Family therapy of extrafamilial sexual abuse.

A significant portion of children referred for psychiatric treatment have been sexually abused. One of the most difficult symptom manifestations to treat in young children is the management of anger. In this case, a 4-year-old boy was sexually abused by persons outside the family. He showed symptoms of regressive behavior including encopresis, enuresis, difficulty sleeping, fearfulness, recurrent nightmares, and had hyperalertness and frequent outbursts of anger. Treatment initially involved group therapy, with a concurrent parents' group. After experiencing little improvement in group therapy, the youngster was put in individual play therapy and family therapy. Family therapy proved essential in creating a safe environment for the patient where he could learn to regulate his affect and process his traumatic experience successfully.