Expression and Management of Neglected and Maltreated Children’s Sexuality in Symbolic and Traumatic Play: Theoretical and Clinical Reflections

ABSTRACT

Psychotherapeutic work with sexually abused children can prove to be highly taxing, not only for the children in question but also for the psychotherapists who must cope with a heavy emotional, aggressive, and sexual charge. Be it because of the nature of the trauma experienced by these children or because of the defense mechanisms that they use in psychotherapy, the clinician’s capacity for containment is severely tested. In this theoretical and clinical article, we reflect upon the psychic harm that sexual abuse can inflict on children and the psychic functioning engendered in them by this abuse. In addition, we examine the differences in how children who are developing well and those who are sexually abused express sexuality during psychotherapy. Finally, we present the technical and countertransference challenges that psychotherapists who work with sexually abused children are liable to face. Brief clinical vignettes are provided to illustrate particularities of the therapeutic work conducted with these children.

Acknowledgments

The authors wish to thank the Institut universitaire Jeunes en difficulté and the DEA Program of the Fondation Maison sciences de l’homme for their financial support, which made this article possible.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. This notion refers to the idea expressed by Freud (1923, p. 270) as follows: “The ego is first and foremost a bodily ego; it is not merely a surface entity, but is itself a projection of a surface.” A footnote was added to the English translation, with Freud’s approval: “I.e., the ego is ultimately derived from bodily sensations, chiefly from those springing from the surface of the body.”

2. Intrapsychic formation resulting from the convergence of narcissism (ego idealization), identification with parents (and their substitutes), and collective ideals (Laplanche & Pontalis, 1997).

3. Intrapsychic formation that designates an ideal of omnipotence modeled on infantile narcissism (Laplanche & Pontalis, 1997).

4. In the sense ascribed by Winnicott (1965).

5. The notion of epistemic trust refers to the child’s confidence in the fact that the knowledge transmitted by the adults around him is authentic, credible, generalizable, benevolent, and relevant to him. This allows the child to rely on his social environment to learn other things (Fonagy et al., 2019).

6. That is, in an environment where parents generally meet the needs of their children in a sensible manner and do not expose them to situations of neglect or maltreatment.

7. The notion of early relational trauma refers to a young child’s chronic exposure to experiences of maltreatment and neglect that generally occur within the parent-child relationship. Owing to their own major psychic difficulties, the parents fail to recognize their child’s needs and to meet them consistently. They frequently and repeatedly make the child experience situations of severe neglect, violence, narcissistic seduction, and excessive involvement in their thoughts (Bonneville, 2010).

8. Miniaturization is the term used by Gil (2013) to refer to the use of figurines to represent trauma. According to this author (and we share her views), this mode of representation helps the child gain control of the traumatic play, which translates into a progressive attenuation of associated anxiety when the trauma in question is evoked, be it directly (in narration) or indirectly (through play).

9. Traumatic play is an example of a fragile relationship with reality in that, instead of being an expression of the child’s symbolic world, it constitutes a literal reproduction of the supposedly experienced trauma.

10. The notion of reflective function refers to the capacity to interpret and understand one’s behavior and that of others as meaningful and driven by mental states (e.g., desires, needs, feelings, beliefs, intentions; Fonagy & Target, 1997).

11. Term used here to allude to a very short dissociation where one is disconnected from the surrounding world.

Additional information

Notes on contributors

Miguel M. Terradas

Miguel M. Terradas, Ph.D., is in the Department of Psychology, Université de Sherbrooke, Québec, Canada ; the Institut universitaire Jeunes en difficulté, Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l’Île-de Montréal ; and the Centre interdisciplinaire de développement international en santé.

Michel-Alexandre Rioux

Michel-Alexandre Rioux, Ph.D., is at the Centre intégré de santé et des services sociaux de l’Est-de-l’Île-de-Montréal.

Antoine Asselin

Antoine Asselin, B.A., is in the Department of Psychology, Université de Sherbrooke, Québec, Canada.