Child_Abuse

CHAPTER TWO LITERATURE REVIEW AND THEORETICAL FRAMEWORK 2.0 Introduction In this chapter, we present a review of various literatures on topics that have relevance to this study. The discussion that follows is conducted in such a way as to provide summaries and interrogations of what scholars have done in the areas of crime and criminology by way of their thematic coverage, theoretical perspectives, postulates, speculations, findings and recommendations. The theoretical review is presented first. 2.1 Theoretical Framework The following theories were considered to be relevant to this study: 1. Cognitive Behavioural therapy 2. Psychosocial theory 3. The theory of Power and Control 1. Cognitive behavioral therapy (or cognitive behavioral therapies or CBT) is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviours and cognitions through a goal-oriented, systematic procedure. The title is used in diverse ways to designate behaviour therapy, cognitive therapy, and to refer to therapy based upon a combination of basic behavioural and cognitive research (Francis, 2008). There is empirical evidence that CBT is effective for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, and psychotic disorders (Bet et. al 2006). Treatment is often manualized, with specific technique-driven brief, direct, and time-limited treatments for specific psychological disorders. CBT is used in individual therapy as well as group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are more cognitive oriented (e.g. cognitive restructuring), while others are more behaviourally oriented (in vivo exposure therapy). Other interventions combine both (e.g. imaginal exposure therapy) (Foa, Rothbaum, & Furr, 2003). CBT was primarily developed through a merging of behaviour therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the "here and now", and on alleviating symptoms (Rachman, 1997). Many CBT treatment programs for specific disorders have been evaluated for efficacy and effectiveness; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favoured CBT over other approaches such as psychodynamic treatments (Lambert, Bergin, Garfield, 2004). In the United Kingdom, the National Institute for Health and Clinical Excellence recommends CBT as the treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression, and for the neurological condition chronic fatigue syndrome/myalgic encephalomyelitis (Jones, 2003). The roots of CBT can be traced to the development of behaviour therapy in the early 20th century, the development of cognitive therapy in the 1960s, and the subsequent merging of the two. Behaviour therapeutical approaches appeared as early as 1924, with Mary Cover Jones' work on the unlearning of fears in children (Fred, 2001). In 1937 Abraham Low developed cognitive training techniques for patient aftercare following psychiatric hospitalization (Donald, 2005). Low designed his techniques for use in his organization, Recovery International, which supports people recovering from mental illness (Low, 1945). Although Recovery International was originally led by Low, he later adapted the techniques for use in lay-run self-help groups operating under the same name (Wechsler, 1960). It was during the period 1950 to 1970 that CBT became widely utilized, with researchers in the United States, the United Kingdom and South Africa who were inspired by the behaviourist learning theory of Ivan Pavlov, John B. Watson and Clark L. Hull (Stone, 2001). In Britain, this work was mostly focused on the neurotic disorders through the work of Joseph Wolpe, who applied the findings of animal experiments to his method of systematic desensitization (Wolpe, 1958), the precursor to today's fear reduction techniques (Ashton, 2003). British psychologist Hans Eysenck, inspired by the writings of Karl Popper, criticized psychoanalysis in arguing that "if you get rid of the symptoms, you get rid of the neurosis"(Eysenck, 1960), and presented behaviour therapy as a constructive alternative. In the United States, psychologists were applying the radical behaviourism of B. F. Skinner to clinical use. Much of this work was concentrated towards severe, chronic psychiatric disorders, such as psychotic behaviour and autism (Lovaas, 1951). Although the early behavioural approaches were successful in many of the neurotic disorders, it had little success in treating depression (Stone, 2007). Behaviourism was also losing in popularity due to the so-called "cognitive revolution". The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behaviour therapists, despite the earlier behaviourist rejection of "mentalistic" concepts like thoughts and cognitions. Both these systems included behavioural elements and interventions and primarily concentrated on problems in the present. Albert Ellis's system, originated in the early 1950s, was first called rational therapy, and can arguably be called one of the first forms of cognitive behavioural therapy. It was partly founded as a reaction against popular psychotherapeutic theories at the time, mainly psychoanalysis (Ellis, 1975). Aaron T. Beck, inspired by Albert Ellis, developed cognitive therapy in the 1960s (Aaron, 1975). Cognitive therapy rapidly became a favorite intervention technique to study in psychotherapy research in academic settings. In initial studies, it was often contrasted with behavioral treatments to see which was most effective. During the 1980s and 1990s, cognitive and behavioral techniques were merged into cognitive behavioral therapy. Pivotal to this merging was the successful development of treatments for panic disorder by David M. Clark in the UK and David H. Barlow in the US (2007). Concurrently with the contributions of Albert Ellis and Beck, starting in the late 1950s and continuing through the 1970s, Arnold A. Lazarus developed what was arguably the first form of broad-spectrum cognitive behavioural therapy (1958). He later broadened the focus of behavioral treatment to incorporate cognitive aspects (Lazarus, 1971). When it became clear that optimizing therapy's effectiveness and effecting durable treatment outcomes often required transcending more narrowly focused cognitive and behavioural methods, Arnold Lazarus expanded the scope of CBT to include physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors. Samuel Yochelson and Stanton Samenow pioneered the idea that cognitive behavioural approaches can be used successfully with a criminal population. CBT includes a variety of approaches and therapeutic systems; some of the most well known include cognitive therapy, rational emotive behavior therapy and multimodal therapy. Defining the scope of what constitutes a cognitive–behavioural therapy is a difficulty that has persisted throughout its development Dobson (Keith, Dozois, & David 2001). The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviours; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included. Cognitive behavioural therapy is often also used in conjunction with mood stabilizing medications to treat conditions like bipolar disorder. Its application in treating schizophrenia along with medication and family therapy is recognized by the NICE guidelines (see below) within the British NHS. Going through cognitive behavioural therapy generally is not an overnight process for clients. Even after clients have learned to recognize when and where their mental processes go awry, it can in some cases take considerable time or effort to replace a dysfunctional cognitive-affective-behavioral process or habit with a more reasonable and adaptive one. There are cognitive behavioral therapy sessions in which the user interacts with computer software (either on a PC, or sometimes via a voice-activated phone service), instead of face to face with a therapist. This can provide an option for patients, especially in light of the fact that there are not always therapists available, or the cost can be prohibitive. For people who are feeling depressed and withdrawn, the prospect of having to speak to someone about their innermost problems can be off-putting. In this respect, computerized CBT (especially if delivered online) can be a good option. Randomized controlled trials have proven its effectiveness, and in February 2006 the UK's National Institute for Health and Clinical Excellence recommended that CCBT be made available for use within the NHS across England and Wales, for patients presenting with mild to moderate depression, rather than immediately opting for antidepressant medication.[26] Specific applications CBT is applied to many clinical and non-clinical conditions and has been successfully used as a treatment for many clinical disorders, personality conditions and behavioural problems (Grahams, 2006). Whilst CBT is highly effective for a number of disorders it is important to note that cognitive behavioural therapy is unlikely to be effective in treating psychiatric problems caused solely by drug or alcohol abuse. It has been argued that the treatment of such patients should be directed at tackling their substance abuse problems (ideally aiming for complete abstinence) prior to the commencement of CBT. A basic concept in CBT treatment of anxiety disorders is in vivo exposure—a gradual exposure to the actual, feared stimulus. This treatment is based on the theory that the fear response has been classically conditioned and that avoidance negatively reinforces and maintains that fear. This "two-factor" model is often credited to O. Hobart Mowrer (Mowrer, 1960). Through exposure to the stimulus, this conditioning can be unlearned; this is referred to as extinction and habituation. A specific phobia, such as fear of spiders, can often be treated with in vivo exposure and therapist modeling in one session (Ost, 1989). Obsessive compulsive disorder is typically treated with exposure with response prevention. Social phobia has often been treated with exposure coupled with cognitive restructuring, such as in Heimberg's group therapy protocol (Turk, Heimberg, Hope, 2001). Evidence suggests that cognitive interventions improve the result of social phobia treatment (Wild et. al. 2006). CBT has been shown to be effective in the treatment of generalized anxiety disorder, and possibly more effective than pharmacological treatments in the long term.[33] In fact, one study of patients undergoing benzodiazepine withdrawal who had a diagnosis of generalized anxiety disorder showed that those who received CBT had a very high success rate of discontinuing benzodiazepines compared to those who did not receive CBT. This success rate was maintained at 12 month follow up. Furthermore in patients who had discontinued benzodiazepines it was found that they no longer met the diagnosis of general anxiety disorder and that patients no longer meeting the diagnosis of general anxiety disorder was higher in the group who received CBT. Thus CBT can be an effective tool to add to a gradual benzodiazepine dosage reduction program leading to improved and sustained mental health benefits (Baillargeon et. al. 2006). One etiological theory of depression is Aaron Beck's cognitive theory of depression. His theory states that depressed people think the way they do because their thinking is biased towards negative interpretations. According to this theory, depressed people acquire a negative schema of the world in childhood and adolescence as an effect of stressful life events. When the person with such schemata encounters a situation that in some way resembles the conditions in which the original schema was learned, the negative schemata of the person are activated (Neale & Gerald, 2001). Beck also described a negative cognitive triad, made up of the negative schemata and cognitive biases of the person; Beck theorized that depressed individuals make negative evaluations of themselves, the world, and the future. Depressed people, according to this theory, have views such as, "I never do a good job", "It is impossible to have a good day", and "things will never get better." A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. This is the negative triad. Also, Beck proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, over-generalization, magnification and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fuelling the negative schema (Neale & Gerald, 2001). Cognitive behavioural therapy has been shown as an effective treatment for clinical depression (Dobson, 1989). A large-scale study in 2000 (Keller, McCullough, & Klein 2000) showed substantially higher results of response and remission (73% for combined therapy vs. 48% for either CBT or a particular discontinued antidepressant alone) when a form of cognitive behaviour therapy and that particular discontinued anti-depressant drug were combined than when either modality was used alone. Several meta-analyses have shown CBT effective in schizophrenia and the American Psychiatric Association includes CBT in its schizophrenia guideline as an evidence-based treatment. There is also some limited evidence of effectiveness for CBT in bipolar disorder and severe depression. CBT can help patients with severe mental disorders to make sense of experiences that lead to symptoms, and to associate key thoughts and feelings with factors that predispose to or precipitate them. For instance, it can help to make rational connections between precipitating causes such as stimulants or hallucinogenic drugs and symptoms such as psychotic episodes. With the help of a therapist, patients may even devise and carry out behavioral experiments that can help them to learn how to improve their quality of life. CBT with children and adolescents The use of CBT has been extended to children and adolescents with positive results. It is often used to treat major depressive disorder, anxiety disorders, and symptoms related to trauma and posttraumatic stress disorder. Significant work has been done in this area by Mark Reinecke and his colleagues at Northwestern University in the Clinical Psychology program in Chicago. Paula Barrett and her colleagues have also validated CBT as effective in a group setting for the treatment of youth and child anxiety using the Friends Program she authored. This CBT program has been recognized as best practice for the treatment of anxiety in children by the World Health Organization. CBT has been used with children and adolescents to treat a variety of conditions with good success. CBT is also used as a treatment modality for children who have experienced complex posttraumatic stress disorder and chronic maltreatment (Briere, Scott, & Catherine 2006). It is in this regard that the theory becomes relevant to this study. As Brian (2006) has instructively pointed out, child abuse and maltreatment are particularly traumatic emotional conditions that can be better appreciated and understood in the context of their impacts on the psychological well-being of victims. Adolescents who have been subjected to abuse through neglect, physical attack (in form of beating etc), sexual exploitation, and so on, often experience a psychological withdrawal which is curable using CBT (Slone. 2008). Psychosocial Theory This is a theory which gives recognition to interpersonal influence of people close to us and the environment as essential characteristic in the development and maintenance of healthy and fulfilling human living. It states, in essence, that human development may be curtailed, distorted, damaged or warped by numerous interpersonal and environmental influences. The theory is usually linked to the writing of Florence Hollis in 1964 and 1970 (Elderson, 2006, Coulshed, 2001). The theory focuses on the integration of psychological and sociological functioning of the individual (intra and interpersonal and intersystemic behavior). Another good example of this theory is the eight stages of psychosocial development as postulated by Erik Eriksson in 1954. Erickson’s ‘psychosocial’ term is derived from the two source words – namely psychological (or the root, ‘psycho’ relating to the mind brain, personality, etc) and social (external relationships and environment), both at the heart of Erickson’s theory. Each stage involves a crisis of two opposing emotional forces. A helpful term used by Eriksson for these opposing forces is ‘contrary dispositions’. Each crisis stage relates to a corresponding life stage and its inherent challenges. Eriksson used the words ‘syntonic’ for the first-listed ‘positive’ disposition in each crisis (e.g. Trust) and ‘dystonic’ for the second-listed ‘negative’ disposition (e.g. Mistrust). To signify the opposing or conflicting relationship between each pair of forces or dispositions Eriksson connected them with the word ‘versus’, which he abbreviated to ‘v’. (Versus is Latin, meaning turned towards or against). The stages of development in Erickson’s theory are illustrated in Table 1 below. Table 1: Stages of Psychosocial development |Stage (age) |Psychosocial crisis |Significant relations |Psychosocial modalities |Psychosocial virtues |Maladaptations & | | | | | | |malignancies | |I (0-1) -- |trust vs mistrust |mother |to get, to give in return |hope, faith |sensory distortion -- | |infant | | | | |withdrawal | |II (2-3) -- |autonomy vs shame and |parents |to hold on, to let go |will, determination |impulsivity -- compulsion | |toddler |doubt | | | | | |III (3-6) -- |initiative vs guilt |family |to go after, to play |purpose, courage |ruthlessness -- inhibition | |preschooler | | | | | | |IV (7-12 or so) -- |industry vs inferiority|neighborhood and school|to complete, to make |competence |narrow virtuosity -- inertia| |school-age child | | |things together | | | |V (12-18 or so) -- |ego-identity vs |peer groups, role |to be oneself, to share |fidelity, loyalty |fanaticism -- repudiation | |adolescence |role-confusion |models |oneself | | | |VI (the 20’s) -- |intimacy vs isolation |partners, friends |to lose and find oneself |love |promiscuity -- exclusivity | |young adult | | |in a | | | | | | |another | | | |VII (late 20’s to 50’s)|generativity vs |household, workmates |to make be, to take care |care |overextension -- rejectivity| |-- middle adult |self-absorption | |of | | | |VIII (50’s and beyond) |integrity vs despair |mankind or “my kind” |to be, through having |wisdom |presumption -- despair | |-- old adult | | |been, to face not being | | | Source: Eriksson, H.E. (1959) Identity and the Life Cycle Psychological Issues 1, 2, 23-24 From the table above, Erickson’s psychosocial stages of development include the following: 1. Trust v Mistrust This is the first stage in which the infant will develop a healthy balance between trust and mistrust if fed and cared for and not over-indulged or over-protected. Abuse or neglect or cruelty will destroy trust and foster mistrust. Mistrust increases a person’s resistance to risk-exposure and exploration. On the other hand, if the infant is insulated from all and any feelings of surprise and normality, or unfailingly indulged, this will create a false sense of trust amounting to sensory distortion, in other words a failure to appreciate reality. Infants who grow up to trust are more able to hope and have faith that ‘things will generally be okay’. 2. Autonomy v Shame and Doubt Autonomy means self-reliance. This is independence of thought, and a basic confidence to think and act for oneself. Shame and doubt mean what they say, and obviously inhibit self-expression and developing one’s own ideas, opinions and sense of self. Toilet and potty training is a significant part of this crisis. 3. Initiative v Guilt Initiative is the capability to devise actions or projects, and a confidence and belief that it is okay to do so, even with a risk of failure or making mistakes. Guilt means what is says, and in this context is the feeling that it is wrong or inappropriate to instigate something of one’s own design. Guilt results from being admonished or believing that something is wrong or likely to attract disapproval. Initiative flourishes when adventure and game-playing is encouraged, irrespective of how daft and silly it seems to the grown-up in charge. Parents, carers and older siblings, spouse and friends (as the case may be) have a challenge to get the balance right between giving cancer patients enough space and encouragement so as to foster a sense of purpose and confidence, but to protect against danger, and also to enable a sensible exposure to trial and error, and to the consequences of mistakes, without which an irresponsible or reckless tendency can develop. 4. Industry v Inferiority Industry here refers to purposeful or meaningful activity. It’s the development of competence and skills, and a confidence to use a ‘method’, and is a crucial aspect of school years experience. A child who experiences the satisfaction of achievement – of anything positive will move towards successful negotiation of this crisis stage. A child who experiences failure at school tasks and work, or worse still who is denied the opportunity to discover and develop their own capabilities and strengths and unique potential, quite naturally is prone to feeling inferior and useless. Inferiority is feeling useless; unable to contribute, unable to cooperate or work in a team to create something, with the low self-esteem that accompanies such feelings. In the case of cancer patients, there is need to help them develop a sense of purpose and create an atmosphere of camaraderie that would ensure that they live a productive life. 5. Identity v Role Confusion Identify means essentially how a person sees themselves in relation to their world. It’s a sense of self or individuality in the context of life and what lies ahead. Role confusion is the negative perspective – an absence of identity – meaning that the person cannot see clearly or at all who they are and how they can relate positively with their environment. This stage coincides with puberty or adolescence, and the reawakening of the sexual urge whose dormancy typically characterizes the previous stage. Young people struggled to belong and to be accepted and affirmed, and yet also to become individuals. 6. Intimacy v Isolation Intimacy means the process of achieving relationships with family and marital or mating partner(s). Eriksson explained this stage also in terms of sexual mutuality – the giving and receiving of physical and emotional connection, support, love, comfort, trust, and all the other elements that we would typically associate with healthy adult relationships conducive to mating and child-rearing. There is a strong reciprocal feature in the intimacy experienced during this stage – giving and receiving especially between sexual or marital partners. Isolation conversely means being and feeling excluded from the usual life experiences of dating and mating and mutually loving relationships. This logically is characterized by feeling of loneliness, alienation, social withdrawal or non-participation. 7. Generativity v Stagnation Generativity derives from the word generation, as in parents and children, and specifically the unconditional giving that characterizes positive parental love and care for their offspring. Stagnation is an extension of intimacy which turns inwards in the form of self-interest and self-absorption. It’s the disposition that represents feelings of selfishness, self-indulgence, greed, lack of interest in young people and future generations, and the wider world. 8. Integrity v Despair Integrity means feeling at peace with oneself and the world. No regrets or recriminations. The linking between the stages is perhaps clearer here than anywhere: people are more likely to look back on their lives positively and happily if they have left the world a better place than they found it in whatever way, to whatever extent. There lies integrity and acceptance. Despair and/or ‘Disgust’ (i.e., rejective denial, or ‘sour grapes’ feeling towards what life might have been) represent the opposite disposition: feelings of wasted opportunities, regrets, wishing to be able to turn back the clock and have a second chance. The basic assumptions of the theory which has relevant to this study are: 1. The behaviour of an individual depends on his/her psychological state as well as his/her social environment; 2. A person’s past is important in seeking to understand his or her current behaviour. It follows then that if certain factors (including psychological factors) within an individual social environment imposes more stress on the individual than he can cope with, his psychological state is disturbed. This could result in an abnormal behaviour or a condition of psychiatric illness. However, if the social environment of an individual is conducive or where he has enough social support to cushion the negative effect of some of these factors, he is more likely to be in good psychological state and hence enjoy good mental health. The psychosocial theory would prove very useful in the generation of questions and in making of recommendations that will assist the caregivers, relatives, government and even social worker in the proper management of abused adolescents. This theory laid emphasis on the past experiences of abused adolescents within their social environment. These experiences include the amount of familial and extra-familial attention they receive, his/her social economic status, loss of a close relation etc. Drawing from the theory, it follows that helping children or adolescents who have suffered one form of abuse or the other to fully recover and be integrated into the community requires effort of the victims’, relations, parents others and professionals. The Theory of Power and Control In many instances, abuse and violence arise out of a perceived need for power and control, a form of bullying and social learning of abuse. Abusers' efforts to dominate their partners have been attributed to low self-esteem or feelings of inadequacy, unresolved childhood conflicts, the stress of poverty, hostility and resentment toward women (misogyny), hostility and resentment toward men (misandry), hostility and resentment toward children (misandry), personality disorders, genetic tendencies and sociocultural influences, among other possible causative factors. Most authorities seem to agree that abusive personalities result from a combination of several factors, to varying degrees [Elliott 1989] A causalist view of child abuse is that it is a strategy to gain or maintain power and control over the victim. This view is in alignment with Bancroft's "cost-benefit" theory that abuse rewards the perpetrator in ways other than, or in addition to, simply exercising power over his or her target(s). He cites evidence in support of his argument that, in most cases, abusers are quite capable of exercising control over themselves, but choose not to do so for various reasons [Elliott 1989] An alternative view is that abuse arises from powerlessness and externalizing/projecting this and attempting to exercise control of the victim. It is an attempt to 'gain or maintain power and control over the victim' but even in achieving this it cannot resolve the powerlessness driving it. Such behaviours have addictive aspects leading to a cycle of abuse or violence. Mutual cycles develop when each party attempts to resolve their own powerlessness in attempting to assert control (Elliott 1989). Questions of power and control are integral to the widely utilized Duluth Domestic Abuse Intervention Project. They developed "Power and Control Wheel" to illustrate this: it has power and control at the center, surrounded by spokes the titles of which include: Source: The Duluth Domestic Abuse Intervention Project, (2007) (25 - 26). • Coercion and threats • Intimidation • Emotional abuse • Isolation • Minimizing, denying and blaming • Using children • Economic abuse • Male privilege The model attempts to address abuse by one-sidedly challenging the misuse of power by the 'perpetrator'. Critics of this model suggest that the one-sided focus is problematic as resolution can only be achieved when all participants acknowledge their responsibilities, and identify and respect mutual purpose. The power wheel model is not intended to assign personal responsibility, enhance respect for mutual purpose or assist victims and perpetrators in resolving their differences. It is an informational tool designed to help individuals understand the dynamics of power operating in abusive situations and identify various methods of abuse [Elliott 1989] Unless or until more parents identify themselves and go on record as having been abused by their children, and in a manner whereby the nature and extent of their abuse can be socially or clinically assessed, parents will continue to be identified as the most frequent perpetrators of physical and emotional violence [Buzawa & Buzawa 2000) This theory sees abuse as arising out of a need by the individual to assume control or exercise some power over the partner, here the abuser wants to control and dominate the partner, thus the resort to all forms of abuse (including violence) to still any opposition or form of revolt against his domination of the partner and because of the desire to control and have dominion over his partner the individual results to violence which gradually becomes a way of life with him. 2.2 REVIEW OF LITERATURE Child abuse can take many forms, including direct physical violence ranging from unwanted physical contact to rape and murder. Indirect physical violence may include destruction of objects, striking or throwing objects near the victim, or harm to pets. In addition to physical violence, child abuse often includes mental or emotional abuse, including verbal threats of physical violence to the victim, the self, or others including children, ranging from explicit, detailed and impending to implicit and vague as to both content and time frame, and verbal violence, including threats, insults, put-downs, and attacks. Nonverbal threats may include gestures, facial expressions, and body postures. Psychological abuse may also involve economic and/or social control, such as controlling the victim's money and other economic resources, preventing the victim from seeing friends and relatives, actively sabotaging the victim's social relationships, and isolating the victim from social contacts [Carswell 2006). 2:2:1 Physical violence Physical violence is the intentional use of physical force with the potential for causing injury, harm, disability, or death, for example, hitting, shoving, biting, restraint, kicking, or use of a weapon. In most relationships where there is a struggle for dominance by any of the partners or where there are pressures which cannot be controlled by the partners, there is always a tendency for the partners to result to violence expressed physically through beating, punching etc, these physical expression of violence to a large extent affects the psychological disposition and well-being of adolescents (Christine, 2007) and could even affect his/her performance in school or at work because of the abuse he or she may have suffered may no longer be in that tip top shape to perform at his or her utmost and this may result directly in reduced productivity and also increase workplace insecurity(Grenoble, 2003) Sexual violence Sexual violence is divided into three categories: • use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed, attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, unable to decline participation, or unable to communicate unwillingness to engage in the sexual act, e.g., because of underage immaturity, illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure; • and abusive sexual contact, the effects of this acts of violence on the individual is usually psychological and sometimes physical too (Street, 2006). It is also quite traumatic and disorientating and to a large extents affects the performance of the adolescents in the workplace or in school, as sometimes such violence may result in the victim being hospitalized for several days. It also reduces the workers lack of concentration in the workplace thus resulting in accidents as the worker most times would not be concentrating on the job but would rather be thinking of ways and means to avert further abuse and to find solace from such violence (Schfell, 2007). Emotional abuse Emotional abuse (also called psychological abuse or mental abuse) can include humiliating the victim privately or publicly, controlling what the victim can and cannot do, withholding information from the victim, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, implicitly blackmailing the victim by harming others when the victim expresses independence or happiness, or denying the victim access to money or other basic resources and necessities (Wordsworth, 2001). Such abuse may affect the adolescent in several ways, it may create a reduction in the individual’s performance in school or at work especially if such abuse is perpetuated in the individual’s place of work or where the individual’s co-workers are, it will make the individual become susceptible to mistakes at the workplace which may increase accidents at the workplace (Sand, 2004). Children who are being emotionally abused often feel as if they do not own themselves; rather, they may feel that their abuser has nearly total control over them (Schfell, 2007). Children undergoing emotional abuse often suffer from depression, which puts them at increased risk for suicide, eating disorders, and drug and alcohol abuse and this creates a serious drop down in their productivity and also open them to accidents in school or workplace. Economic abuse Economic abuse is when the abuser has complete control over the victim's money and other economic resources. Usually, this involves putting the victim on a strict "allowance," withholding money at will and forcing the victim to beg for the money until the abuser gives them some money. It is common for the victim to receive less money as the abuse continues. This also includes (but is not limited to) preventing the victim from finishing education or obtaining employment, or intentionally squandering or misusing communal resources (Torres 2000). This creates a serious disconnect for the victim in his or her school or workplace, as there is a gradual reduction in the performance of the individual and lack of concentration in the school or workplace. The victim feels cheated and inadequately compensated for his or her inputs and thus the victim no longer feels that the work is worth it. Such lack of concentration may result in accidents in the workplace and definitely a reduction in performance. Child sexual abuse Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation (Helen, 2004). Forms of CSA include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure of the genitals to a child, displaying pornography to a child, actual sexual contact against a child, physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using a child to produce child pornography. The effects of child sexual abuse include depression, post-traumatic stress disorder, anxiety, propensity to re-victimization in adulthood, and physical injury to the child, among other problems. Sexual abuse by a family member is a form of incest, and can result in more serious and long-term psychological trauma, especially in the case of parental incest. Child sexual abuse is also strongly connected to the development of Complex post-traumatic stress disorder and borderline personality disorder. It has been estimated that approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, mothers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases. Child Abuse in Varied Context Since the recognition in 1962 of the seriousness of child physical abuse (Kempe, Silverman, Steele, Droegemueller, & Silver,1962), child maltreatment has received heightened media and scholarly attention. Abuse estimates soared following the implementation of mandatory reporting laws in the United States during the 1960s and 1970s (Lindsey, 2004). Moreover, anonymous surveys demonstrate the virtually universal practice of parental physical discipline of children and even more severe parent-child violence. The media typically spotlight the most brutal and fatal instances of child abuse, neglecting that most cases of maltreatment emerge from the routine practice of physical discipline strategies. Physical abuse often results from an unintended escalation while administering physical punishment for perceived child transgressions (Herren-kohl, Herrenkohl, & Egolf, 2003), and maltreatment is often conceptualized as on a continuum with physical discipline (Rodriguez & Sutherland, 1999; Whipple & Richey, 2007). Although physical discipline and child abuse can be considered variants of parental aggression, abusive behaviour is generally deemed unacceptable, whereas public opinion regarding corporal punishment is clearly divided. This debate over the usefulness of physical punishment has persisted for generations despite support from experts (e.g., Straus, 2001) regarding the need to discontinue all forms of family violence. In light of calls to end all legalized forms of corporal punishment toward children (e.g., Hammarberg & Newell, 2002), researchers must address this controversy over physical punishment by compiling further evidence regarding the immediate and long-term functioning of children receiving any physical punishment. The risk factors are considered similar for both child physical abuse and physical punishment (Straus, 2003). Consequently, it is important to ascertain whether the effects of physical abuse and physical discipline overlap. To date, the evidence indicates that child maltreatment is characterized as detrimental to victims, resulting in both short-term and long-term sequelae in psychosocial and cognitive functioning (e.g., Fantazzo, 2000; Starr & Wolfe, 2001). Thus physically abused children are more likely than non-abused children to demonstrate such characteristics as oppositionality, behaviour problems, depression, fearfulness, social withdrawal, and lower self-esteem. For example, abused children were found to be more likely to display higher levels of depressive symptomatology and hopelessness as well as lower levels of self-esteem than comparison groups (Kazdin, Moser, Colbus, & Bell, 2005). Another study confirmed increased depression and hopelessness in children with abuse histories as well as a tendency toward an external locus of control (Allen & Tarnowski, 2001). Moreover, a more maladaptive, depressogenic attributional style was reported for abused children (Cerezo & Frias, 2004). Thus children who are victims of abuse display many signs reflective of internalizing disorders. Some indications in the research, however, point to negative outcomes ensuing from corporal punishment in the absence of parental behaviours injurious enough to qualify as abusive (e.g., Straus & Kantor,2004). Child maltreatment research has often relied on research designs that assess children after the fact when confirmed abuse has already occurred. Retrospective research strategies, however, are typically subject to recall biases and errors. It remains unclear whether problematic symptoms manifested in some abused children actually appear in non-clinical samples of children who have received less serious forms of parental aggression, such as physical punishment. Theoretically, some of the emotional and behavioural difficulties associated with physical child abuse may develop primarily as a function of parents' harsher disciplinary styles and attitudes. Thus the difficulties experienced by children may differ depending on whether they grow up with more versus less physical discipline. Research has indeed supported a relationship between childhood history of harsh discipline and adult psychopathology (Holmes & Robins, 2008), although by using retrospective research designs. Another study demonstrated that the more severe the discipline experienced by the child, the more aggressively the child behaves (i.e., externalizing behaviour problems; Weiss, Dodge, Bates, & Pettit, 2002), although these researchers did not find a relationship between physical discipline and internalizing behaviour problems. Another study supported discipline as a significant predictor of behaviour problems in children (Brenner & Fox, 2008). One dissertation indicated higher depression and anxiety symptoms for those children cat-egorized in high discipline risk groups (Dingwall, 2007). Yet noticeably more research, as well as public discussion, has centered on the influence of physical discipline leading to aggressive and externalizing behaviour problems via social learning. The preponderance of research literature ties corporal punishment to aggressive behaviour (e.g., Straus, 2001), whereas the association of physical punishment with internalizing problems remains less apparent in the literature. Although the connection between physical discipline and aggression is clearly meaningful to both family and society, research continues to overlook its association with the emotional life of the child. Anecdotally, we hear of children's subjective reports of distress at physical discipline (e.g., Willow & Hyder, 2008), although actual empirical research investigating the child's internal experience of discipline is lacking. Whereas both child and adolescent boys reportedly demonstrate more disruptive behaviour and externalizing difficulties compared with girls (e.g., Crijnen, Achenbach, & Verhulst, 2007), several studies of pre-pubertal children have not detected gender differences in depression or attributional style (e.g., Joiner & Wagner, 2005; Thompson, Kaslow, Weiss, & Nolen-Hoeksema, 2008). Indeed, an interesting line of inquiry has begun to investigate the emergence of gender differences in depression and anxiety during adolescence (Hayward & Sanborn, 2002). Thus, comparing the internalizing processes for pre-pubertal boys and girls growing up with harsh physical disciplinarians would be meaningful. Some components of the internalizing domain mirroring those drawn from the child maltreatment literature (including depression, anxiety, and attributional style) may be particularly important to investigate in children receiving physical punishment. Although some research has included symptoms of depression and anxiety, depressogenic attributional style-a risk factor for depression as conceptualized by Abramson and colleagues (Abramson, Metalsky, & Alloy, 2000; Abramson, Seligman, & Teasdale, 2003)-has been relatively neglected in research on the physical discipline of children. Maladaptive attributions, as delineated in the learned helplessness model of depression, could potentially develop in response to uncontrollable physical discipline, which may in turn lead to depressive or anxious symptomatology in children. Further, of particular interest in the current study was the element of internal locus of control, given that findings in the maltreatment literature (Allen & Tarnowski, 2000) suggest that physical discipline is likely to be perceived as outside of the child's control. In addition, research on attributional style has concentrated on children's explanation of both positive and negative events in their lives, with support across samples that both are relevant to children's depression (Gladstone & Kaslow, 2006; Joiner & Wagner, 2005; Thompson et al., 2008). Both are relevant as well in maltreated children (Kress & Vandenberg, 2008; Runyon& Kenny, 2002). A study by Rodriguez (2003) investigated several symptoms linked to internalizing dimensions in an attempt to determine whether a non-clinical sample of children receiving physical discipline demonstrates difficulties typically associated with child abuse victims. Children whose parents hold more physically abusive attitudes and those who engage in harsher discipline were compared with lower risk parents. Families with no established history of abuse were selected in order to assess whether increased depressive or anxious symptomatology was detected in children whose parents had a harsher discipline style and abusive attitudes. Moreover, to examine how discipline attitudes and practices may relate to how children explain events in their own lives, children's attributional style was also examined, specifically their explanations for both positive and negative events as well as how they internalize responsibility, that is, locus of control. Orr et al. (2002) have observed that surveys of adolescent behaviour often rely upon single-item, self-report measures. When this method is used, it is quite possible to misclassify experiences, particularly when assessing sensitive subjects such as adolescent sexual experiences (Newcomer & Udry, 2005). Given this reality, researchers have attempted to assess the reliability of certain behaviours in adolescent sexuality research, such as timing of initial sexual experiences and lifetime sexual intercourse (Alexander, Somerfield, Ensminger, Johnson, & Kim, 2003; Capaldi, 2006). The consistency of adolescent self-report of initial sexual experience timing, for example, appears poor (Alexander et al., 2003; Capaldi, 2006). In light of this fact, it seems possible that self-report of other sensitive experiences, such as childhood sexual abuse (CSA) may also be inconsistently reported in adolescent populations. CSA is linked to wide-ranging emotional, behavioural, and adjustment problems including adolescent pregnancy, aggression, anxiety, depression, risky sexual behaviours, low self-esteem, school problems, and withdrawn behaviours (Kendall-Tackett, Williams, & Finkelhor, 2007; Luster & Small, 2007). The relationship between CSA and future behavioural problems has previously been demonstrated; however, the specific psychosocial mechanisms leading to these outcomes are not clearly understood (Orr et al. 2002). One reason for this lack of clarity is methodological in nature, given that CSA measurement varies greatly across studies (Briere, 2002; Goldman & Padayachi, 2000; Roosa, Reyes, Reinholtz, & Angelini, 2008). For example, in many self-report questionnaire studies, CSA is measured by a single item (Bensley, Van Eenwyk, Spieker, & Schoder, 1999; Luster & Small, 2007; Thompson, Potter, Sanderson, & Maibach, 2007), which eliminates the possibility of assessing internal reliability. Other studies have used more extensive measurement methods, such as clinical interviews or medical/psychosocial evaluations (Brown, Kessel, Lourie, Ford, & Lipsitt, 2007; Meyer, Muenzenmaier, Cancienne, & Struening, 2006). Using an interview to assess CSA allows for information concerning the duration and nature of the abuse to be gained. However, these methods are time intensive and the reliability of interview methods has been poorly evaluated. Even relatively brief scales assessing childhood sexual abuse, such as the Early Sexual Experiences Checklist (Miller & Johnson, 1998) and the Unwanted Childhood Sexual Experiences Questionnaire (Stevenson, 1998), are lengthy: 20 items and 13 items respectively. In sum, studies using brief scales to assess CSA are noticeably absent (Orr et. al 2002). Using a brief self-report assessment of CSA is important when assessing a wide range of behaviours and psychosocial attitudes in one study. Methodological research concerning the stability of CSA reporting over time has not been conducted even though researchers have called for data to be collected at more than one time point to assess for developmental differences in symptomatology (Kendall-Tackett, Williams, & Finkelhor, 2007). In an extensive literature search of studies related to CSA reporting, only one recent study (Costello, Angold, March, & Fairbank, 2008) measured the reliability of CSA reporting across two time points. In a study by Orr et. al (2003)-the focus of which was to assess the utility of a measure of post-traumatic stress disorder( PTSD) with children-10 participants indicated they had been sexually abused. Two weeks later, 9 participants reported that they had been sexually abused, resulting in a Cohen's Kappa correlation of .81. Hence, a significant gap in the CSA research literature exists in terms of stability of reporting. Self-report consistency at different time points is one approach to assessment of reporting stability (i.e., correctly identifying as non-CSA or CSA). This method has proven CSA Stability effective in past studies of adolescent self-report consistency (Alexander et al., 2003; Capaldi, 2006). Using two time points was expected to create three distinct groups of CSA reporting: consistent non-reporters (deny CSA at both time points), inconsistent reporters (endorse CSA at one point and deny at the other time point), and consistent reporters (endorse CSA at both time points). If the two-time-point approach reduces misclassification, we expect the following: the consistent non-reporters group will include a lower proportion of persons with a true experience of abuse; the inconsistent reporters group will include persons with true positive and false positive reports; and the consistent reporters group ill include a larger proportion of true positive reports and a smaller proportion of false positive reports. If the preceding premise is true, we would then expect problem behaviours associated with CSA to be differentially distributed across the three groups. This is expected given that CSA is associated with specific problem behaviours. As a result, it is expected that consistent non-reporters would have lower levels of problem behaviours, inconsistent reporters would have intermediate levels, and consistent reporters would have higher levels. Inter-mediate levels of problem behaviour among inconsistent reporters were expected because their identification of CSA experiences may be influenced by temporal stress, such as relationship difficulty or other life stressors. The demonstration of differential problem behaviour involvement will provide another measure of validity. Additionally, endorsement of two or more CSA items should be related to an increased likelihood of consistent reporting. Child abuse is a complex phenomenon with multiple causes (Fontana, 2004). Understanding the causes of abuse is crucial to addressing the problem of child abuse. According to Ross (2006) parents who physically abuse their spouses are more likely than others to physically abuse their children. However, it is impossible to know whether marital strife is a cause of child abuse, or if both the marital strife and the abuse are caused by tendencies in the abuser. Substance abuse can be a major contributing factor to child abuse. One U.S. study found that parents with documented substance abuse, most commonly alcohol, cocaine, and heroin, were much more likely to mistreat their children, and were also much more likely to reject court-ordered services and treatments (Goshko, 2001) Another study found that over two thirds of cases of child maltreatment involved parents with substance abuse problems. This study specifically found relationships between alcohol and physical abuse, and between cocaine and sexual abuse (Famularo, Kinscherff, & Fenton, 2002). Children with a history of neglect or physical abuse are at risk of developing psychiatric problem, or a disorganized attachment style (Malinosky-Rummell, & Hansen, 2003). Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms, as well as anxiety, depressive, and acting out symptoms (Lyons-Ruth, 2006). A study by Dante Cicchetti (2000) found that 80% of abused and maltreated infants exhibited symptoms of disorganized attachment. When some of these children become parents, especially if they suffer from posttraumatic stress disorder (PTSD), dissociative symptoms, and other sequelae of child abuse, they may encounter difficulty when faced with their infant and young children's needs and normative distress, which may in turn lead to adverse consequences for their child's social-emotional development (Robinson et. al 2007). Despite these potential difficulties, psychosocial intervention can be effective, at least in some cases, in changing the ways maltreated parents think about their young children (Liebowitz, 2006). Victims of childhood abuse, it is claimed, also suffer from different types of physical health problems later in life. Some reportedly suffer from some type of chronic head, abdominal, pelvic, or muscular pain with no identifiable reason. Even though the majority of childhood abuse victims know or believe that their abuse is, or can be, the cause of different health problems in their adult life, for the great majority their abuse was not directly associated with those problems, indicating that sufferers were most likely diagnosed with other possible causes for their health problems, instead of their childhood abuse (Cox, 2003). The effects of child abuse vary, depending on the type of abuse. A 2006 study found that childhood emotional and sexual abuse were strongly related to adult depressive symptoms, while exposure to verbal abuse and witnessing of domestic violence had a moderately strong association, and physical abuse a moderate one. For depression, experiencing more than two kinds of abuse exerted synergetically stronger symptoms. Sexual abuse was particularly deleterious in its intrafamilial form, for symptoms of depression, anxiety, dissociation, and limbic irritability. Childhood verbal abuse had a stronger association with anger-hostility than any other type of abuse studied, and was second only to emotional abuse in its relationship with dissociative symptoms. More generally, in the case of 23 of the 27 illnesses listed in the questionnaire of a French INSEE survey, some statistically significant correlations were found between repeated illness and family traumas encountered by the child before the age of 18 years. (Middlebrooks & Audage 2008). These relationships show that inequality in terms of illness and suffering is not only social. It also has its origins in the family, where it is associated with the degrees of lasting affective problems (lack of affection, parental discord, the prolonged absence of a parent, or a serious illness affecting either the mother or father) that individuals report having experienced in childhood. New research illustrates that there are strong associations between exposure to child abuse in all its forms and higher rates of many chronic conditions. The strongest evidence comes from the Adverse Childhood Experiences (ACE's) series of studies which show correlations between exposure to abuse or neglect and higher rates in adulthood of chronic conditions, high-risk health behaviors and shortened lifespan (Middlebrooks & Audage, 2008). A recent publication, Hidden Costs in Health Care: The Economic Impact of Violence and Abuse, makes the case that such exposure represents a serious and costly public-health issue that should be addressed by the healthcare system. Cohen et. al (2006) have identified a number of treatments for victims of child abuse. One of them is the trauma-focused cognitive behavioural therapy, first developed to treat sexually abused children, and which, as we noted in the theoretical framework under girding this research, is now used for victims of any kind of trauma. It targets trauma-related symptoms in children including post-traumatic stress disorder (PTSD), clinical depression, and anxiety. It also includes a component for non-offending parents. Several studies have found that sexually abused children undergoing TF-CBT improved more than children undergoing certain other therapies. Abuse-focused cognitive behavioural therapy was designed for children who have experienced physical abuse. It targets externalizing behaviours and strengthens prosocial behaviours. Offending parents are included in the treatment, to improve parenting skills/practices. It is supported by one randomized study. Child-parent psychotherapy was designed to improve the child-parent relationship following the experience of domestic violence. It targets trauma-related symptoms in infants, toddlers, and preschoolers, including PTSD, aggression, defiance, and anxiety. It is supported by two studies of one sample. Other forms of treatment include group therapy, play therapy, and art therapy. Each of these types of treatment can be used to better assist the client, depending on the form of abuse they have experienced. Play therapy and art therapy are ways to get children more comfortable with therapy by working on something that they enjoy (colouring, drawing, painting, etc.). The design of a child's artwork can be a symbolic representation of what they are feeling, relationships with friends or family, and more. Being able to discuss and analyze a child's artwork can allow a professional to get a better insight of the child. RESEARCH HYPOTHESIS i. There will be no significant joint effect of physical abuse, sexual abuse, and financial abuse on emotional stability of adolescents. ii. There will be no significant relative effect of physical abuse, sexual abuse, and financial abuse on emotional stability of adolescents. iii. There will be no significant relationship between emotional stability of adolescents in secondary school and physical abuse. iv. There will be no significant relationship between emotional stability of adolescents in secondary school and sexual abuse ----------------------- Coercion and threats r Emotional abuse Intimidation Isolation Isolation, lack of support Minimizing, denying and blaming Using children of resources Economic abuse Power and Control Male privilege egation and institutionalization