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Helping Abused and Traumatized Children -- Integrating Directive and Nondirective Approaches
by Eliana Gil, Ph.D.
(The Guilford Press, New York, NY)
All rights reserved.
[Answer 17 of 25 questions correctly to receive
13 hours of Continuing Education credit.]


Chapter 1: Basic Principles for Working with Abused and Traumatized Children (p. 3-19)1. Which is NOT true?
a. Children seem to negotiate their emotional injuries by two drives: 1) The drive to master what is painful or confusing, and 2) The drive to avoid painful emotions.
b. It is best to avoid pressuring children into talking about abuse when they don't feel ready to do so.
c. Talking about trauma always makes children feel better.
d. In play therapy, children can identify with objects or symbols, project their thoughts and feelings onto those symbols or objects, and then process difficult, painful, or conflictual material in a protected and safe way that respects defensive mechanisms and pacing.

Chapter 2: Guidelines for Integrated Assessment -- The Multidisciplinary Framework For Assessment and Treatment (p. 20-51)
2. In what session did Gene, the 7-year old child, use miniatures of his family members to tell Ed, the man who sexually abused Gene, what they thought about what Ed did to Gene?
a. Session 2
b. Session 3
c Session 4
d Session.5

3. What did the author have Gene do in Session 6?
a. Construct a play genogram.
b. Build a sand world.
c. Fill out the paper-and-pencil TSCC, the Trauma Symptom Checklist for Children
d. Make a kinetic family drawing.

4. An extended developmental assessment is a structured approach that allows clinicians to evaluate children's overall functioning, identify symptomatic behaviors, assess the impact of trauma (if any), and assess children's phenomenological experience of the abuse (including the perceptions of parental support and guidance). An extended developmental assessment lasts between ____ sessions, at the end of which a clinician should be able to determine therapy plans with specific, measurable goals and clear time frames. In some cases, where the traumatic impact is relatively low, and there is sufficient family love and support, little or no further treatment may be required, other than follow-up sessions.
a. 4 to 6
b. 6 to 8
c. 8 to 10
d. 10 to12

Chapter 3: Guidelines for Integrated Treatment (p. 52-68)
5. The author discovered that when most parents or other caretakers found out about their children's abuse, they
a. already had a vague suspicion that something bad had happened
b. took the necessary steps to reconstruct a safe and nurturing environment.

c. knew who to contact immediately for help.
d. tried to keep quiet about the matter.

Chapter 4: Expressive Therapies (p. 69-97)
6. Which is NOT true?
a. In play genograms, children pick miniatures which best show their thoughts and feelings about each person in their family.
b. Sand therapy can be a helpful alternative for children who lack confidence in their drawing or painting abilities.
c. The author gives simple rather than complicated instructions when beginning sand therapy, such as "Use as few or as many miniatures as you wish to make a world in the sand."
d. It is possible through sole reliance on children's drawings to determine if child sexual abuse has occurred.

7. One day Caroline, a 13-year-old, came into the author's office and said, "I'm not talking today. I had a rotten day." In response, the author
a. said, "Tell me why your day was so rotten."
b. asked her to pick miniatures which would best show the rotten day she had just had.
c. asked her if she would like to draw her self-portrait.
d. watched her play in the sand box.

Chapter 5: Cognitive-Behavioral Therapy (p. 98-121)

8. In the 2nd session with Curtis, an 11-year-old boy who had sexually abused his 4-year-old sister, the author
a. asked Curtis to describe situations in which he inappropriately touched his sister.
b. asked Curtis if anyone had ever touched him inappropriately.
c. had Curtis watch a video describing three kinds of touching: safe, hurtful, and the touching of private parts.
d. asked Curtis to select miniatures for his family genogram.

9. Which did NOT take place during Curtis' 10 months of therapy?
a. Curtis disclosed being abused by a neighbor who had moved away 2 years ago.
b. Curtis wrote and read an apology to his sister, clearly stating that his inappropriate touching of her had been wrong.
c. Curtis grew in self-esteem and decreased behaving in inappropriate ways in order to get attention.
d. The author was able to find out why Curtis' parents were so negative to him.

10. Esperanza was a 6-year old Hispanic child who had been sexually abused by her step-father. The author taught Esperanza how to stop an unwanted thought by
a. teaching her to visualize her stepfather being arrested by the police.
b. stopping the thought when a timer went off, and then putting a nice memory in place of the bad thought.
c. drawing the bad thought on paper, then throwing it away.
d. reconstructing the bad thought in the sand box, then covering it over with sand.

11. Just prior to termination, Esperanza had one persistent concern: She wondered whether
a. her stepfather had abused her because she was a bad person
b. she would ever get married some day.
c. her mother really loved her.
d. she would ever be a normal person.

Chapter 6: Family Therapy and Family Play Therapy (p. 122-150)

In working with parents of sexually abused children, it is necessary to confront parental denial at any level. Trepper and Barrett (1989) have described four types of parental denial in child sexual abuse: denial of facts, denial of awareness, denial of responsibility, and denial of impact. It is possible for parents to agree to the fact that their child was actually sexually abused, but still disagree with the abuser's motive or intent. A mother may say that their husband or boyfriend who committed the abuse did not understand what he was doing because he was drunk. This is a denial of ____. However, it is important for mothers to clarify how and why the abuse occurred. Many mothers will need to be told that adults who abuse are seductive, initiate sex, and often threaten children into silence.
a. facts
b. awareness
c. responsibility
d. impact

13. In working with child sexual abuse cases, a clinician's greatest priority is
a. to insure the stability of the parents.
b. to insure the safety of the child.
c. to prevent further abuse by bringing the perpetrator to justice.
d. to comply with the law in reporting suspected or actual child abuse or neglect.

14. Many parents of abused children have their own painful histories of childhood abuse. Indeed, multi-generational patterns of child sexual abuse are the rule rather than the exception. The author says that during intake appointments, she typically will use ____ to get an overview of family issues (troubled relationships, problems, deaths, illnesses, violence, abuse, etc.).
a. genograms
b. House-Tree-Person
c. Draw-a-Person
d. Kinetic Family Drawing

15. In this chapter, the author recommends which highly visible, national organization that advocates for specialized training for professionals who help children, teens, or adults who have sexually abusive behaviors?

American Professional Society on the Abuse of Children (APSAC)
b. The Association for the Treatment of Sexual Abusers (ATSA
c. Child Molestation Research & Prevention Institute (CMRPI)
d. Faith Trust Institute

16. What helped Estelle Daniels, the mother of four children, to eventually see her 6-year-old son, Jackson, as a child with "boy energy" and a tender heart rather than a "provocative" child who was destined to behave like his threatening father and stepfather?
a. The author helped Estelle empathize more with Jackson by realizing that he was the only male in a family with a single mother and 3 sisters.
b. Estelle realized that every time she corrected Jackson, she was doing it not so much to set good limits on his aggressive behavior but to prevent him from acting like his father and stepfather, both who were frightening and violent.
c. During Family Puppet Therapy, Estelle saw Jackson's goofy-looking alligator as "pretending to be a tough guy," and she said "it's hard to get angry at that alligator or feel too scared of him."
d. All of the above.

"Abused children sometimes carry tension and stress in their bodies and can have contracted muscles, restricted breathing patterns, and lack of fluidity in their movements -- they can appear stiff and uncomfortable in their bodies. Often they have experienced pain and discomfort in their bodies due to physical violence, boundary violations, or lack of appropriate hygiene or nutrition. They can also develop somatic complaints such as stomachaches, headaches, and hypersensitivity to injury. Because of this, it may be helpful to encourage a broad range of physical activity, such as dancing, running, movement, gymnastics, and team sports like baseball or softball. These recreational activities allow children to explore their bodies, release constricted energy, and experience a sense of well-being and enjoyment."
(p. 148)

Chapter 7: Special Issues -- Posttraumatic Play, Trauma-Focused Play Therapy (TF-PT), and Problems of Dissociation (p. 151-171)
17. Margie was a 9-year-old girl who literally took care of her alcoholic parents. At first, she was unresponsive to therapy, preferring to sit and look down, with her hair covering her face. What did Margie eventually respond to?
a. Building a sand world.
b. Constructing a play genogram.
c. Playing the Talking, Feeling, Doing game.
d. Playing with Playmobil hospital toys.

18. Which of the following would be characteristic of "Stagnant Posttraumatic Play"?
a. Affect becomes available.
b. Physical fluidity becomes evident.
c. Play is conducted in the same spot.
d. Interactions with clinician become varied.

19. One example of the author's high-challenge, high-intrusion interventions is

a. directing the child to one segment of the play.

b. asking the child to make physical movements (moving the arms or oxygenating the body).
c. doing a verbal narration of the child's play (descriptive, not interpretive).
d. all of the above.

20. Which is NOT a helpful intervention for dissociative responses in traumatized children?
a. Helping children to describe their dissociative behaviors in their own language, such as "spacing out", "zoning out", or "daydreaming".
b. Finding out exactly when dissociation occurs. What is happening right before it occurs? Is it triggered by boredom, fatigue, fear, stress, or anxiety?
c. Normalize dissociation for children by telling them that everyone does it.
d. Describe how dissociation is helpful in every situation because it protects the child from pain

21. In order to help clients identify when they are dissociating, the author has them conduct an experiment in which they are pretending to dissociate, and then observing what they are saying to themselves, what they are doing, and what sensations they are having. To interrupt their own dissociation, the author says there are a variety of interventions. Which intervention does the author find to be quite effective?
a. Telling yourself to stop dissociating.
b. Reassuring yourself that you are safe and don't need to dissociate.
c. Using physical movement and oxygenating their body
d Having the child ask for someone to help them stop dissociating.

Chapter 8: Scotty, the Castle, and the Princess Guard (p. 175-191)
22. Scotty was a 6-year-old African-American child who developed selective mutism (not speaking) after being sexually abused in a previous foster home. Which was NOT part of how Scotty got better?
a. Having a new foster mother, Diane, who was a ferocious protector.
b. Scotty reconstructing his abuse through posttraumatic play in a sand box.
c. The author encouraging Scotty to speak to her while he played in the sand.
d. Scotty fondly recalling his loving grandmother who took him for walks and hugged him when he was scared.

Chapter 9: Carla' Search for Her Lost Mother (p. 192-206)

23. Carla was a 7-year-old European American child who was dropped on her father's doorstep by her homeless mother who had a drug addiction. Which of the following played a part in Carla's improvement?
a. The author utilizing the assessment tools of the Child Behavior Checklist (CBCL) and the Child Sexual Behavior Inventory (CSBI).
b. Carla having a loving and responsible father, Fred, who also cared for his elderly mother.
c. Carla using Winnie the Pooh play figures to act out her search for and rescue of her mother.
d. All of the above.

Chapter 10: Danger in the Backyard (p. 207-219)
24. Jessica was a 5-year-old European American child who was abused by a teenage boy in the woods behind her home. What thoughts about her mother did Jessica portray during her play therapy?
a. She wanted her mother to say she was sorry for not protecting her.
b. She wanted her mother and father to get back together.
c. She wanted her mother to prosecute the teenage boy who abused her.
d. She wanted her mother to quit work and stay home with Jessica.

Chapter 11: The Witch, the Baby, and the Bug (p. 220-232)
25. Nicole was a 4-year-old African American girl who had been sexually abused by her father. In what way did play therapy make her feel safe?
a. She picked an angel figure to protect the baby.
b. She used a toy jail to lock up the bad people.
c. She said the police should be called if the witch tried to hurt the baby.
d. All of the above.