Treatment for Child Victims

Mental health treatment for the child typically includes first developing safety and social skills and then reducing self-blame, embracing a wellness script while releasing an illness script, improving attachment relationships and reducing opposition-ality, developing autonomy, reducing dissociation and compartmentalization of thinking and feeling, maintaining appropriate boundaries, understanding and managing family conflicts and loyalties, and re-framing positive peer relationships. By early adolescence, most of the children are encouraged to consider and rework their understanding of MBP victimization. Young teens who are unable to work through their victimization have more difficulty negotiating adolescence than those who are able to reorganize their experiences in such a way as to reduce their sense of blame and confusion. Children who receive little or no treatment directed at their victimization are more likely to struggle with acting out and oppositionality, as well as depression and self-harm issues.

Efforts should be made to normalize and optimize the child's functioning as much as possible. Psychotherapy is indicated unless the victim is an infant or preverbal toddler. Victims of illness falsification may deny it; have intense anger at the medical team, abuser, or other collusive family members; have residual sick-role beliefs and behavior; and/or have posttraumatic stress disorder (especially in medical settings), self-esteem problems, difficulty defining family relationships, and immense grief (Ayoub 2006; Bools et al. 1993; Bursch 1999). The psychological impact of MBP victimization appears to be significant and chronic. Ongoing problems with social interaction, attention and concentration, oppositional disorders, patterns of reality distortion, poor self-esteem, and attachment difficulties with adults and peers are documented in the literature (Libow 1995). Although children can present as socially skilled and superficially well adjusted, they often struggle with the basic relationships. Lying is a common finding, as is some sadistic behavior toward other children.

Children in stable long-term placements in which they were protected from their mothers and supported in their move toward health had fewer long-term difficulties than children who had more exposure to their mothers and less stable placements (Ayoub 2006). Even after an extended recovery, many children remained trauma reactive and were vulnerable to cyclical anger, depression, and opposi-tionality (Libow 1995). Ayoub (2006) found that despite maternal legal rights being restricted or terminated due to MBP, the mothers contacted all of the children in her study who had reached adulthood (n=8) around the time the children turned age 18 years. In spite of up to 10 years of no contact, the mothers presented themselves to their children and typically expressed that they loved their children and that they were not guilty of the MBP victimization. Therefore, professionals who treat these children may need to include a plan for the experience of reconnection and possible continued victimization after legal contact restrictions end when the children become adults.

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