Psychologist prevents sexual abuse of children

The Play Room Study. New psychoanalytic perspectives on prevention and assessment of child sexual abuse.

It is estimated that one out of every 10 children is sexually abused either by adults or by other children. Sexual abuse is found across all ethnic, social and cultural groups and can result in children experiencing serious psychological problems later on in life, like depression, alcohol abuse and PTSD.

Cases of sexual abuse can be difficult to investigate and resolve when the child has been subjected to adult sexuality which they do not understand the significance of. The perpetrator is often a person whom the child has a close relationship with. Consequently, the child finds it difficult to talk about the abuse in a coherent and credible manner that might stand up in court.

Whether or not the assaults are discovered straight away or many years later, it is often very difficult to establish exactly what happened between the child and the person who carried out the abuse, and what the child has actually been subjected to.

Research into child sexual abuse has therefore attempted to establish correlations between sexual assaults and specific signs and symptoms in the child. But as children rarely show clear and uniform signs of sexual abuse - and as other experiences can also cause worrying symptoms in a child - it is difficult to identify the precise links between what they say and do and what they have been subjected to.

Method

Since graduating as a psychologist in 2002, Katrine Zeuthen has worked with researching children's sexuality and adults’ sexual abuse of children. She has so far worked on five research projects, and as a result been in contact with several hundred children aged 3 to 14 years suspected of having or known to have suffered sexual abuse. She has also studied children in special risk groups, while children who have not been abused have served as a control group.

Through interviews and play-oriented therapy, she has carefully examined children’s experiences in order to find methods of helping them express what they have been through. She has also gone through journals and gathered information via interviews with the children's parents. At the same time, Katrine Zeuthen has been in continuous dialogue with the many different professional groups working with these cases, through teaching, supervision and interviews.

In the many interviews she has had with children, Katrine Zeuthen found that one of the most helpful methods was to start by looking at a number of small, simple drawings of children and adults in everyday situations, and gradually she and her research team began to identify some small but significant differences in how children told their stories:

The data showed that children who are experiencing - or have experienced - sexual abuse are not as good at answering questions about the pictures as other children. The sexually abused children's answers were both shorter and more imprecise than answers from both children who had been exposed to other forms of neglect and from children in a control group who had not been subjected to any abuse or neglect. Even though the survey is based on relatively few participants, it is an important discovery compared with other research into this sensitive area. 

I developed 'Play Room' because we didn’t have an interview tool to understand how children see themselves in relation to their external environment or how they understand sexuality. The conversations childcare professionals can have with a child on the basis of the pictures in Play Room can help the child to distinguish between care and abuse and to understand their own personal and physical boundaries, so in that sense it can help to prevent abuse. Our research has also shown that there is a difference in the way children understand and talk about the pictures and that this difference can be linked to possible sexual abuse. But Play Room can never be used in isolation when investigating these cases - the individual child's specific situation and context must always be examined too.

Results

In 2009, after gaining considerable experience from cases involving suspected sexual abuse, Katrine Zeuthen got the idea for "Play Room" - a picture-based "interview tool" which can be used by preschool teachers when talking with children who have been placed outside the home or who have physical or mental disabilities. These groups of children are at particularly high risk of being subjected to sexual abuse.

The 20 drawings in Play Room show everyday situations which the teacher can use when talking to a child about what they have experienced: For example, what happens at bedtime when you brush your teeth or take a bath. The pictures are open and neutral and do not invite any specific interpretation, but make it easy for the child to project their own world into them - and provide the teacher with a good starting point for a conversation, e.g. about boundaries.

In 2011, Play Room was produced in three versions for children aged between 3-6 years, 7-10 years and 11-14 years old respectively. With the support of the National Board of Social Services, Katrine Zeuthen also developed teaching material and a course, as Play Room must only be used by an adult who both knows the child very well and who has completed the two- to four-day course in how to use it.

Play Room can be used as a basis for individual or group conversations. The aim of the conversations is not to reveal whether a child has been subjected to sexual abuse, but to support the child in distinguishing between care and abuse and in this way prevent abuse taking place. The material is aimed at helping the child learn how to distinguish between a voluntary and a forced act, wanting or not wanting to do something and between fantasy and reality.

Using Play Room in an interview can be of enormous benefit to the child. It is also a helpful tool for the more introverted children who are given the time and space to tell their story. And we adults get an insight into the world of the children in a new and different way than a hectic day at the kindergarten would otherwise allow. It’s a chance to really get to know the child’s perspective..

We learn something about what’s going on in the child’s mind, and the child learns more about themselves and about others by mirroring themselves in others. Participants on the course also learn about themselves as adults and as professionals through raising their awareness of their reactions, patterns, ways of thinking, etc.

Further research

The main focus of Katrine Zeuthen’s further work with Play Room is training different groups of people working with children. These could be staff in day care institutions, police officers and others who work specifically with children suspected of having suffered sexual abuse.

Over the next few years, Katrine Zeuthen’s research will be central to informing the Danish Parliament when they decide how to improve protection of children against sexual abuse.

A research grant for the period 2016-2018, has allowed Play Room to become more widespread in kindergartens across the country, and childcare and other professionals will be offered the chance to take the course in how to use Play Room and to enhance their skills generally when talking to children about boundaries and inappropriate behaviour. These interviews can help children to set their own limits and to respect other children's boundaries - skills that can prevent sexual abuse from taking place.

The research project is a joint collaboration between the National Board of Social Services and the University of Copenhagen. Lecturers from the Board will learn to identify the problems that childcare professionals encounter in their everyday work with children, and researchers from the Department of Psychology will collect data in order to improve teaching and to develop even more target-oriented methods to prevent sexual abuse of children between 3-14 years old. 

1,000 childcare professionals trained in 'Play Room' ('Spillerum')

• ‘Play Room' is an interview tool designed to prevent sexual abuse.
• The material is aimed at interviewing children aged between 3-14 years old. 
• Developed by Karine Zeuthen together with The Danish Natinal Board of Social Services.
• The National Board of Social Services offers free courses for childcare professionals
• In early 2018, around 1,000 childcare professionals from Danish kindergartens and special daycare schemes participated in the courses.

Katrine Zeuthens research projects

2004-2006: Love and survival. Children's sexuality and sexual abuse.
2007-2009: Children's sexuality and sexual assaults on children. How are development and trauma linked in children?
2009-2012: Development and traumas. Developing and evaluating teaching materials for children and young people about boundaries, empathy and sexuality.
The development of Play Room
2013-2016: The body locked by a lack of meaning.
2013-2018: The Play Room Study. New psychoanalytic perspectives on prevention and assessment of child sexual abuse.
2016-2018: Improved initiatives to protect children against sexual abuse, with a particular focus on the daycare context.

Media reviews and publications

Article in the Danish newspaper Jyllandsposten from May 2017: Nye tiltag tages i brug i kampen mod misbrug af børn (New initiatives in the fight against child abuse).

Review on the National Board of Social Services' portal in November 2015: SPILLERUM: Undervisningsmateriale til forebyggelse af overgreb på børn og unge (Play Room: Teaching material for preventing sexual abuse among children and young people).

Film on Youtube: Spillerum (Play Room) – Katrine Zeuthen

Book 'Kærlighed og overlevelse' (Love and survival), published in 2009.

See also news article on samf.ku.dk 'Pædagoger landet over lærer at tale med børn om overgreb' (Childcare professionals in Denmark learn to talk to children about sexual abuse)

Selected interviews with Katrine Zeuthen

• 'Giv dit barn et sundt forhold til sex' (Give your child a healthy relationship to sex) (dr.dk)
• 'Voksne misforstår børns seksualitet' (Adults misunderstand children's sexuality) (videnskab.dk)