s / N o / M a y b e Continuum" with questions about feelings
"Sentence Completion" (with snack during the discussion)
"If You're Angry and You Know It" (using all feelings)
Draw pictures of feelings you feel sometimes (happy, mad, sad, confused)
Closing exercise such as passing a hand squeeze around the circle

Week 4

Goal: Boundaries (with a focus on anger)

"Ball Toss" with questions about different feelings they had during the week
"Target of the Offender"
" Y e s / N o / M a y b e Continuum" with feelings about situations when they might feel angry
and ways they sometimes express that anger
"Clay Faces" (and snack)
"If You're Angry and You Know It" (focusing just on anger)
Closing exercise—a fun game
294 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

Week 5

Goals: Internal boundaries; dynamics of abuse

"Ball Toss" with questions regarding feelings about the abuse
"Revised Cookie Jar Tune"
"Magic Tricks"
Write a list of three ways you were tricked by your abuser.
Using paper taped to the wall, draw a line to represent how tall the abuser was and a line
showing how tall the child was. Discuss how difficult it is to stand up to someone
larger than you. Do this for each child. (Serve snack during this time)
Quick discussion of why people abuse others (Include an explanation that they have a
touching problem and are drawn to children. Explain that this has nothing to do with
homosexuality.)
"Let It All O u t / S o u n d Train"

Week 6

Goals: External boundaries; triggers

"Ball Toss" with questions about how their abusers tricked them
"Life Vest"
"Feelings/Thoughts Mask" (with snack)
"Centering"
"Simon Says and I Say"

Week 7

Goal: Self-protection
"Ball Toss" with questions about a time this week they used their vest and one thing they
like about another person in group
"Preventions Skit"
"Safety Plan" (with snack)
"Simon Says and I Say"

Week 8

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony" and party
Appendix 295

1
Boys Therapy Group
(8 W e e k s , 90-minute sessions)

Weekl

Goal: Safety and trust

"Imaginary Object" to learn each others' names and other general information
"Safety Rules" (while eating snack)
"Group Mascot"
Tag (if you have enough room) or Red Light/Green Light

Week 2

Goals: Safety and trust; self-esteem

"Ball Toss" to relearn names and say one thing you like about yourself
Quick review of safety rules
"Group Mascot"
" Y e s / N o / M a y b e Continuum"
"My Own Safe Place" (snack during the exercise)
Fun closing game, such as Telephone, Freeze Tag, or Duck, Duck, Goose

Week 3
Goals: Self-esteem; boundaries (identifying feelings)
"Ball Toss" using general questions about identifying feelings
"Group Collage"
"Sentence Completion" (with snack during the discussion)
"If You're Angry and You Know It" (using all feelings)
Closing exercise such as passing a hand squeeze around the circle

Week 4

Goal: Boundaries (with a focus on anger)

"Ball Toss" with questions about different feelings they had during the week
"Target of the Offender"
"Sentence Completion" (in front of a video camera)
"If You're Angry and You Know It" (focusing just on anger)
Snack
Closing exercise—a fun game
296 GROUP W O R K WITH SEXUALLY A B U S E D C H I L D R E N

Week 5

Goals: Internal boundaries; dynamics of abuse

"Ball Toss" with questions regarding feelings about the abuse
"Revised Cookie Jar Tune"
"Magic Tricks" (one or two tricks)
"The Trick Hat"
Using paper taped to the wall, draw a line to represent how tall the abuser was and a line
showing how tall the child was. Do this for each child. (Serve snack during this time.)
Quick discussion on why people abuse others (Include an explanation that they have a
touching problem and are drawn to children. Explain that this has nothing to do with
homosexuality.)
Begin " M y Own BASK Book"
"Let It All O u t / S o u n d Train"

Week 6

Goals: External boundaries; triggers

"Ball Toss" with questions about how their abusers tricked them
Begin " M y Own BASK Book" (while eating snack)
"Boundary Line"
"Centering"

Week 7

Goal: Self-protection
"Ball Toss" with questions about a time this week they used their personal space and one
thing they like about another person in group
Finish " M y Own BASK Book"
"Prevention Skits"
"Safety Plan" (with snack)
"Simon Says and I Say"

Week 8

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony" and party
Appendix 297

1
Girls Support Group
(14 weeks, 90-minute sessions)

Weekl

Goal: Safety and trust

"Imaginary Object" to learn each others' names and other general information
"Safety Rules"
"Group Mascot"
"Sharing Our Stories"
If there is time, Tag (if you have enough room) or Red Light/Green Light

Week 2

Goals: Safety and trust; Self-esteem

"Ball Toss" to relearn names and say one thing you like about yourself
Quick review of safety rules
"Group Collage About the Abuse"
" Y e s / N o / M a y b e Continuum"

Week 3

Goals: Self-esteem; boundaries (identifying feelings)

"Check-In" (What thoughts or feelings did you have this week regarding the abuse?)
"Sharing Our Stories" (beginning part: Who touched you? How old were you? Are you safe
now?)
Draw a picture of yourself big and strong
Closing exercise such as passing a hand squeeze around the circle

Week 4

Goals: Self-esteem; boundaries

"Check-In" (Share one great thing and one rotten thing that happened this week.)
" Y e s / N o / M a y b e Continuum"
"Feelings/Thoughts M a s k "
"Questions and Answers Box"
Group hug or hand squeeze
298 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

Week 5

Goals: Self-esteem; boundaries

"Check-In" (Share one time in the past week you showed an inside feeling to someone on
the outside.)
"Friendship Medals"
"Questions and Answers B o x "
Red L i g h t / G r e e n Light or Tag

Week 6

Goals: Boundaries
"Check-In" (Has being sexually abused changed you in any way? If so, how has it changed
you?)
"Boundary Line"
"Life Vest"
Drawing of yourself wearing the life vest
"Questions and Answers B o x "

Week 7

Goals: Boundaries; dynamics of abuse

"Check-In" (Share a time this week that you used your life vest.)
"Familiar Feelings"
"Sentence Completion"
"Letter From Angie"
"Let It All O u t / S o u n d Train"

Week 8

Goal: Dynamics of abuse

"Check-In" (Is there anyone you trust? If yes, what about that person helps you to trust him
or her?)
"The Butterfly and the Spider"
"Personal Butterfly"
"Questions and Answers B o x "
Hot Potato with a ball (if time permits)

Week 9

Goals: Triggers; self-esteem

"Check-In" (Name three things you like about yourself.)
"101 Dalmatians"
"Centering"
"Target of the Offender"
"Questions and Answers B o x "
Appendix 299

Week 10

Goal: Boundaries
"Check-In" (Share a trigger you had this past week.)
"The Alligator River Story"
"Letter/Video to the Offender"
"Questions and Answers B o x "

Week 11

Goal: Healthy body image

"Check-In" (Share one thing you like about your body.)
"Body Rights and Responsibilities"
"Body Tracing"
"Questions and Answers B o x "

Week 12

Goals: Self-protection; healthy body image

"Check-In" (Name some ways you felt you used your body this week that felt good.)
Stretches (each person takes a turn leading the group in a body stretch)
"Healing I m a g e "
"My Safety and Comforts"
"Questions and Answers B o x "
"Simon Says and I S a y "

Week 13

Goal: Self-protection
"Check-In" (Share one time you stood up for yourself or protected yourself this week.)
Roleplay what to do if: (1) you notice a fire; (2) a car pulls up and a driver asks you for
directions; (3) you're home alone and someone comes to the door; and (4) your uncle
wants you to hug him but you don't because you feel a little bit icky inside.
Draw a picture of yourself healthy and strong
"Questions and Answers B o x "

Week 14

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony" and party
300 GROUP WORK WITH SEXUALLY A B U S E D CHILDREN

Girls' Therapy Group

( 1 5 w e e k s , 90-minute sessions)

Weekl

Goal: Safety and trust

"Imaginary Object" to learn each others' names and other general information
"Safety Rules"
"Group Mascot"
"Sharing Our Stories" (first set of questions)
If there is time, Tag (if you have enough room) or Red Light/Green Light

Week 2

Goals: Safety and trust; self-esteem

"Ball Toss" to relearn names and say one thing you like about yourself
Quick review of safety rules
"Group Collage About the Abuse"
" Y e s / N o / M a y b e Continuum"

Week 3

Goals: Self-esteem; boundaries (identifying feelings)

"Check-In" (What thoughts or feelings did you have this week regarding the abuse?)
"Sharing Our Stories" (second set of questions)
"Me, Through the Years"
Closing exercise such as passing a hand squeeze around the circle

Week 4

Goals: Self-esteem; boundaries

"Check-In" (Share one great thing and one rotten thing that happened this week.)
"Internal/External Self"
"Life Vest"
"Questions and Answers B o x "
Group hug or hand squeeze

Week 5

Goal: Boundaries
"Check-In" (Share one time in the past week that you used your life vest.)
"Sentence Completion"
Begin " M y Own BASK Book"
"Questions and Answers B o x "
Appendix 301

"Simon Says and I S a y "

Week 6

Goal: Boundaries
"Check-In" (Has being sexually abused changed you in any way? If so, how has it changed
you?)
"Why People Sexually Abuse Kids"
Continue " M y Own BASK Book"
"The Trick Hat"
"Questions and Answers B o x "

Week 7

Goal: Dynamic of abuse

"Check-In" (Do you think you could have stopped the sexual assault? If yes, how?)
"Letter From Angie"
"Sexual Assault Continuum"
"Sharing Our Stories" (third set of questions)
"Let It All O u t / S o u n d Train"

Week 8

Goal: Dynamics of abuse

"Check-In" (Is there anyone you trust? If yes, what about that person helps you to trust him
or her?)
Word association
"The Butterfly and the Spider"
"Personal Butterfly"
If there is time, "Questions and Answers B o x "

Week 9

Goals: Dynamics of abuse; boundaries (regarding feelings about the offender)

"Check-In" (What are some of your feelings toward the abuser?)
"My Own Safe Place"
"Talking to the Offender Psychodrama"
"Letter/Video to the Offender"
"Let It All O u t / S o u n d Train"

Week 10

Goal: Triggers
"Check-In" (Share one way your offender tricked or manipulated you.)
"Elizabeth's Triggers"
302 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

"Drawing Where Molested"

"Centering"
"Questions and Answers B o x "

Week 11

Goal: Triggers
"Check-In" (Share a time this week that you were triggered. What happened?)
"Triggered Memories"
"How We Sabotage Ourselves"
"Centering"
Group cheer

Week 12

Goals: Self-protection; healthy body image

"Check-In" (Share one thing you like about your body.)
"Body Rights and Responsibilities"
"Boundary Line"
"My Safety and Comforts"
"Questions and Answers B o x "

Week 13

Goal: Self-protection
"Check-In" (Share one time you stood up for yourself or protected yourself this week.)
"Prevention Skits"
"Healing Image"
"Questions and Answers B o x "

Week 14

Goals: Self-protection; dynamics of abuse

"Check-In" (What do you need to feel safer in your life now?)
" L e t t e r / V i d e o to Nonoffending Parent(s)"
"Safety Plan"
"Questions and Answers B o x "

Week 15

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony"
"Friendship Medals" while eating and partying
Appendix 303

Teen Support Group

(Ages 11+) (15 weeks, 90-minute sessions)

Weekl

Goal: Safety and trust

"Check-In" (How are you feeling about being here and what do you hope to get out of the
group?)
Self collage
"Safety Rules"
"Questions and Answers B o x "

Week 2

Goals: Safety and trust; self-esteem

"Check-In" (What was the most outrageous thing you did this week?)
Quick review of safety rules
"Group Mascot"
"Sharing Our Stories" (first set of questions)
Hot Potato with a ball

Week 3

Goal: Self-esteem
"Check-In" (Name three things you like about yourself.)
"Group Collage About the Abuse"
"Sharing Our Stories" (second set of questions)
Closing exercise such as passing a hand squeeze around the circle

Week 4

Goal: Boundaries
"Check-In" (Share one great thing and one rotten thing that happened this week.)
"Feelings/Thoughts M a s k "
"Life Vest"
Group hug or hand squeeze

Week 5

Goal: Dynamics of abuse

"Check-In" (Share one time in the past week that you used your life vest.)
"Letter From Angie"
304 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

"Sexual Assault Continuum"

"Sharing Our Stories" (third set of questions)
"Questions and Answers B o x "

Week 6

Goal: Boundaries
"Check-In" (Has being sexually abused changed you in any way? If so, how has it changed
you?)
"The Alligator River Story"
"Clay Faces"

Week 7

Goal: Dynamics of abuse

"Check-In" (Do you think you could have stopped the sexual assault? If yes, how?)
Checklist in "Why People Sexually Abuse Kids"
"Boundary Line"
"Lean On M e "
"Let It All O u t / S o u n d Train"

Week 8

Goal: Dynamics of abuse

"Check-In" (Is there anyone you trust? If yes, what about that person helps you to trust him
or her?)
"The Butterfly and the Spider"
"Personal Butterfly"
"Questions and Answers B o x "

Week 9

Goals: Dynamics of abuse; boundaries (regarding feelings about the offender)

"Check-In" (What are some of your feelings toward the abuser?)
"My Own Safe Place"
Sentence Completion
"Questions and Answers Box"
"Let It All O u t / S o u n d Train"

Week 10

Goal: Triggers
"Check-In" (Share one way your offender tricked or manipulated you.)
" L e t t e r / V i d e o to the Offender"
Appendix 305

"Centering"
"Questions and Answers B o x "

Week 11

Goal: Triggers
"Check-In" (Share a time this week that you were triggered. What happened?)
"How We Sabotage Ourselves"
"Centering"
"Questions and Answers B o x "
Group cheer

Week 12

Goals: Self-protection; healthy body image

"Check-In" (Share one thing you like about your body.)
"Body Rights and Responsibilities"
"My Safety and Comforts"
"Healing I m a g e "
"Questions and Answers B o x "

Week 13

Goal: Self-protection
"Check-In" (Share one time you stood up for yourself or protected yourself this week.)
"Date R a p e "
"Questions and Answers B o x "

Week 14

Goals: Self-protection; dynamics of abuse

"Check-In" (What do you need to feel safer in your life now?)
"Body Tracing"
"Safety Plan"
"Questions and Answers B o x "

Week 15

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony"
"Friendship Medals" while eating and partying
306 GROUP W O R K WITH SEXUALLY A B U S E D C H I L D R E N

Teen Therapy Group

(Ages 11+) (15 Weeks, 90-minute sessions)

Weekl

Goal: Safety and trust

"Check-In" (How are you feeling about being here and what do you hope to get out of the
group?)
Self collage
"Safety Rules"
"Questions and Answers B o x "

Week 2

Goals: Safety and trust; self-esteem

"Check-In" (What was the most outrageous thing you did this week?)
Quick review of safety rules
"Group Mascot"
"Sharing Our Stories" (first set of questions)
Hot Potato with a ball

Week 3

Goal: Self-esteem
"Check-In" (Name three things you like about yourself.)
"Group Collage About the Abuse"
"Sharing Our Stories" (second set of questions)
Closing exercise such as passing a hand squeeze around the circle

Week 4

Goal: Boundaries
"Check-In" (Share one great thing and one rotten thing that happened this week.)
"Internal/External Self"
"Life Vest"
Group hug or hand squeeze

Week 5

Goal: Dynamics of abuse

"Check-In" (Share one time in the past week that you used your life vest.)
"Letter From Angie"
"Sexual Assault Continuum"
Begin " M y Own BASK Book" (if there is time)
Appendix 307

"Questions and Answers B o x "

Week 6

Goal: Boundaries
"Check-In" (Has being sexually abused changed you in any way? If so, how has it changed
you?)
"The Alligator River Story"
Continue " M y O w n BASK Book"

Week 7

Goal: Dynamics of abuse

"Check-In" (Do you think you could have stopped the sexual assault? If yes, how?)
"Boundary Line"
Continue " M y O w n BASK Book"
"Sharing Our Stories" (third set of questions)
"Let It All O u t / S o u n d Train"

Week 8

Goal: Dynamics of abuse

"Check-In" (Is there anyone you trust? If yes, what about that person helps you to trust him
or her?)
"Why People Sexually Abuse Kids"
"The Butterfly and the Spider"
"Personal Butterfly"
If there is time, "Questions and Answers B o x "

Week 9

Goals: Dynamics of abuse; boundaries (regarding feelings about the offender)

"Check-In" (What are some of your feelings toward the abuser?)
"My Own Safe Place"
"Talking to the Offender Psychodrama"
"Let It All O u t / S o u n d Train"

Week 10

Goal: Triggers
"Check-In" (Share one way your offender tricked or manipulated you.)
"Letter/Video to the Offender"
"Elizabeth's Triggers"
"Centering"
"Questions and Answers B o x "
308 GROUP WORK WITH SEXUALLY A B U S E D C H I L D R E N

Week 11

Goal: Triggers
"Check-In" (Share a time this week that you were triggered. What happened?)
"Drawing Where Molested"
"Triggered Memories"
"Centering"
Group cheer

Week 12

Goals: Self-protection; healthy body image

"Check-In" (Share one thing you like about your body.)
"Body Rights and Responsibilities"
"My Safety and Comforts"
"Healing I m a g e "
"Questions and Answers B o x "

Week 13

Goal: Self-protection
"Check-In" (Share one time you stood up for yourself or protected yourself this week.)
"Date R a p e "
"Questions and Answers B o x "

Week 14

Goals: Self-protection; dynamics of abuse

"Check-In" (What do you need to feel safer in your life now?)
" L e t t e r / V i d e o to Nonoffending Parent(s)"
"Safety Plan"
"Questions and Answers B o x "

Week 15

Goal: Closure
"Debriefing and Evaluating Group"
"Completion of Group Ceremony"
"Friendship Medals" while eating and partying
 REFERENCES

Alexander, P. C. (1993). The differential effects of abuse characteristics and attachment in the
prediction of long-term effects of sexual abuse. Journal of Interpersonal Violence, 8, 346-362.
Brauns, B. G. (1993). The BASK model of dissociation. Paper presented at the Outcome-Oriented
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 ABOUT THE AUTHORS

Lynn Grotsky, MSW, CSW, began working with traumatized and abused children in
1979. Through the years, she has combined her background in hospice, play therapy,
feminist theory, trauma work, and child development in forming her theories and
practice for her work with children. She strongly believes in the importance of advo-
cating for children, and therefore serves on numerous committees and works on policy
and legislative changes to benefit children and their families. She is also a trainer and
consultant as well as a presenter at conferences throughout Washington State and the
nation on such subjects as group work with sexually abused children, the dynamics of
sexual abuse, sibling incest, and the mental health professional as expert and fact
witness in court. With the staff at the Center for Individual and Family Counseling, she
developed the SAFTE (Sexual Abuse Family Treatment and Education) Program, an
intensive 6- to 9-month treatment program for all nonoffending family members,
including siblings and extended family, that provided individual, group, and family
treatment. She is currently in private practice and works with the Providence/St. Peter
Hospital Sexual Assault Clinic in Olympia, Washington, developing and organizing
sexual abuse therapy groups and supervising graduate-level interns. She also loves
parenting her son and daughter and managing the singing group the Righteous
Mothers—four funny, philosophical folk-rock musicians.

Carel Camerer, M A , LMT, has a background as an educator and trainer and has worked
with children and families since 1980. She began therapeutic intervention work with
abused, traumatized children and nonoffending adults in 1983. She cofounded the
Center for Individual and Family Counseling and has led interstate as well as national
trainings and workshops on identification and treatment of child sexual assault as well
as group therapy as treatment for child sexual abuse. With a passion for the complexity
and diversity found throughout all of nature and humankind, she weaves together the

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principles of two congenial therapeutic partners: Oriental medicine and psychology.

Her extensive studies of Jin Shin Jyutsu and Chinese Five-Element Theory dramatically
affect her unique treatment style and mind-body work. In her current private practice,
she treats sexually abused children and adult survivors as well as individuals with
stress management issues, anxiety disorder, psychosomatic and autoimmune disease.
She also teaches "Wellness Wise" classes to the staff at Providence/St. Peter Hospital
and Jin Shin Jyutsu classes privately in the community. Her practice has grown to
include women and couples with fertility and adoption issues, adoptive children, and
preadolescent girls coming of age. Her integrated method of practice helps people heal
at the subtle level of spirit, which positively influences mental, emotional, and physical
health.

Lynn Damiano, MA, is a state-certified psychotherapist in private practice in Olympia,

Washington, and adjunct Associate Professor at St. Martin's College in the Master's of
Psychology Program. She began working with chemically dependent adolescents and
their families in 1984 and developed one of the first adolescent chemical dependency
intensive outpatient programs in the state. During that time, she pioneered efforts to
bring early identification and assessment practices into county high schools and
middle schools. This early experience laid a foundation for the later cocreative devel-
opment of the SAFTE (Sexual Abuse Family Treatment and Education) Program at the
Center for Individual and Family Counseling, where she became a partner and co-
owner in 1988. The current focus of her practice includes group work with women
survivors of sexual abuse. Her "Adult Daughters of Not So Functional Families" group
has been offered twice a year since 1989 as a powerfully transformative complement
to individual therapy. She also treats couples in traditional and alternative marriages
and partnerships who are experiencing difficulty or growing pains. She regularly
presents workshops, consultation, and supervision groups on a unique assessment and
treatment method she developed over years of practice and study called Intra Psychic
Mapping (© 1994). This method combines object relations, developmental, and dialec-
tic theories into a powerful and practical tool for exploring behavior and motivation,
understanding defensive patterns, and creating change at the core level of personality.
About the Authors 313

We would love to hear from you!

Do you have any feedback for us on exercises in this book that you have tried?
We may be doing a sequel to this book, so we are also interested to know if you
have additional exercises that you have found to be especially effective. If you do,
please describe them for us. If we use them in the next book, we want to be sure to give
you credit, so remember to include your name.

Please send responses to

Lynn Grotsky
2419 Carpenter Road
Lacey, WA 98503
e-mail: [email protected]

Or if you have questions and interest in the application of m i n d / b o d y work for the
treatment of psychosomatic symptoms of sexual abuse, curiosity about how to adapt
our exercises to adult survivor groups, or have specific questions regarding the treat-
ment of 3-6 year olds, please send inquiries and thoughts to:

Carel Camerer
2222 A State Ave NE
Olympia, WA 98506
e-mail: [email protected]

And if you like to wax pyschological about sexual abuse theory or related issues
such as treatment protocols for sexual abuse and chemical dependency (in primary or
secondary victims), or "family dynamics associated with sibling abuse" and "blaming
the victim," or would like information about "Intrapsychic Mapping" as a tool for
assessing and treating sexual abuse and family patterns, please send us your questions,
musings, and experience to:

Lynn Damiano
2222 A State Ave NE Suite A
Olympia, WA 98506
e-mail: [email protected]