Personal bias against those who commit abuse and neglect of children can have significant impact on the ways a professional arrives at a diagnosis and treats a patient. Because of the prevalence of abuse and neglect, it is possible that the professional has personal experience influencing the lens through which information is received and the aspects of an individual’s circumstances are analyzed. For purpose of engaging in an examination of the DSM and assessment and diagnosis of a fictional character, the following profile is offered.
Sally is a sixteen year-old female currently residing in foster care. She has spent the majority of her life in foster care, being removed from her biological parents at the age of six due to physical abuse and neglect. Sally has three siblings who were also removed from the home, each of which are younger than her. The parental rights of Sally’s biological mother and father were terminated when she was eleven and each of her siblings has since been adopted. There is no contact between Sally, her siblings, and her biological parents.
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"The Role of Abuse and Neglect in Diagnosis".
Sally has moved between foster homes multiple times during her stay in foster care, at one point living in a group home for troubled girls. Two of the moves were initiated after Sally ran away from her foster families. She claims to have done so due to abuse by the foster family that has been substantiated in one of the cases. Sally is currently living with a family she has been in the care of for eight months. She reports feeling anxious about her current placement but does not claim abuse in this setting.
Throughout her experience in foster care, Sally has demonstrated difficulty forming relationships with her foster parents and other children in the homes where she has been placed. When she was younger, Sally was noted to create fictional stories about her past that she communicated as truth to others; it was not clear if she believed the stories or if she understood them to be fabrications. She frequently experiences episodes of rage and acts out through verbal and physical altercations. Sally does not appreciate physical contact such as hugs and prefers not to have others in close physical proximity. In the school setting, Sally is frequently off-task and behind her peer group with regard to grade-level standards. Sally is not on track to graduate with her age-appropriate peer group.
In addition to her aggression and anger issues, Sally has been noted to exhibit sexually inappropriate behaviors. Beginning with her first foster placement, Sally has behaved in ways that suggest she lacks boundaries with regard to sexual behaviors. She has received counseling for these behaviors but chooses not to participate to a great degree. Sally has also been noted to have acted out sexually with peers and is considered an at-risk youth with respect to human trafficking due to her propensity to elope and engage in inappropriate relationships with males over the age of eighteen.
To date, Sally has not demonstrated any behaviors that would suggest drug dependency, although she has been found in possession of alcohol on a number of occasions. Her current foster family cares deeply for her and recognizes that she is reaching an age where she will soon lose the benefits available to children in the foster care system. They are seeking support and assistance with her but feel she is disrupting their household where two biological children and one other foster child reside. As one of the biological children is a male approximately the same age as Sally, there is concern about her relationship with that individual and the sexualized behaviors she exhibits.
Impact of Personal Biases on Assessment and Diagnosis of Abuse
Therapists and counselors approach each situation with ostensibly neutral opinions, allowing the facts of each case to present themselves before making a determination about causes, outcomes, and potential supports. In a perfect world, this approach yields outcomes that serve the needs of the client as well as the individuals suspected of causing harm to the client. However, because individuals approach every situation with thoughts and opinions impacted by prior life experiences, attitudes, and formed beliefs, the assurance of neutrality and an open mind cannot be considered a foregone conclusion. When therapists and counselors have experienced abuse or have internalized situations from prior clients, they may approach the diagnosis of abuse through lenses that do not appropriately allow the situation at hand to be objectively evaluated.
Personal bias, when not bracketed and removed from consideration in a case, can influence diagnosis and outcomes of treatment for clients. It can lead therapists to make assumptions about the history of the lives of their clients and the role individuals in their spheres of influence have in the suspected abuse. Some personal biases may result in hasty diagnoses that do not reflect reality, while still others can lead therapists to decline to diagnose when a situation of abuse does exist. In between those two extremes, biases may influence the interpretation of harm, fear, and violence in the lives of those individuals a therapist serves.
Evaluation of Personal Biases
My own personal biases arises primarily through the interactions I have had with peers and family members who have experienced episodes of abuse in their own lives. While I personally have never suffered, I have been a resource for friends who have been abused mentally, physically, and sexually. These experiences have created opinions and changed my perspective about the role of an abuser in the victim’s life. I have come to understand that I hold a high level of anger and frustration about the ways in which the legal system deals with abusers and that, because many of the abusers in the lives of my family and friends have been male, I associate all abuse with a male perpetrator.
These biases must be bracketed for me to be able to appropriately serve a population of individuals who may suffer from abuse from many individuals and of a variety of types. I understand that my past influences the ways I see my clients and know that I must consciously put aside my preconceived notions if I am to be a valuable resource to those I seek to help. By consciously recognizing my biases, I give myself permission to accept them and set them aside for purposes of work.
Assessment of Sally
Sally’s behaviors, including fictionalizing her own life, acting out sexually, and failing to connect with adults in her life, are indicative of a child who has experienced significant trauma. Sally is likely a victim of sexual abuse and potentially physical abuse resulting in Post-Traumatic Stress Disorder and Reactive Attachment Disorder. Indicators of PTSD include her mistrust of others, anxiety, and hostility, each of which Sally exhibits. Reactive Attachment Disorder, which occurs when the relationship between a child and her primary caregiver is disrupted due to neglect or trauma, is indicated by unexplained irritability, withdrawal, and a failure to ask for help when needed. Because Sally exhibits these characteristics as well, this diagnosis appears appropriate. Sally should be treated for both PTSD and RAD to address her past traumas. Therapies that may be appropriate for Sally include Cognitive Behavior Therapy and family therapy including Sally and her current caregivers. Family therapy should focus on building trust and bonds between her current family as a means of providing her with a foundation for developing trust in the future.
