Marja Onsjö vill med sin avhandling öka kunskapen om hur barn och unga med erfarenheter av våld i familjen har upplevt de insatser de erbjudits inom Bup.
Handledare
Jennifer Strand, Göteborgs universitet. Ulf Axberg, Göteborgs universitet
Opponent
Docent Matti Cervin, Lunds universitet
Abstrakt
Barn som utsätts för våld riskerar att utveckla både fysiska och allvarliga psykiatriska problem.
Våldsutsatthet inom ramen för anknytningsrelationer tycks vara särskilt skadligt för barn och
kan medföra livslånga svårigheter i förmågan att ingå i trygga och tillitsfulla relationer. Bristen
på tillit kan även påverka förtroendet för vårdpersonal. Barn och unga som kommer i kontakt
med barn- och ungdomspsykiatrin (BUP) har ofta erfarenheter av direkt våld och/eller har
bevittnat våld mellan omsorgspersoner. Många har upplevt flera former av våld både inom
familjen men även utsatts för våld utanför familjen, som sexuellt våld och mobbning. Den höga
prevalensen av våldsutsatthet och risken för allvarliga konsekvenser gör det angeläget att
utveckla fungerande psykologisk behandling. Även om många barn kan tillgodogöra sig
traumafokuserad behandling så som traumafokuserad kognitiv beteendeterapi (TF-KBT) eller
Eye Movement Desensitization and Reprocessing terapi, blir inte alla barn hjälpta. Traditionellt
har studier om behandlingseffektivitet utgått från kvantitativa mätningar av psykiatriska
symtom och ofta fokuserat på föräldrars bild av barnets mående. Under de senaste åren har
dock intresset för barns subjektiva upplevelser ökat. När det gäller traumafokuserad behandling
har studier visat att många barn upplever samtalen som en fristad, där deras erfarenheter blivit
validerade. Att terapeuten upplevts som empatisk och neutral, samt framstått som expert på
området har också lyfts fram som betydelsefullt. Fokuset på de traumatiska upplevelserna, trots
att det varit plågsamt, har upplevts som hjälpsamt, men behovet av anpassningar utifrån den
individuella situationen har betonats. När det gäller traumatisering orsakad av våldsupplevelser
inom familjen är dock forskningsstödet fortsatt begränsat. Barn som bedöms tillhöra sårbara
grupper tillfrågas sällan om sina upplevelser av insatser, trots att det ofta är just de barnen som
påverkas mest av dessa.
Det övergripande syftet med denna avhandling var att öka kunskapen om hur barn och unga
med erfarenheter av våld i familjen har upplevt de insatser de erbjudits inom BUP. Fokus låg
dels på deras livssituation under tiden för behandling, dels på hur de generellt upplevt
behandlingen. Avhandlingen innehåller även en långtidsuppföljning av hur måendet utvecklats
över tid hos deltagare som genomgått TF-KBT-behandling, samt i vilken mån
behandlingsmålen för TF-KBT tycks ha uppnåtts.
Avhandlingen består av tre studier som alla bygger på en tidigare randomiserad klinisk
behandlingsstudie genomförd mellan 2012 och 2014
Abstract in English
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.
