Study examines use of creative therapy in treatment of sexual abuse

Many children suffering from the trauma of sexual abuse can benefit from a therapy using creative methods, according to a study by Durham and Bristol universities.

The therapy offered by the NSPCC, called Letting the Future In, gives children a chance to talk about their abuse experiences and to express themselves through activities such as painting, drawing and storytelling with a therapist.

The therapy sessions enable the children, aged four to 17, to safely work through past experiences and come to understand and move on from what has happened. The child’s parent or safe carer is also offered individual sessions as well as joint sessions with their child.

Therapeutic support vital

In this largest ever trial of a sexual abuse therapy anywhere in the world, the researchers found that the Letting the Future In therapy worked particularly well in helping children aged eight and over recover from their experiences of sexual abuse. For younger children, those between 3 and 7 years old, the study suggests the therapy may take longer to work.

Co-author of the report, Professor Simon Hackett (pictured) from the School of Applied Social Sciences at Durham University, said: “Our study sends out an important message to children affected by sexual abuse and to their families. With the right help and support it is possible to recover and move on from abuse.

“Our study shows the importance of offering children and young people who have been sexually abused therapeutic support to deal with their experiences, but all too often children are left to suffer the consequences of sexual abuse without professional help.”

The Durham and Bristol study found that children over eight showed significant recovery from their experiences of sexual abuse after they completed the programme, compared with children who did not take part in the programme*.

Children under the age of seven showed good signs of recovery but only after they had taken part in the programme for a year or more, suggesting it takes longer for younger children to improve.

Lead author, John Carpenter, Professor of Social Work and Applied Social Science at the University of Bristol, commented: “Evidence-based therapeutic approaches are vital to help all children deal with the effects of sexual abuse. It is crucial that commissioners know which interventions work in ‘every day’ community-based services to improve outcomes for children, in a cost-effective way.

“This ‘real world’ evaluation of Letting the Future In is a significant contribution to the evidence base, providing benchmarks for others to evaluate interventions.”

Impact of sexual abuse

Sexual abuse can have a devastating impact on children. Figures show one in 20 children in the UK have been sexually abused, yet only 1 in 8 comes to the attention of statutory agencies. 

Where victims are known, effective treatments and interventions are crucial to help children recover from their traumatic experiences.

Jon Brown, NSPCC Head of Development and Impact, said: “These findings provide promising indications that the Letting the Future In intervention can significantly reduce the highest levels of trauma experienced by children who have been sexually abused. We know that professionals say support for children after abuse is inadequate. Over half say that tight criteria to access local NHS mental health services means these children are increasingly struggling to access vital help.

“This study shows that therapeutic work can be delivered by a greater range of professionals, including social workers who receive additional training in therapeutic work – as in the case of Letting the Future In.”

Positive changes

Parents and carers who were interviewed were unanimous in thinking that the intervention had resulted in positive changes. They identified improved mood, confidence, and being less withdrawn, a reduction in guilt and self-blame, reduced depression, anxiety and anger, improved sleep patterns and better understanding of appropriate sexual behaviour. As many said: “I’ve got my child back.”

The trial included 242 children and young people and their carers, with 74 per cent girls and 26 per cent boys. Two thirds of those taking part were abused by someone within the family and most by a single perpetrator. Over half of the older children had experienced three or more types of victimization in addition to sexual abuse.

Participating children were assessed at the start of the programme, after six months and again after 12 months, using a range of standardised measures which show their levels of trauma, and related symptoms such as anxiety and stress. Interviews were also conducted with practitioners delivering the therapy, and with children receiving it.

The Letting the Future In programme is currently offered by 20 NSPCC teams across England, Wales and Northern Ireland.

The study has shown promising evidence about what works to help children recover from the trauma of being sexually abused.

• For those children aged eight and over, the proportion of children receiving the intervention who experienced the highest levels of trauma dropped from 73% at the start of the programme to 46% after six months.
• Even taking into account out those who failed to engage in the intervention, or who had dropped out early, the reduction was 68% to 51%. 
• There was no statistically significant change in scores for the waiting list control group in either analysis, so improvements can be attributed to receiving Letting the Future In.

The evaluation of Letting the Future In is one of a number of research projects conducted by the Centre for Research into Violence and Abuse at Durham University. The Centre is dedicated to improving knowledge about interpersonal violence and abuse and the driving force of the Centre’s members is to prevent violence and abuse in society and to help those who have been victimised. Other projects are looking at domestic violence, rape and sexual assault.

* Children in the control group took part in the programme six months later.