Beyond anatomical dolls: Professionals' use of other play therapy techniques

Abuse

c’hdd & Negjpc1,Vol. 16, pp. 139-142, Printed in the U.S.A. All rights reserved.

1992

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BEYOND ANATOMICAL DOLLS: PROFESSIONALS’ USE OF OTHER PLAY THERAPY TECHNIQUES KATHLEEN

A. KENDALL-TACKETT

Family Research Laboratory, University of New Hampshire, Durham, NH

MANY RESEARCHERS have recently focused on professionals’ use of anatomical dolls. This focus is appropriate since professionals who use anatomical dolls have drawn so much fire, and since anatomical dolls have recently been barred from court proceedings in some states (Yates & Terr, 1988). However, the current emphasis on anatomical dolls has presented a skewed picture of sexual abuse evaluations. This emphasis seems to indicate that anatomical dolls are the only tools that professionals use to evaluate cases of sexual abuse. The present study asks professionals who work with suspected victims of sexual abuse to indicate if they use techniques in addition to anatomical dolls, and which techniques they use. The study also examines whether factors such as sex of the interviewer, profession of the interviewer (mental health vs. law enforcement), expectation of the interviewer (believe that children do not lie about sexual abuse vs. interview neutrally), and years of experience with child victims inff uences the number of techniques that professionals use.

METHOD Subjects A sample of 20 1 Boston-area professionals were interviewed by telephone. There were 63 males and 138 females with a mean of 10.1 years experience in their professions, 9.4 years working with children in general, and 6.1 years working with child victims of sexual abuse. To be eligible to participate in the study, subjects had to work within a designated geographical catchment area, and had to work with child victims of sexual abuse ( 12 years old or younger). The catchment area consisted of all 38 cities and towns within a 20-mile radius of Boston. Since not all members of the sampling frame could be identified ahead of time, a nonprob-

Prepared under National Institute of Justice grant #89-IJ-CX-0040, U.S. Department of Justice, and NIMH grant T32 MH 1.5I6 1 for “Family Violence Research Training.” Additional support provided by dissertation award from the American Psychological Association, and the Association for Women in Science. Received for publication November 9, 1990; final revision received June 20, 199 I: accepted July 2, 199 I. Requests for reprints may be sent to Kathleen A. Kendall-Tackett, Ph.D., Family Research Laboratory, 126 HSSC. University of New Hampshire, Durham, NH 03824. 139

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Kathleen A. Kendall-Tackett

abilistic sampling technique (purposive sampling) was used (Suen & Ary. 1989). Once subjects were identif&d, the recruitment and data collection procedures were identical for all subjects. Each potential subject was contacted at least six times. Subjects who never returned calls after six tries were counted as refusals, and attempts to contact these persons ceased. Law enforcement ~~~~s~~u~~~s. Police departments from all 38 cities and towns within the catchment area were contacted; thirty-three cities and towns had officers who worked with child victims. A total of 65 law enforcement officers were approached. Fifty officers participated, one officer refused, and 14 were ineligible. District attorneys’ offices in three counties were also contacted. A total of 26 district attorney staff members were approached, and 24 participated. Two were ineligible and no one refused to participate. There were 10 assistant district attorneys, 6 victim/witness advocates, and 8 other staff members from sexual assault units. In summary, 74 law enforcement professionaIs participated (42 males and 32 females). ~~~~~~~heafrh ~~~~~~j~~~~~.AI1 mental heafth professionals were recruited from either hospital or general mental health settings (including private practice and mental health clinics). AI1 54 hospitals located within the catchment area were contacted. Only 1 t hospitals had personnel who worked with chiId victims. Within these 11 hospitals, 46 mental health professionals were contacted, but 1 I professionals were ineligible. The other 35 were eligible and agreed to participate; there were no refusals. In addition to the professionals contacted at hospitals, a list of 112 potentially eligible non-hospital mental health practitioners was compiled from referrals and professional organizations. Of the 112 potential subjects, 18 were ineligible, 2 refused to participate, and 92 participated. In summary, 127 mental health professionals participated (21 males and 106 females). There were 35 psychologists, 66 social workers, 4 psychiatrists, 9 therapists, 7 nurse clinical specialists, and 6 others in mental health professions. There was no separate category for CPS workers because much of the investi~tive work in ~as~~hu~tts is done by mental health professionals under contract to the Department of Social Services. There were only 6 full-time protective workers in this sample. A total of 249 professionals were approached to participate in the study. Ofthese, 45 were ineligible because they did not work with children, and 3 refused to participate (two directly refused and one never returned phone calls). Of the 204 who were eligible, 201 participated, leading to a compliance rate of 99%.

Questionnaire The questionnaire that was used covered three main topics: Demographic characteristics of the professionals, professionals’ presentation of anatomical dolls to chiidren, and professionals’ ratings of ~onvin~ingness of behavioral indicators of sexual abuse. Anatomical-dolI questions and the questions about behavioral indicators were adaptations of questions developed by Boat and Everson f I%%). Seventy-three percent ofprofessionals in this sample used anatomicaI dolls. More complete information on these subjects’ use of the dolls is presented in another article (see Kendall-Tackett & Watson, in press). For the present analysis, subjects were asked about the techniques they used in addition to anatomical dolls when talking to children about sexual abuse. Subjects’ answers were recorded verbatim. The number of techniques used was also coded. RESULTS The descriptive data indicated that 23 subjects did not use any techniques other than anatomical dolts. Most subjects, however, used a wide variety of techniques, These are fisted in Table 1. Subjects used an average of 3.23 techniques (range = 0 to 12).

Play techniques

Number of Professionais Using this Technique (N= 201)

Type of Technique Drawings Free Anatomical What Happened Perpetrator Self/Family Kinetic Family House-Tree-Person Feelings

;: I5 3: :z 7 2

Toys Puppets Telephone Doctors’ Kit Barbie Dolls/Other Dolls Dollhouse Family Dolls General Toys Cars/Trucks Other Play Play Dough PaintingKoIoring Unstructu~d Play Games Structured Pfay Verbal Verbal Interviewing 3-Wishes Projective Qs Cognitive/Memory Qs Stnryboaks/Story Telling Competency Tasks Sexual Abuse Cards Observation

61 5 5 14 56 ;5;

1 10 5 I9 12 5 23 : 1 18 II 2

1

Data were analyzed using an ANOVA with four factors (2 X 2 X 2 X 3). The f&r factors were sex of the interviewer, expectation of the interviewer (believing children vs. interviewing children neutrally), profession of the interviewer (law enforcement vs. mental health), and years of experience with child victims (< 5 years, 5 to 10 years, > 10 years). Because the four factors were correlated, the regression method of ANOVA was used which assesses each variable for its independent contribution. The results indicated that mental health professionals used significantly more techaiques (M=4.10) than did law enforcement professionals (M==I .74), F( 1, 197) = 17.60, p <.OOOl. There were no other significant main effects or interactions.

DISCUSSION Professionals, especially mental health professionals, use a wide variety of techniques when ev~uatin~ suspected child victims. The most commonly used techniques are free drawings, anatomical drawings, puppets, and doll houses. Mental health professionals use significantly more techniques, possibly because they work with the children for more sessions than do law

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enforcement professionals, and may be less focused on only collecting evidence. However, even this possibility does not fully explain these findings. Many of the mental health professionals conduct investigative inte~iews for all or part of their case loads. This finding might have more to do with the training professionals receive and the way they approach children. Even when conducting an investigation, mental health professionals might put more emphasis on or feel more comfortable with a variety of techniques designed to create rapport between themselves and children. It is interesting that the other factors did not significantly relate to the number of techniques professionals use. The other factors were correlated with profession, but when they were assessed for their independent contributions, no effects appeared. This study presents a more balanced picture of the evaluation of sexual abuse victims. It also raises the issue of why so much attention and research is focused on anatomical dolls when they are clearly not the only technique that most professionals use. Professionals use a wide variety of projective techniques which could also eventually be barred from court proceedings because they have not been “validated by the scientific community.” Future research should address these other techniques as well. Only in this way can we continue to move toward more standardized and accurate methods of assessing suspected child victims.

REFERENCES Boat, B. W., & Everson, M. D. (1988). Use of anatomical dolls among professionals in sexual abuse evaluations. Child Abuse& Neglect, 12, 171-179. Kendall-Tackett, K. A., & Watson, M. W. (in press). Use of anatomical dolls by Boston-area professionals. Child Abuse & Neglect. Suen, H. K., & Ary, D. (1989). Analyzing quantitative behuv~ora~observation data. Hiltsdale, NJ: Erlbaum. Yates, A., & Terr, L. C. (1988). Anatomically correct dolls: Should they be used as the basis for expert testimony? Journal ofthe American Academy oJChild and Adolescent Ps.~h~at~, 27,254-257.