{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T22:23:42Z","timestamp":1781130222247,"version":"3.54.1"},"reference-count":45,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T00:00:00Z","timestamp":1646352000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["RES PSYCHOTHER-PSYCH"],"abstract":"<jats:p>Introduction: Change in psychotherapy research in cases of child sexual abuse (CSA) has mainly emerged from a symptomatologic view, which needs to be complemented by a subjective perspective of change. Thus, this article aim is to describe different outcomes and stages of change during psychotherapy in children and adolescents who have been sexually abused, from the subjective perspectives of those involved in the process. Methods: A longitudinal qualitative study was developed. Qualitative interviews were conducted at different moments of the psychotherapeutic process (at around 6 months of therapy, 12 months and at the end of therapy) with 28 children and adolescents aged 6 to 17, with their caregivers and therapists. All children and adolescents attended and then completed psychotherapy due to sexual abuse in natural settings, in public specialized centres in Santiago, Chile. Sexual abuse occurred mainly in an intrafamilial context or by acquaintances. Data analysis was conducted using narrative analysis. Results: Three stages of therapy were identified: (1) settling into therapy, (2) approaching CSA and (3) healing from abuse. Three different outcomes of psychotherapeutic change were also identified: (1) protective and psychosocial changes, (2) changes related to diminishing the effects of abuse and (3) changes related to healing from abuse. Psychosocial characteristics of the cases and features of the therapeutic process are described in each group. Discussion: The outcomes of change and the stages of therapy are interrelated in a dynamic and gradual process where change is linked with the case\u2019s psychosocial characteristics and the features of the therapeutic process. Results allowed the authors to situate the voices of the participants within a proposed model of psychotherapeutic change for CSA, with clinical practical implications.<\/jats:p>","DOI":"10.4081\/ripppo.2022.583","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T14:49:40Z","timestamp":1646405380000},"source":"Crossref","is-referenced-by-count":5,"title":["Psychotherapeutic change in children and adolescents who have been sexually abused: a model from participants\u2019 perspectives"],"prefix":"10.4081","volume":"25","author":[{"given":"Claudia","family":"Capella","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loreto","family":"Rodr\u00edguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estrella","family":"Az\u00f3car","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ximena","family":"Lama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"N\u00fa\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"\u00c1guila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Gomez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macarena","family":"Espeleta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vania","family":"Vasquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"key":"17240","doi-asserted-by":"crossref","unstructured":"\u00c1guila, D., Lama, X., Capella, C., Rodr\u00edguez, L., Dussert, D., Guti\u00e9rrez, C. & Beiza, G. (2016). Narratives from therapists regarding the process of psychotherapeutic change in children and adolescents who have been victims of sexual abuse \/ Narrativas de terapeutas sobre el proceso de cambio psicoterap\u00e9utico en ni\u00f1os, ni\u00f1as y adolescentes que han sido v\u00edctimas de agresiones sexuales. Estudios de Psicolog\u00eda, 37(2-3), 344-364. doi:10.1080\/02109395.2016.1204780.","DOI":"10.1080\/02109395.2016.1204780"},{"key":"17241","unstructured":"Alamo, N. (2019). Contenidos y evoluci\u00f3n del cambio en la psicoterapia con ni\u00f1os y ni\u00f1as [Content and evolution of change in psychotherapy with children]. (Doctoral Thesis). Pontificia Universidad Cat\u00f3lica de Chile, Santiago, Chile."},{"key":"17242","doi-asserted-by":"crossref","unstructured":"Altimir, C., Krause, M., de la Parra, G., Dagnino, P., Tomicic, A., Vald\u00e9s, N. & Vilches, O. (2010). Clients\u2019, therapists\u2019, and observers\u2019 agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome. Psychotherapy Research, 20(4), 472-487. doi:10.1080\/10503301003705871.","DOI":"10.1080\/10503301003705871"},{"key":"17243","doi-asserted-by":"crossref","unstructured":"Areas, M., Olivera, J., & Roussos, A. (2020). Cambio y psicoterapia: la perspectiva del ni\u00f1o [Change and Psychotherapy: The Child\u2019s Perspective]. Diversitas: Perspectivas en Psicolog\u00eda, 16(2). doi:10.15332\/22563067.5553.","DOI":"10.15332\/22563067.5553"},{"key":"17244","doi-asserted-by":"crossref","unstructured":"Banyard, V., & Williams, L. (2007). Women\u2019s voices on recovery: A multi-method study of the complexity of recovery from child sexual abuse. Child Abuse and Neglect, 31(3), 275-290. doi:10.1016\/j.chiabu.2006.02.016.","DOI":"10.1016\/j.chiabu.2006.02.016"},{"key":"17245","doi-asserted-by":"crossref","unstructured":"Barth, J., Bermetz, L., Heim, E., Trelle, S., & Tonia, T. (2013). The current prevalence of child sexual abuse worldwide: A systematic review and meta-analysis. International Journal of Public Health, 58(3), 469-483. doi:10.1007\/s00038-012-0426-1.","DOI":"10.1007\/s00038-012-0426-1"},{"key":"17246","doi-asserted-by":"crossref","unstructured":"Capella, C. & Boddy, J. (2021). Listening to the opinista? Relational understandings of voice and silence in a multiperspective narrative study of child psychotherapy. Children & Society, 35, 835-849. doi:10.1111\/chso.12458.","DOI":"10.1111\/chso.12458"},{"key":"17247","doi-asserted-by":"crossref","unstructured":"Capella, C. & Guti\u00e9rrez, C. (2014). Psicoterapia con ni\u00f1os\/as y adolescentes que han sido v\u00edctimas de agresiones sexuales: Sobre la reparaci\u00f3n, la resignificaci\u00f3n y la superaci\u00f3n. Psicoperspectivas, 13(3), 93-105. doi:10.5027\/PSICOPERSPECTIVAS-VOL13-ISSUE3-FULLTEXT-348.","DOI":"10.5027\/psicoperspectivas-Vol13-Issue3-fulltext-348"},{"key":"17248","doi-asserted-by":"crossref","unstructured":"Capella, C., Guti\u00e9rrez, C., Rodr\u00edguez, L. & G\u00f3mez, C. (2018). Change during psychotherapy: the perspective of children and adolescents who have been sexually abused. Research in Psychotherapy: Psychopathology, Process and Outcome, 21(1), 24-39. doi:10.4081\/ripppo.2018.288.","DOI":"10.4081\/ripppo.2018.288"},{"key":"17249","doi-asserted-by":"crossref","unstructured":"Capella, C., Lama, X., Rodriguez, L., Aguila, D., Beiza, G., Dussert D. & Gutierrez, C. (2016). Winning a race: Narratives of healing and Psychotherapy in children and adolescents who have been sexually abused. Journal of Child Sexual Abuse, 25(1), 73-92. doi:10.1080\/10538712.2015.1088915.","DOI":"10.1080\/10538712.2015.1088915"},{"key":"17250","doi-asserted-by":"crossref","unstructured":"Capella, C., N\u00fa\u00f1ez, L., V\u00e1squez, V. & Fuentes, S. (2020). Adherencia o deserci\u00f3n de adolescentes en psicoterapia por agresiones sexuales: la perspectiva de sus terapeutas. Revista CES Psicolog\u00eda, 13(3), 124-141. doi:10.21615\/cesp.13.3.8.","DOI":"10.21615\/cesp.13.3.8"},{"key":"17251","doi-asserted-by":"crossref","unstructured":"Capella, C., Rodriguez, L., Aguila, D., Dussert, D., Lama, X., Gutierrez, C. & Beiza, G. (2015). Storied images of psychotherapeutic change: Approaching children\u00b4s voices through drawings. 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Interventions for sexually abused children: Initial treatment outcome findings. Child Maltreat, 3(1), 17-26. doi:10.1177\/1077559598003001002.","DOI":"10.1177\/1077559598003001002"},{"key":"17255","unstructured":"Cohen, J. A., Mannarino, A. P., & Deblinger, E. (Eds.). (2012). Trauma-focused CBT for children and adolescents: Treatment applications. New York, NY: The Guilford Press."},{"key":"17256","doi-asserted-by":"crossref","unstructured":"Draucker, C. B., Martsolf, D. S., Roller, C., Knapik, G., Ross, R., & Stidham, A. W. (2011). Healing from childhood sexual abuse: A theoretical model. Journal of Child Sexual Abuse, 20(4), 435-466. doi:10.1080\/10538712.2011.588188.","DOI":"10.1080\/10538712.2011.588188"},{"key":"17257","doi-asserted-by":"crossref","unstructured":"Dussert, D., Capella, C., Lama, X., Guti\u00e9rrez, C., \u00c1guila, D., Rodr\u00edguez, L. & Beiza, G. (2017). Narrativas de Padres de Ni\u00f1os, Ni\u00f1as y Adolescentes que Han Finalizado Psicoterapia por Agresiones Sexuales: Un Proceso de Superaci\u00f3n Conjunta. Psykhe, 26(1), 1-14, doi:10.7764\/psykhe.26.1.916.","DOI":"10.7764\/psykhe.26.1.950"},{"key":"17258","unstructured":"Echavarr\u00ed, O., Gonz\u00e1lez, A., Krause, M., Tomicic, A., P\u00e9rez, C., Dagnino, P., De la Parra, G., et al., (2009). Cuatro terapias psicodin\u00e1micas breves exitosas estudiadas a trav\u00e9s de los indicadores gen\u00e9ricos de cambio [Four successful brief psychodynamic therapies studied through the generic change indicators]. Revista Argentina de Cl\u00ednica Psicol\u00f3gica, 28(1), 5-19."},{"key":"17259","doi-asserted-by":"crossref","unstructured":"Elliott, R. (2008). Research on client experiences of therapy: Introduction to the special section. 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Research in Psychotherapy: Psychopathology, Process and Outcome, 19(1), 1-9. doi:10.4081\/ripppo.2016.180.","DOI":"10.4081\/ripppo.2016.180"},{"key":"17262","doi-asserted-by":"crossref","unstructured":"Foster, J. & Hagedorn, B. (2014). Through the Eyes of the Wounded: A Narrative Analysis of Children\u2019s Sexual Abuse Experiences and Recovery Process. Journal of Child Sexual Abuse, 23, 538-557. doi:10.1080\/10538712.2014.918072.","DOI":"10.1080\/10538712.2014.918072"},{"key":"17263","doi-asserted-by":"crossref","unstructured":"Guerra, C., Farkas, C. & Moncada, L. (2018). Depression, anxiety and PTSD in sexually abused adolescents: Association with self-efficacy, coping and family support. Child Abuse & Neglect, 76, 310-320. doi:10.1016\/j.chiabu.2017.11.013.","DOI":"10.1016\/j.chiabu.2017.11.013"},{"key":"17264","doi-asserted-by":"crossref","unstructured":"G\u00f3mez, E., Cifuentes, B. & Sieverson, C. (2010). Caracter\u00edsticas asociadas al abuso sexual infantil en un programa de intervenci\u00f3n especializada en Santiago de Chile [Characteristics associated to child sexual abuse in a specialized intervention program from Santiago, Chile]. SUMMA Psicol\u00f3gica UST, 7(1), 91.104. doi:10.18774\/448x.2010.7.114.","DOI":"10.18774\/448x.2010.7.114"},{"key":"17265","doi-asserted-by":"crossref","unstructured":"Gon\u00e7alves, M., Matos, M., & Santos, A. (2009). Narrative therapy and the nature of \u2018innovative moments\u2019 in the construction of change. Journal of Constructivist Psychology, 22(1), 1-23. doi:10.1080\/10720530802500748.","DOI":"10.1080\/10720530802500748"},{"key":"17266","doi-asserted-by":"crossref","unstructured":"Guha, A., Luebbers, S., Papalia, N., Ogloff, J. (2019). A follow-up study of mental health service utilisation in a cohort of 2433 sexually abused Australian children utilising five years of medical data. Child Abuse & Neglect, 90, 174-184. doi:10.1016\/j.chiabu.2019.01.015.","DOI":"10.1016\/j.chiabu.2019.01.015"},{"key":"17267","doi-asserted-by":"crossref","unstructured":"Hetzel-Riggin, M., Brausch, A., & Montgomery, B. (2007). A meta-analytic investigation of therapy modality outcomes for sexually abused children and adolescents: An exploratory study. Child Abuse and Neglect, 31(2), 125-141. doi:10.1016\/j.chiabu.2006.10.007.","DOI":"10.1016\/j.chiabu.2006.10.007"},{"key":"17268","doi-asserted-by":"crossref","unstructured":"Jessiman, T., Hackett, S., & Carpenter, J. (2017). Children\u2019s and carers\u2019 perspectives of a therapeutic intervention for children affected by sexual abuse. Child and Family Social Work, 22(2), 1024-1033. doi:10.1111\/cfs.12322.","DOI":"10.1111\/cfs.12322"},{"key":"17269","unstructured":"Krause, M. (2011). Psicoterapia y cambio. Una mirada desde la subjetividad [Change and psychotherapy. A look from the subjetivity] (2\u00b0ed). Santiago: Ediciones Universidad Cat\u00f3lica."},{"key":"17270","doi-asserted-by":"crossref","unstructured":"Krause, M., De la Parra, G., Ar\u00edstegui, R., Dagnino, P., Tomicic, A., Vald\u00e9s, N., Ech\u00e1varri, O., et al. (2007). The evolution of therapeutic change studied thtough generic change indicators. Psychotherapy Research, 17(6), 673-689. doi:10.1080\/10503300601158814.","DOI":"10.1080\/10503300601158814"},{"key":"17271","doi-asserted-by":"crossref","unstructured":"Levitt, H., Butler, M., Hill, T. (2006). What clients find helpful in psychotherapy: Developing principles for facilitating moment to moment change. Journal of Counseling Psychology, 53(3), 314-324. doi:10.1037\/0022-0167.53.3.314.","DOI":"10.1037\/0022-0167.53.3.314"},{"key":"17272","doi-asserted-by":"crossref","unstructured":"Midgley, N. (2004). Sailing between Scylla and Charybdis: Incorporating qualitative approaches into child psychotherapy research. Journal of Child Psychotherapy, 30(1), 89-111. doi:10.1080\/0075417042000205814.","DOI":"10.1080\/0075417042000205814"},{"key":"17273","doi-asserted-by":"crossref","unstructured":"Midgley, N., et al. (2018). Introduction to the special section on child and adolescent psychotherapy research. Psychotherapy Research, 28(1), 1-2. doi:10.1080\/10503307.2017.1380864.","DOI":"10.1080\/10503307.2017.1380864"},{"key":"17274","unstructured":"Narang, J. (2016). A Grounded Theory Analysis of Therapeutic Interventions Practiced by Professionals in India and the UK with Child and Adolescent Survivors of Sexual Abuse (Doctoral Thesis). University of Edinburg."},{"key":"17275","doi-asserted-by":"crossref","unstructured":"Nelson-Gardell, D. (2001). The voices of victims: surviving child sexual abuse. 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International Journal of Clinical and Health Psychology, 11(1), 67-93."},{"key":"17280","doi-asserted-by":"crossref","unstructured":"Stapley, E., O'Keeffe, S. & Midgley, N. (2021). Essentials of ideal-type analysis: A qualitative approach to constructing typologies. American Psychological Association. doi:10.1037\/0000235-001.","DOI":"10.1037\/0000235-000"},{"key":"17281","unstructured":"Servicio Nacional de Menores [SENAME] (2019). Orientaci\u00f3n t\u00e9cnica: l\u00ednea programas de Protecci\u00f3n Especializada en Maltrato y Abuso Sexual Grave (PRM) [Technical guidelines: specialized protection programs in maltreatment and sexual abuse (PRM)] . Available from: https:\/\/www.sename.cl\/web\/wp-content\/uploads\/2019\/05\/Orientaciones-Tecnicas-PRM.pdf Accessed: 30th August 2021."},{"key":"17282","doi-asserted-by":"crossref","unstructured":"Tichelaar, H., Dekovi\u0107, M., & Endendijk, J. (2020). Exploring effectiveness of psychotherapy options for sexually abused children and adolescents: a systematic review of randomized controlled trials. Children and Youth Services Review, 119. doi:10.1016\/j.childyouth.2020.105519.","DOI":"10.1016\/j.childyouth.2020.105519"},{"key":"17283","unstructured":"Valles, M. (2003). T\u00e9cnicas cualitativas de investigaci\u00f3n social [Qualitative techniques of social research]. Madrid: Editorial S\u00edntesis."},{"key":"17284","doi-asserted-by":"crossref","unstructured":"Zarrella, I., Russolillo, L., Caviglia, G. & Perrella, R. (2017). Continuity and discontinuity between psychopathology of childhood and adulthood: a review on retrospective and prospective studies. 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