Additionally, Rankin (2003) stated that art interventions begin with self-management, then proceed with safety planning, telling the trauma story, grieving traumatic losses, self-concept and world view revision and finally ends with self and relational development. Treatment progress and outcomes will vary from patient to patient, as therapy is an individualized process. Although the amount of empirical research regarding art therapy is limited, the use of art therapy has been confirmed as a means for victims to express how they feel and find some closure. Art therapy has also become a type of intervention that is used in combination with other interventions. With this understood, the preceding section of this discussion will focus on play therapy as an intervention.

Play Therapy

Play therapy is a long-established and highly effective treatment method used in working with children who are experiencing various conflicts, contrasting role expectations, or dissociated feelings (Weber, 2009). These concepts are enacted in play, and brought to conscious awareness by the therapist's comments (Weber, 2009). Play therapy is a very heterogeneous type of therapy that permits the therapist and patient to have a freedom of expression that is different from that of traditional counseling. Clinicians who utilize play therapy use a variety of props and settings when meeting with clients. Some of the items used include anatomically correct dolls, puppets, stories, sand boxes, toy cars and trucks, games, and various forms of art (Gil, 1991).

According to Crenshaw and Hardy (2007) the purpose of play therapy is to assimilate what goes on around the child into his or her present scheme of knowledge and assisting the patient in mastering self and the environment. Play therapy is also designed to assist the victim in overcoming the situation, increase relatedness and express feelings. As with other types of intervention, play therapy is also designed to improve self-esteem.

Like art therapy, play therapy is often yields high levels of success with children because it allows them the ability to express themselves in a form more conducive to their cognitive and developmental abilities. Traumatized children had more intense play, play disruptions, repetitive play, avoidant play behavior, and negative affect. Now that the research has examined art therapy and play therapy, the intervention known as Cognitive Behavioral Therapy will be examined.

Cognitive Behavioral Therapy

As one might assume, cognitive behavioral therapy (CBT) offers a combination of strategies from cognitive and behavioral theories. According to Nicholaichuk and Yates (2002), this treatment approach is based on the premise that cognitive and affective processes and behavior are linked, and that cognitions, affect, and behavior are mutually influential. The National Association of Cognitive Behavioral Therapist offers a simple explanation for CBT: according to McGrath et al. (1998), CBT typically includes targeting deviant sexual behavior and interests and a wide range of social skills/relational deficits. In addition CBT addresses the issue of cognitive distortions, which permit the offender to justify, rationalize and/or minimize the offending behavior (McGrath et al., 1998).

As it pertains to the use of CBT in addressing the issue of child sexual abuse, the United States Department of Health and human services has developed and implemented a Cognitive Behavioral Therapy intervention specially designed for Child Sexual Abuse. According to a report published by the government agency

"Cognitive Behavioral Therapy for Child Sexual Abuse (CBT-CSA) is a treatment approach designed to help children and adolescents who have suffered sexual abuse overcome posttraumatic stress disorder (PTSD), depression, and other behavioral and emotional difficulties. The program emphasizes the support and involvement of no offending parents or primary caretakers and encourages effective parent-child communication. Cognitive behavioral methods are used to help parents learn to cope with their own distress and respond effectively to their children's behavioral difficulties. This CBT approach is suitable for all clinical and community-based mental health settings and its effectiveness has been documented for both individual and group therapy formats ("Cognitive Behavioral

Therapy for Child Sexual Abuse")."

This particular program is designed to assist abuse victims from the ages of 3 to 18 who suffer from post traumatic stress disorder ("Cognitive Behavioral

Therapy for Child Sexual Abuse"). The program can be used in private or public clinics ("Cognitive Behavioral Therapy for Child Sexual Abuse"). The program has proved to be a successful intervention fro children of all races and ethnicities regardless of socioeconomic backgrounds. In most cases those that participated in the program were treated at medical school campuses and public clinics. However, this particular intervention has been implemented by therapist in community setting ("Cognitive Behavioral

Therapy for Child Sexual Abuse").

The report...

Also, the treatment interventiion can be effective with 12 sessions. This form of intervention has also been utilized in both groups and individual sessions. The goals of the treatment consist of educating the children as it pertains to child sexual abuse and healthy sexuality. This intervention also teaches children how to cope with their feelings. To this end children are taught various techniques including relaxation, expression of emotion, and cognitive coping. The intervention is also geared toward assisting children in processing the traumatic memories and reminders they may encounter. Children are also taught how to protect their bodies from sexual predators.
Additionally "Parents are also provided with behavioral management training to strengthen children's positive behaviors while minimizing behavioral difficulties ("Cognitive Behavioral Therapy for Child Sexual Abuse"). Joint parent-child sessions are designed to help parents and children practice and utilize the skills learned, while also fostering more effective parent-child communication about the abuse and related issues ("Cognitive Behavioral Therapy for Child Sexual Abuse")."

The report also explains that outcomes of this intervention have been positive. According to the report those who participated in the program experience a 41% decrease in depression levels among children and a 23% decrease in the amount of acting out demonstrated by the children ("Cognitive Behavioral Therapy for Child Sexual Abuse"). The report also explains that there was a 45% increase in the children comfort level as it pertained protecting their bodies against sexual predators ("Cognitive Behavioral Therapy for Child Sexual Abuse"). In addition, to the positive outcomes of children, parents also experienced positive outcomes. For instance there was a 26% decrease in the emotional distress of parents and a 45% decrease in the parents though concerning the abuse that their children had endured. • 63% reduction in children's PTSD

symptoms

CBT can be used in family-based, group, and individual treatment settings and at varying developmental levels. CBT empowers adolescent clients by giving them a voice in setting treatment goals that is equal to that of their parents and by teaching them to better regulate their own thoughts and feelings by means of psycho education Ehrenreich et al. According to Kendall (2000), CBT can be either therapeutic, preventative, or enhancement focused. Enhancement-focused interventions are focused on improving quality of life, rather than targeting individuals who are at risk for a problem or who have a problem (Kendall, 2000).

Pharmacological Treatment

As a result of behaviors such as anger, depression, aggression and grief, that may be associated with sexual abuse; many physicians may utilize medication in order to stabilized and/or treat clients. Medications may also be utilized to treat co morbid conditions, such as attention deficit hyperactivity disorder, major depression, obsessive -- compulsive disorder, or posttraumatic stress disorder (Weber, 2009). Using medication for treatment of youths and adults who have gone through significant trauma has become a generally accepted practice throughout the world today.

There are several theorists who believe that many symptoms that arise as a result of sexual abuse occur due to chemical imbalances and/or changes in the brain. The medication prescribed would be used in order to treat specific symptoms, rather than treating sexual abuse. For example, Cohen et al. (2002) assert, children who suffer from post-traumatic stress disorder may experience over reactivity of the amygdala, over reactivity of the medical prefrontal cortex, elevated levels of dopamine, increased activities of the orepinephrine/epinephrine (adrenergic) system, elevated endorphine levels, dysregulation of the HPA axis, decreased hippocampal and corpus collosum size and low levels of serotonin. This statement speaks of the types of chemical imbalances that may occur and require the use of medication. It is important to note that the medication does not fix the problems, nor does it cure the patient. It only provides hormones that will help to balance chemicals in the brain that may bring on unwanted symptoms of abuse, such as depression, aggression, paranoia and agitation.

Comparisons and Contrast of Interventions

Play therapy, art therapy, cognitive-behavioral therapy and pharmacological therapies are all used to treat children who have been sexually abused. In order to determine which intervention will be used to treat a sexual abuse survivor, it is important for clinicians to become aware of various treatments. Knowledge of a variety of interventions enables clinicians to compare the components of one intervention against that of another and chose what works best for the client.

Play therapy and art therapy are similar theories. Play and art therapies are forms of therapy that are…