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Family and Children's
Resource Program

Vol. 20, No. 3
July 2015

Emotional Maltreatment: One Clinician's Perspective
A Conversation with Nancy Berson

Nancy Berson, LCSW, began her career as a DSS child welfare worker in Robeson and Durham counties. Since 1989 she's been with the Program on Childhood Trauma and Maltreatment at UNC Hospitals in Chapel Hill, which specializes in the assessment and treatment of abused, neglected, and psychologically traumatized children and adolescents.

What has your work taught you about emotional maltreatment?
Emotional abuse is often referred to as leaving invisible scars. In reality the scars are present if we look carefully at what's missing from the child's world: unconditional love, positive praise, and acceptance. Emotional abuse goes to the heart of a person--to their sense of self--and damages their belief in their worth and capability.

When this happens children see themselves as worthless, bad, flawed, undeserving, unlovable. They struggle with problems of social relationships, attachment, and the ability to believe in themselves. You often see a sense of hopelessness. These children have difficulty with self-regulation. Rather than communicating needs and feelings with words, their behaviors communicate their distress. Emotionally abused children are frequently anxious, depressed, and have somatic (physical) complaints. Teens may abuse drugs in an effort to manage their anxiety, depression, and self-loathing.

Emotional abuse presents in a variety of ways. It is more than belittling or yelling. It can also take the form of terrorizing, threatening, or isolating the child. One of the more troubling forms is when the parent's behavior is unpredictable--one minute loving, the next cruel and degrading. This can be "crazy making."

Is emotional abuse rare?
Emotional abuse is not uncommon. Too often it is under-identified and under-addressed.

Why do you think that is?
Unfortunately, we don't do enough to help CPS workers feel comfortable or competent identifying emotional maltreatment. Workers may see signs of emotional abuse but don't know how to proceed. Or they don't pursue it because they think it will be rejected by the court.

When investigating sexual or physical abuse, we want tangible evidence. In our focus on the concrete, emotional abuse is sometimes ignored. When this happens, we fail to protect children from the long-term impact of emotional maltreatment.
In fairness, it's not just DSS. Our child welfare system, including mental health, is overworked, inadequately trained, and poorly funded.

The courts also fail to understand the insidiousness of emotional abuse. Too often judges and attorneys treat non-criminal abuse cases like criminal ones, with higher standards of evidence. Although, I have found judges take emotional abuse quite seriously if it is presented clearly and convincingly.

Can you give an example?
Judges want facts on which to base decisions. When a child has been the victim of emotional maltreatment the facts are there--they just look different. It's not going to be an x-ray. Instead it's going to be things you have documented from a variety of sources. I remember a judge who completely shifted the way he viewed a parent when he heard exactly what the reporter and collaterals had heard this mother repeatedly screaming at her 3-year-old and 4-year-old. Documenting these details can make a critical difference.

Practice Suggestions for Child Protection

Avoid tunnel vision. If you get a report about one form of maltreatment, be open to the possibility that emotional maltreatment may also be present. It often co-exists with physical abuse, sexual abuse, and gross neglect.

Look for patterns of behavior. Sometimes you have access to years of reports regarding the same family. Be curious. How does all this information flow together? What does it tell you?

Dig deeper. If a child says they hear their parents yelling, ask what words they hear. Children often tell me their parents make comments to them such as, "You're nothing and will always be nothing. I wish I had never had you."

If this is what you find, ask children, "What do you feel when you hear this?" Document their answers. Ask yourself how these comments affect the child's sense of safety, sense of self, and psychological well-being.

Beware of assumptions. For example, sometimes we assume teens can take care of themselves. We think, "If it's bad enough, they'll get out, run away." This is incorrect. Emotional maltreatment can strip children of their ability to cope.

Be attentive to what people say. Be alert to parents' negative statements and perceptions of their children. In addition, do not discount children's statements and perceptions.
Parents often fail to recognize how negative they are about their children. Be alert to messages and behaviors such as: "He's just like his father"; "She acts like a whore"; "It's hopeless, she will never be a good child."

Document, document, document. Contact teachers, daycare workers, neighbors, family friends, and any other sources. Document their concerns, observations, and insights.

Act on what you learn. If you establish emotional maltreatment, address these behaviors in your plan with the family even if you are not in a position to formally substantiate emotional abuse.