Children subjected to family violence: a retrospective study of life situation and trauma-focused treatment

Child maltreatment is a risk factor for developing serious psychopathology. Trauma-focused treatment is effective, but not all children benefit from it. The experiences of affected children are a vital source of knowledge for improving interventions, but research focusing on them is limited. The aim of this thesis was to investigate how treatment for children subjected to family violence can be improved by exploring the experiences of the children affected. The participating children were interviewed, retrospectively, about their experiences of the treatment they had been offered at the Child and Adolescent Mental Health Service (CAMHS) four–five years earlier, and about their life situation at the time. The material in studies I and II was analysed using inductive thematic analysis. In Study III a convergent mixed-method design was employed, separately analysing both qualitative and quantitative data, followed by a synthesis of both methodologies. Study I focused on the children’s life situation before and while they were receiving interventions from the CAMHS. Thirteen children were interviewed, and the results indicated that many had continued to live in unsafe circumstances, and that experiences of ongoing conflict and violence at home and elsewhere were common. Study II focused on the experiences of the treatment the children had been offered at the CAMHS. Seventeen children were interviewed, many of whom emphasized the importance of receiving treatment for children subjected to family violence. The importance of the therapeutic relationship being characterized by empathy and curiosity was highlighted. Their own agency and motivation had been decisive for many, but other factors, such as the family situation, had influenced their ability to engage in therapy. Study III aimed to gain a deeper understanding of changes in trauma-related symptoms in children and youths who had taken part in traumafocused cognitive behavioural therapy (TF-CBT) four–five years earlier. Nine participants were assessed and interviewed. The analysis revealed that, while the majority still reported being affected by the violence, most reported a reduction in symptoms immediately after treatment and at the follow-up years later. However, participants who did not report any immediate reduction in symptoms often presented trauma-related symptoms, frequently accompanied by additional severe mental health issues, at the follow-up. In conclusion, the findings emphasize the importance of not viewing children as isolated units, detached from their broader life context. Many children continued to live in chaotic environments, sometimes enduring violence at home during treatment without the therapist’s knowledge. This underscores the need to understand the complexities faced by children subjected to family violence and illuminates the importance of, in addition to providing trauma-focused treatments such as TF-CBT, recognizing the need for parental interventions and safety measures. In implementing treatments for children affected by family violence, these children’s agency and the many factors that influence their life circumstances and overall well-being should also be acknowledged.