case three: Boy, six years old, Incest
It is still a very common belief that sexual abuse, incest, and rape are violations that only happen to girls and women. This is not true. Patients that have been referred to me over the years have been boys as well as girls.
In some cases, children and teens come into the office ready to talk and tell about what happened. In other cases, they will agree to draw and play about the abuse “as long as we don’t have to talk about it,” which is always okay. There is, however, a third scenario, which this case illustrates. This is a situation where the child denies that anything has happened. By the time they have come into my office for treatment, they have recanted their original disclosure of the abuse.
In these cases, I will always start by inviting the child to draw. While they are drawing, I will make one or two brief, metaphorical statements to let them know, that I know, what happened. It doesn’t matter what they draw.
In the case of this six year old boy’s initial picture, I was not surprised to see his choice of content. Sexually abused boys often draw super-hero type figures, often with a weapon, to help them feel empowered.
In this case, I remember saying “Wow, look at the size of that guy and his knife! I bet nothing bad is going to happen to him!” (At this point the perpetrator of the abuse had been removed from the home, so I was not giving false hope.) And later, while he was still drawing, “…and your mom told me that some bad, yucky stuff happened to a little boy she knew, but he’s safe now. So let’s keep drawing, because drawing is fun, and it feels good, right?!”
In a case like this, the therapist has to go very, very slowly. Note the bloodstain and the noose in the picture- both had details to do with how this patient was violated- yet at this early stage of therapy the smile on the figure’s face indicates that the child was still in a great deal of denial and that the therapist must proceed with caution.

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