Understanding Substance Use, Intimate Partner Violence, Sexual Assault & Trauma: A Therapist’s Guide

Mental health concerns rarely exist in neat categories. Substance use can overlap with stress, trauma can affect relationships, and experiences such as intimate partner violence or sexual assault can shape the way someone thinks, feels, and responds long after the immediate crisis has passed. For therapists, understanding these connections is an important part of providing thoughtful and effective care.

I originally created the following questions as part of my graduate training in crisis intervention and counseling. They cover topics including alcohol and substance use, readiness for change, intimate partner violence, sexual assault, PTSD symptoms, childhood sexual abuse, safety assessment, and treatment approaches. I decided to share them here because they offer a behind-the-scenes look at some of the concepts mental health professionals study when learning how to support people through difficult and sometimes traumatic experiences.

You can take the quiz to test your own knowledge, or simply read through the explanations to learn more about how counselors think about assessment, safety, trauma, and recovery. Some of the topics are understandably sensitive, so feel free to skip any questions that you would rather not engage with. The material is intended for education and should not be used as a substitute for individualized mental health, medical, or crisis support.

Question 1: Understanding the Stages of Alcoholism

Question 1. (Source: Chapter 6, p. 130-131, Section on "Etiology and Risk Factors of Substance Abuse and Dependence'') There are many models that describe the etiology behind alcoholism and substance abuse. Jellineks’s 1946 model, which influenced the American Medical Association (AMA) involved which of the following stages?

A. Prealcoholic, Prodromal, Chronic (Incorrect. While these stages are contained in Jellinek’s disease or medical model approach to alcoholism, there is one more stage that this response neglects. It’s important to note that, according to Jellinek, alcoholism is progressive and eventually leads to death.)

B. Prealcoholic, Prodromal, Crucial, Chronic (Correct. Jellinek’s model includes four stages of alcoholism. The prealcoholic stage is when alcohol is used to relieve tension, next, physical symptoms appear. Next, withdrawal and loss of control occur. And finally, severe psychological, social, and psychical problems arise, culminating in death.)

C. Mild, Severe, Chronic (Incorrect. While “mild” and “severe” may appear to be familiar terms, they are not a part of Jellinek’s model. However, we can think of the Prealcoholic and Prodromal stages of this model as mild, while the Crucial stage [defined as a loss of control over alcohol] can be likened to severe.)

D. Prodromal, Chronic (Incorrect. Since Jellinek describes alcoholism as a progressive disease, we can conclude that it’d be illogical ot jump into the prodromal stage [which is when one becomes preoccupied with alcohol and physical symptoms begin appearing] without first initiating the prealcoholic phase, i.e. when alcohol is used to take the edge off.)

E. Prealcoholic, Chronic Alcoholic (Incorrect. This response jumps from the most mild form of the disease of alcoholism, prealcoholic, to the most severe form, chronic. As such, it’s missing other necessary steps. It would be unnatural for a person to progress from using alcohol to relieve stress and anxiety to becoming a chronic alcoholic without intermediate steps)

Correct Answer: B. Prealcoholic, Prodromal, Crucial, Chronic

General Feedback: Being able to identify the various levels of alcoholism is important for counselors. Knowing at which stage of alcoholism users are can help counselors develop pathways to sobriety that fit their current needs. It’s important to note that there are other etiological views of alcoholism, including moral models, genetic and biological models, social learning models, psychological models, and multi-causal models. Of note, the disease/medical model (which aligns with Jellinke’s above model) was an alternative to past thinking that reduced alcoholism to a moral problem.

Question 2: Screening for Problematic Alcohol Use

Question 2. (Source: Chapter 6, p. 135, Section on "Screening, Assessment, and Diagnosis of Substance Use Disorders'') There is one specific question, developed by Williams and Vinson (2001), that detects problem drinking or substance abuse with 90% accuracy. Which of the following is it, specifically for women?

A. “When was the last time you had five drinks?” (Incorrect. While this answer may seem familiar and correct at first glance, this is actually the correct response specifically for men. Since men and women differ in their capacity to biologically process alcohol, men are frequently allotted more drinks in medical models. The correct answer for women is four drinks)

B. “When was the last time you had more than four drinks?” (Correct. This is the correct answer; this question has been used to identify alcohol abuse in a sample by Williams and Vinson, leading to the detection of abuse or dependence in nearly 9 out of 10 sampled. Asking the question should be done carefully as it can result in a defensive shift in the client)

C. “Would you consider yourself to be an alcoholic?” (Incorrect. This question is probably too direct in a counseling session, and would probably result in denial and other defense mechanisms. If a counselor asks this question, they should ensure that rapport has been established first so that it doesn’t land awkwardly. Another thing to consider is that those in the pre-contemplation or contemplation phases [discussed in the next question] may be more prone to denial and resistance.)

D. “How many drinks do you consume per week?” (Incorrect. While this can be a useful probing question, it may not be supported by research. Asking a client, particularly women in this case, when the last time they’ve had four or more drinks seems to be one of the most effective ways to screen for alcohol abuse)

Correct Answer: B. “When was the last time you had more than four drinks?”

General Feedback: To start the treatments of alcohol and other drugs (AOD), it’s important to first screen and assess the situation. Properly evaluating the clients allows the clinician to understand the extent to which their use is problematic. Asking women when the last time they’ve had more than four drinks is an important step in the evaluation process that lets the counselor know whether further investigation or assessment is needed. Asking screening questions should be asked to all clients, including those who aren’t suspected of having substance abuse issues initially.

Question 3: Readiness to Change Substance Use

Question 3. (Source: Chapter 6, p. 140, Section on "Assessing a Client’s Readiness to Change'') There are five stages that individuals contemplating changing their substance abuse patterns experience, as developed by Prochaska and DiClement. The second stage, contemplation, involves:

A. Thinking about life without being addicted to drugs or alcohol (Incorrect. While this response seems contemplative in nature, it doesn’t meet the criteria for the contemplation stage. Merely thinking about not being addicted to drugs is not the same as being ambivalent toward drug use and weighing the effects of continued use)

B. Working on maintaining abstinence and addressing relapse issues and triggers (Incorrect. This answer describes a different stage in the model, namely the maintenance stage. During the maintenance stage, the addict continues working toward sobriety and addresses issues with relapse and triggers, should or when they arise)

C. During the contemplation stage, users often deny a problem exists (Incorrect. This answer describes a different stage in the model, namely the precontemplation phase. During this initial phase, users often downplay or repudiate their issues with the drug or alcohol use, which contrasts the contemplation stage, where they acknowledge their use might be a problem and develop ambivalence toward their use)

D. During the contemplation stage, users are ambivalent and weigh the pros and cons of continued use (Correct. The contemplation stage involves users assessing whether drugs or alcohol are defiling their lives, and whether their cessation of use would contribute to a better sense of well-being)

Correct Answer: D. During the contemplation stage, users are ambivalent and weigh the pros and cons of continued use

General Feedback: Understanding where individuals are at along the five stages of contemplating substance use and abuse is important for counselors, as treatments, questions, and the direction of therapy can and should be customized to the unique needs of the client, and where they are along their journey. It’s worthwhile to mention that the progression along the five stages isn’t linear, and sometimes clients can tumble back a stage, or several. Transitioning across stages is never smooth, and comes with unique sets of challenges along the way.

Question 4: Who Can Experience Intimate Partner Violence?

Question 4. (Source: Chapter 7, p. 157, Section on "Overview of Intimate Partner Violence'') When it comes to the term “Intimate Partner Violence”, intimate partners can refer to:

A. Straight and LGBT+ partners engaged in sexual and non-sexual (platonic) relationships, who are married or unmarried (Correct. Intimate partner violence, or IPV, is not limited to one’s sexual orientation. IPV can occur in both straight and non-straight partnerships. Not only, intimate partner violence doesn’t necessarily preclude relationships that aren’t sexually intimate, and can include relationships that aren’t marriages)

B. Straight and LGBT+ partners engaged in sexual relationships, who are typically married (Incorrect. While this answer is inclusive of both straight and the LGBT+ community, the response misses the mark in two categories. First, the answer only mentions sexual relationships, however, IPV can occur in non-sexual partnerships as well. Next, the answer mentions IPV typically occurs in married couples; this can’t be concluded, and IPV extends to non-married couples, too)

C. Friendships, roommates, and family members (Incorrect. While intimate partner violence can include friendships as a feature of partnership, in general, partnership in this context refers to an exclusive or romantic sense, which precludes friendship. While intimate relationships can form with roommates, it’s important to distinguish that partners refer to those who are platonically dating or who are married or coupled. Finally, family members do not apply.)

D. Exclusively straight couples who are typically married (Incorrect. The definition of intimate partner violence extends to the LGBT+ community since they can have legitimate, intimate relationships. Next, intimate partners can also be non-married. The textbook does not discuss whether intimate partners are typically married or not, so this response is not the one that fits best, given the prompt)

Correct Answer: A. Straight and LGBT+ partners engaged in sexual and non-sexual (platonic) relationships, who are married or unmarried

General Feedback: It’s important to acknowledge the breadth of the term “intimate partners” in relation to intimate partner violence. That is, the term intimate partners not only applies to heterosexual couples, but also to the lesbian, gay, bisexual, trans and other communities. Not only that, partners can take a variety of formats, be they platonic dating or devoted marriages. While the definition of intimate partners is broad, a caveat is that it does not apply to friendships, roommates, or strictly platonic relationships. In other words, there must be romantic or exclusive intent behind the relationship, even though the relationship may involve platonic dating.

Question 5: Recognizing the Tension-Building Phase of Abuse

Question 5. (Source: Chapter 7, p. 160, Section on "Phase 1: The Tension-Building Phase'') During the Tension-Building Phase, the abused partner:

A. Lashes out and demeans the abuser, leading to the ensuing abuse (Incorrect. Oftentimes, in the “Cycle of Violence Theory,” it’s rather the abuser, not the abusee, who makes denigrating remarks. The abuser may make insults and threats, e.g. over the way the abused partner cooks food, and may even escalate their externalization of the problem by slamming doors, throwing things, and more.)

B. Begins to stir up issues, along with the abuser partner, which results in one of the partners abusing the other (Incorrect. As with the previous demonstration to the last response, it appears from the textbook that it’s typically the abusive partner who creates a pressurizing storm and not the abused partner. The abused partner in this phase tends to walk on eggshells, being careful not to strain the relationship)

C. Walks on eggshells and becomes compliant and nurturing to avoid escalation (Correct. While the abusive partner begins to hurl insults at the abused partner, and may opt for violent actions such as throwing things or punching objects, the abused partner becomes reclusive, compliant, and nurturing to prevent an emotional outpouring from the abusive partner. In other words, the abused partner attempts to placate the abusive partner to avoid escalation)

D. There is no particular pattern that characterizes the abused partner in this stage (Incorrect. It does appear that there is an identifiable cycle to violence, which first begins with the tension-building phase, involving the abusive partner creating strain and pressure in the relationship by hurling insults and engaging in violent actions. Next, the acute battering incident occurs, and finally, the honeymoon phase happens, only for the cycle to continue)

Correct Answer: C. Walks on eggshells and becomes compliant and nurturing to avoid escalation

General Feedback: Knowing where a partnership lies along the cycle is imperative for a crisis counselor, both when caring for an abused partner and dealing with an abusive partner. When in the tension-building phase, it’s important to relay information and resources to the abused partner so that they have tools and help should the situation escalate. Screening for intimate partner violence is crucial, and a lethality assessment is absolutely necessary to ensure the victim client receives the right tools to protect themselves from the abusive client. Also, pointing out the cyclical nature of the abuse may help to empower the victim and foster a sense of introspection and pattern recognition, permitting them to take healthy steps.

Question 6: Assessing Danger in Intimate Partner Violence

Question 6. (Source: Chapter 7, p. 175, Section on "The Crisis Counselor’s Response to IPV: Screening for IPV'') When IPV is disclosed by a client, it’s important to conduct a lethality assessment. All of the following are components of a lethality assessment, except:

A. The abuser’s medical records. It’s important to know what biological conditions the abuser is diagnosed with, such as diabetes, cancer, and heart disease. (Correct. When it comes to conducting a lethality assessment, knowing which physiological conditions the abusive partner is suffering from is not of vital importance. Rather, the counselor should be screening for things like past incidents, stalking, substance abuse, and access to weapons)

B. The abuser’s past stalking or obsessive behaviors. It’s important to know whether the abuser has engaged in behaviors that place the victim at risk. (Incorrect. This is one of the things a counselor should be screening for to effectively assess the degree to which an abusive relationship dynamic is lethal. Past incidents of stalking or obsessive behaviors indicate a higher risk of lethality)

C. The severity of the abuser’s violence. It’s important to understand how severe the violence is so that immediate action can be taken, if necessary. (Incorrect. This is something a crisis counselor must take into account. Knowing the severity of the violence is key to determining an appropriate safety plan. If an abusive partner has made threats of violence in the past, or has pushed a client, that requires a different safety plan than a client involved with an abuser who has burned him or her on a stove, or who has choked them previously or held a gun to their head)

D. The abuser’s access to weapons. It’s important to know whether the abuser has access to lethal weapons that could endanger the victim. (Incorrect. When an abused person is living in a home whether there is access to common weapons, such as guns and machetes, this poses a much more significant danger to the abused client. However, a lack of means does not indicate the absence of serious threat; other objects can be used to inflict serious harm, and even death, including hammers, tools, household objects, bricks, and more.)

Correct Answer: A. The abuser’s medical records. It’s important to know what biological conditions the abuser is diagnosed with, such as diabetes, cancer, and heart disease.

General Feedback: A lethality assessment helps the clinician understand the degree to which the client is endangered. There are a variety of characteristics to look out for, including the severity of violence, criminal behaviors of the abuser (such as ignoring court orders, past calls made to 911, etc.), previous homicidal or suicidal threats, external life stressors, substance abuse problems, perceived threats to the relationship (e.g. divorce, infidelity, etc.), access to weapons, and preventing the survivor from using emergency services, such as dialing 911 or contacting an emergency domestic violence shelter.

Question 7: Psychological First Aid After Sexual Assault

Question 7. (Source: Chapter 8, p. 205, Section on "Treatment of Survivors of Sexual Assault'') Psychological First Aid is an important first step when working with a client who has been sexually assaulted. Which of the following are the correct core actions to follow when immediate intervention is necessary?

A. Contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, connection with social supports, information on coping support, linkage with collaborative services (Correct. These eight essential measures are often dubbed “core actions” and are necessary sequential steps to follow after a client experiences rape or other sexual assault. The clinician should approach gently, allowing the victim to determine what role you can play for them)

B. Contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, connection with social supports, information on coping support, linkage with collaborative services, remediation with the aggressor (Incorrect. While the eight essential measures, or core actions, are included, an extra step is also indicated, which falls outside of the scope of best practices. Further, remediating the relationship with the aggressor would likely result in harm to the client)

C. Contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, linkage with collaborative services (Incorrect. While this response includes many of the appropriate core competencies, there are two concluding steps that should additionally be taken. Those steps are: information on coping support, and connection with social supports. These steps help to better ensure a more healing recovery process with external services and relationships for the victim to rely on)

D. Contact and engagement, safety and comfort, stabilization, turn over to the hospital so the victim can receive immediate physical and psychological care, immediately file a report with the police (Incorrect. While this response includes some of the correct eight essential measures, it deviates from the standard of care. The first three steps are correct, however, the last two are remiss. While receiving medical attention may be necessary, it’s important to first stabilize the client and gather information.)

Correct Answer: A. Contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, connection with social supports, information on coping support, linkage with collaborative services

General Feedback: While counseling a client who has experienced sexual assault is not easy, following Psychological First Aid (PFA) can be a powerful and effective framework that helps guide the victim along the path of recovery. The steps involve ensuring the client is emotionally and physically taken care of, and allows the victim to access a support member of family and friends, as well as other external services. It’s important to be gentle and explain some of the things you can offer to the client, and to be aware of factors that can impede the medical exam process (e.g. not allowing the client to brush their teeth). Other key actions to take include allowing the victim to lead the conversation, and respecting their wishes to remain silent.

Question 8: Understanding Risk Factors for Sexual Assault

Question 8. (Source: Chapter 8, p. 196, Section on "Definitions and Types of Rape: Acquaintance Rape'') The following are all risk factors of rape for college-aged women, except:

A. Frequent intoxication to the point of incapacitation (Incorrect. This is one of the risk factors associated with the rape of college-aged women. While being incapacitated in no way allows another individual to take advantage of someone in their altered state, it does place women at risk for being raped in a college setting)

B. Being single (Incorrect. While being single does not necessarily mean you will be raped, it is correlated with the rape of college-aged women. The textbook does not specify which sense of single they mean; being single might refer to being alone i.e. being out at a party without the company of friends, or it may signify being relationally alone, i.e. not being intimately involved with a partner. Either way, being single is associated with rape of rape in college-aged women)

C. Previous sexual victimizations (Incorrect. Being previously victimized sexually in the past is a risk factor for being raped again for college-aged women. As a crisis counselor, it’s imperative to know this, as those who have been previously raped may be at risk of being raped again. It’s important to understand the dynamics behind why victims continue to be victimized)

D. Living on campus (Incorrect. While living on campus may come with perks, often including being able to walk to lectures, food passes, and proximity to friends, one of the disadvantages is that living on campus actually put college-aged women at risk of being raped.)

E. Living with parents or relatives (Correct. When it comes to college-aged women being sexually victimized, living with parents or relatives, assuming they live off campus, is not a risk associated with being raped. As such, we can conclude that there may be benefits in terms of prevention of rape, by living off-campus with family, as rape is less likely to occur there)

Correct Answer: E. Living with parents or relatives

General Feedback: Unfortunately, college-aged women who have been sexually assaulted in the past are more likely to be sexually assaulted again in the future. Not only, college campuses are not the safest places of residency for college-aged girls, as rape is more likely to concur in this setting. Being single is also a risk factor for counselors to be aware of, as is frequent intoxication to the point of incapacitation. In summary, living off campus, avoiding intoxication to the point of “blacking out”, being involved in a relationship (or not being alone), and not having been a prior victim of sexual assault seem to confer protection to college-aged women against rape.

Question 9: Trauma Symptoms After Sexual Assault

Question 9. (Source: Chapter 8, p. 201-202, Section on "Effects of Sexual Assault'') The reorganization phase of rape trauma syndrome shares many characteristics with post-traumatic stress disorder (PTSD). The following are all shared symptoms, except:

A. Sleep disturbances (Incorrect. Unfortunately, disrupted sleep is a problem in both rape trauma syndrome, as well as PTSD. As a crisis counselor, it’s advisable to listen to your client if they indicate they are having trouble with sleeping, as there may be more to the story, i.e. the underlying cause may be due to trauma, including rape)

B. Hypervigilance (Incorrect. Being hypervigilant, or seeking out potential threats in one’s environment constantly, can be the manifesting symptom for both post-traumatic stress disorder as well as rape trauma syndrome. If a client appears to be hypervigilant, it may indicate a past trauma or sexual assault, and this may warrant further probing)

C. Decreased involvement in the environment (e.g. withdrawal, feeling numb) (Incorrect. Being withdrawn or numb and interacting less with one’s environment is a sign of both post-traumatic stress disorder as well as rape trauma syndrome. If a client reports being less engaged in activities they normally partake in, or indicates they’re socializing less, there may be a more ominous causative factor)

D. Hallucinations (Correct. While those who experience trauma and rape and develop PTSD or rape trauma syndrome may develop flashbacks, nightmares and may experience intrusive thoughts about their past trauma or sexual assault, hallucinations are not a shred feature between PTSD and rape trauma syndrome)

Correct Answer: D. Hallucinations

General Feedback: It’s vital that a crisis counselor be privy to the signs of both Post Traumatic Stress Disorder (PTSD) and Rape Trauma Syndrome, as the symptoms may present in future clients. Looking out for symptoms can help the clinician diagnose, and subsequently employ a treatment modality that’s effective for this condition. Worth mentioning, those experiencing reactions to sexual assault may be more expressive, by crying, screaming, yellow, or laughing, or they may respond in a controlled way by remaining silent and showing little emotion.

Question 10: Childhood Sexual Abuse and Demographic Differences

Question 10. (Source: Chapter 9, p. 221, Section on "Prevalence of CSA by Gender, Age, Race, and Ability'') Race does not appear to be a differentiating characteristic in the occurrence of Childhood Sexual Abuse (unlike gender and age), however, white children are slightly overrepresented when it comes to being abused by biological parents. This is because:

A. White people trust systems involved in childhood protection less than other groups (Incorrect. It appears that one of the reasons that explains the slightly higher rate of childhood sexual abuse among the white racial group may be that white people trust social services more than their non-white counterparts, leading to an increased number of official reports)

B. White children are easier targets when it comes to sexual assault (Incorrect. There is no evidence that white children are easier targets of sexual assault. Some more logical explanations for the slight uptick include white people being more likely to report, to trust external social systems, and a potentially higher incidence rate)

C. White people commit and are victimized by child sexual abuse more often than other groups (Incorrect. While white children are slightly overrepresented, this cannot be definitively concluded. Since white people might report more often and are less reluctant to engage protective services, these may skew the number of cases of white CSA)

D. White people may report more often, trust systems involved in childhood protection more than other groups, and may potentially have a higher incidence rate (Correct. While white people may in fact have a higher incidence rate of childhood sexual abuse, other possible explanations as to why they are slightly overrepresented include white people being more prone to reporting and relying on protective agencies when necessary)

Correct Answer: D. White people may report more often, trust systems involved in childhood protection more than other groups, and may potentially have a higher incidence rate

General Feedback: Race does not appear to be a significant determining factor when it comes to childhood sexual abuse, which contrasts gender and age (which are significant). However, there is a slightly higher proportion of white children who are abused by their biological parents. This may be explained by a de facto higher incidence rate, but may also be the result of higher reporting rates and trust in social services. Knowing this information helps counselors to be aware of their biases and know which demographics are at risk. As of now, it appears women are more likely to experience CSA, however, the gap is closing rapidly: 40% of college-aged women reported a history of CSA, while 30% of men did (Young et al., 2002).

Question 11: Signs of Childhood Sexual Abuse

Question 11. (Source: Chapter 9, p. 224, Section on "Signs and Symptoms of Child Sexual Assault'') After being sexually abused, boys and girls may differ in how they present their symptoms. Which of the following best characterizes the differences between how boys and girls react to sexual abuse?

A. The differences between boys and girls are overblown. Both sexes respond about the same after sexual abuse. (Incorrect. While there may be overlap between the ways boys and girls react to sexual assault and abuse, it does appear that boys are more likely to externalize their past traumatic sexual assault by acting out, being aggressive, and lashing out. Contrastingly, girls are more likely to internalize)

B. Boys recover much quicker after being sexually abused, while girls require months or even years to recover. (Incorrect. According to the textbook, there is no evidence to support this theory. There was no mention of times of recovery. Since boys often act aggressively and lash out, and girls often internalize their problems, it may be challenging to probe for CSA since these behaviors may be deemed normal gender-stereotypical behavior)

C. Boys are more likely to externalize their symptoms by acting out and engaging in aggressive, violent, or risky behaviors. Girls are more likely to internalize their symptoms, resulting in depression, anxiety, or self-harming behaviors. (Correct. Boys are more likely to engage in aggressive behaviors, while girls are more likely to internalize after being sexually assaulted. However, there is significant overlap between both two, and some girls may externalize, while some boys may internalize)

D. Girls are more likely to externalize their symptoms by acting out and engaging in aggressive, violent, or risky behaviors. Boys are more likely to internalize their symptoms, resulting in depression, anxiety, or self-harming behaviors. (Incorrect. This opposes the typical responses. Boys are more likely to externalize, while girls are more likely to internalize after experiencing CSA)

Correct Answer: C. Boys are more likely to externalize their symptoms by acting out and engaging in aggressive, violent, or risky behaviors. Girls are more likely to internalize their symptoms, resulting in depression, anxiety, or self-harming behaviors.

General Feedback: Acting out and externalizing symptoms are key factors to look out for when it comes to boys who have been sexually abused. Contrastingly, girls tend to internalize and are more prone to anxiety, depression, and self-harm. Other behavioral factors that aren’t limited to gender include attempting to run away, restlessness, drawing sexually explicit images, in-depth sexual interactions with peers, extreme compliance, regressive behaviors (e.g. thumb sucking, separation anxiety), use of sexual language that’s developmentally non-appropriate, and more.

Question 12: Therapy for Children After Sexual Abuse

Question 12. (Source: Chapter 9, p. 234, Section on "Treatment of Survivors of CSA'') While Cognitive Behavioral Therapy (CBT) has been the gold standard when it comes to counseling children who’ve experienced sexual abuse, recent meta-analyses have found CBT to be no more effective than other modalities, and conclude it’s important to consider the child’s developmental stage and presenting complaints. Given that, what type of therapy is most effective for children with deficits in social functioning?

A. Group therapies (Incorrect. Group therapies are indicated for children who are lacking or are low in self-concept or who experience depression. While group therapies may help those with social functioning, play therapies are better suited to them)

B. Psychoanalysis (Incorrect. Psychoanalysis is not currently supported as an effective modality for children with social functioning deficits. Trauma-focused behavioral therapy is currently the go-to treatment modality, however, mounting evidence suggests other modalities may also work just as well)

C. Cognitive Behavior Therapy (Incorrect. While cognitive behavioral therapy [CBT] is the go-to treatment modality when working with children who have been formerly abused, play therapy may be better suited to those with deficits in cognitive functioning. )

D. Play therapy (Correct. Since young children may lack the cognitive and verbal skills needed to utilize trauma-focused cognitive behavioral therapy, resorting to play therapy may be the best alternative. Play therapy is endorsed by the authors of the textbook, and is highlighted for its effectiveness in treating those with social functioning deficits)

Correct Answer: D. Play therapy

General Feedback: choosing the right therapy for the right client at the right times is vitally important. Taking into account that the prompt’s given involved a child who was deficient in social functioning skills, the best course of action to take would be to use play therapy. Play therapy may be just as effective as cognitive behavioral therapy, and is worthy of a counselor’s attention and training. Since play therapy involves less speaking, it’s particularly suited for young children who may struggle to verbalize their past experiences and also accounts for their undeveloped cognitive status.

References

Jackson-Cherry, L. R., & Erford, B. T. (2014). Crisis Assessment, Intervention, and Prevention. Pearson Higher Ed.

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