Child Abuse, Detection and Treatment
Sunday 26th January 2020

The first IPA webinar of 2020 will feature Mali Mann, Jennifer Davids and Vera Regina Fonseca, discussing the very important topic of child abuse. 

Child Abuse within Family and Societal Systems
Mali Mann will present on the detection and treatment of abused children, and how it needs to be addressed at a worldwide level. The recognition, prevention and treatment of child abuse and neglect, are some of the most crucial aspects of our work as Child and Adolescent Psychoanalysts. The child should be protected against all forms of neglect, cruelty and exploitation. Furthermore, the child shall not be the subject of trafficking in any shape or form. 
The inter-generational and trans-generational transmission of trauma is a vital knowledge, which requires our active therapeutic intervention. 
We need to be able to recognise any recent act or failure to act on the part of a parent or caregiver within a family system that results in serious physical or emotional harm, sexual abuse, or exploitation. Additionally, we need to know of the act or failure to act that presents an imminent risk of serious harm in order to plan an intervention strategy to prevent such acts. Download paper

The Abuse of Too Muchness: The Impact of Digital Abuse on Children, Adolescents and their Families

Jennifer Davids will address how 24/7 access to digital communication and entertainment can be a form of emotional abuse. Some parents allow, and to some extent encourage excessive use, and the technology and its different aspects can become a kind of family member. Cyber-bullying is very powerful and young people have told me how they feel “they [the bullies] can get you anytime, there is no escape”. Case illustrations will be presented of vulnerable children who form an addictive relationship via technology. Research on the neurological impact of extended screen usage will be referred to. Download paper

Child Abuse and Governmental Neglect – the Role of Psychoanalysts

Vera Regina Fonseca will discuss how the lack of an emotional nurturing environment during early childhood has a deep and long-lasting impact in child development. When, besides failing in providing security, caretakers impinge upon children physical and / or psychological suffering, the very core of the self is damaged, opening the path to the trans-generational repetition of the trauma. It is the responsibility of the state to cut the lethal circle of abuse and its consequences. When it denies such a role, the spreading and spiralling of violence runs a free course. We are currently witnessing in Brazil, the dissolving of several committees linked to the regulation and enforcement of child protection. As psychoanalysts we have the duty to alert to the catastrophic outcome of such neglect. Download paper

Mali Mann, MD, F.I.P.A – is an Adult, Adolescent and Child Psychiatrist and Psychoanalyst in the San Francisco Bay Area. She is a Training and Supervising Psychoanalyst and Child Analytic Supervisor at San Francisco Centre for Psychoanalysis. She is currently the chair of the IPA’s Inter-Committee Project on Child Abuse. She served as Chair of the North American Committee on Child and Adolescent Psychoanalysis / and associate member of the Committee of Women and Psychoanalysis (COWAP). She is a clinical professor, adjunct at Stanford University School of Medicine, Department of Psychiatry and Behavioural Science. She has a special interest in psychoanalytic aspects of assisted reproductive technology, twins, adoption, and global health. She is involved in Flying Doctors Mission. 

Jennifer Davids – is a Fellow of the British Psychoanalytical Society. She lives and works in full time practice in London. Jennifer is a child, adolescent and adult psychoanalyst. She is a supervising analyst for child and adolescent psychoanalysis. Originally trained at the Anna Freud Centre, she then worked on the clinical and teaching staff for over 20 years. Jennifer also worked in the public sector as a consultant. Her special interests include the links between child and adult psychoanalysis, adopted and looked-after children, and the interface between politics and psychoanalysis. 

Vera Regina Fonseca, MD, PhD – is a Training and Supervising Analyst of the Brazilian Psychoanalytic Society of São Paulo (BPSSP). She is currently the Director of Training of the BPSSP, and has been its Scientific Chair (2013-2016). Her doctoral thesis focused on interdisciplinary studies in autistic disorders; she has been a post-doctoral researcher in post-partum depression and child development. She works in private practice as a child psychoanalyst and as a psychoanalyst with children and adults. Her interests are developmental psychopathology, research and politics. 

If you are unable to attend the live session but would like to receive a recording, please continue to register and a recording will automatically be emailed to you once the live session has ended. 

Dear all, 

Thank you for attending the IPA's webinar: Child Abuse, Detection and Treatment and welcome to the discussion group. 

We hope that you enjoyed the session and found the presentations useful. If you would like to watch the webinar again, you can access the recording in this page. 

If you are reading this, it is because you would like to continue discussing the themes raised during this webinar. 

You are invited to leave your comments, questions and opinions. All comments will be moderated, and we ask all contributors to abide by our community standards. Please note, you can choose to subscribe to be notified when new comments have been published. The discussion will be closed after three months. 

Best regards. 
Silvia Wajnbuch[email protected] 
IPA Webinar Coordinator and Moderator of this discussion group


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Posted by:   Dra. Vera Regina Jardim Ribeiro Marcondes Fonseca
Posted on:   2020-02-11 10:55 AM
Barison, S. (2019) A violência silenciosa do desmentido na situação traumática (The violence of denial in trauma) presented at the Jornada do Grupo de Estudos de Psicanálise de São José do Rio Preto e Região (GEP): Múltiplas faces da violência. October 19, 2019, São José do Rio Preto – São Paulo, Brazil.

Barison, S. (2018) Sexual Abuse: Understanding from Ferenczi. Presented at the 13th International Sándor Ferenczi Conference: Ferenczi in our time and a renaissance of psychoanalysis, May, 3-6 2018, Florence - Italy.

Greif, D. (2010). Explaining the Inexplicable: A Review of Prologue to Violence: Child Abuse, Dissociation and Crime, by Abby Stein, 2007, Analytic Press, 147 pp.. Contemp. Psychoanal., 46(2):272-279.

James, O. (2014). Emotional Child Abuse Has to Be Banned—The Science Backs up Our Instincts. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 8(2):vii-x

Summit, R. (1992). Abuse of the Child Sexual Abuse Accommodation Syndrome. Journal of Child Sexual Abuse, 1(4): 153-163.

White, K. (2013). The Child Sexual Abuse Accommodation Syndrome—Thirty Years On: An Introduction to the Republication of Professor Roland Summit's Article from 1983. Att: New Dir. in Psychother. Relat. Psychoanal., 7(2):xi-xiii.

Posted by:   Dra. Vera Regina Jardim Ribeiro Marcondes Fonseca
Posted on:   2020-02-08 17:04 PM
Comments:   Question: Do you think there is a difference in the mind structuration of the child in different kind of abuse, sexual, violence, or emotional?
Even if more research is needed on this topic, I would say that one of the consequences of child abuse might be a tendency to be engaged in relationships with sadistic-masochistic features. This may happen either during childhood or in adulthood, and may be linked to the kind of abuse suffered (with early erotization in sexual abuse, for example), as if the repetition compulsion manifested as a way to work through or control the experience of powerlessness.
Posted by:   Prof. Dr. med. Mali A. Mann
Posted on:   2020-02-09 10:36 AM
Comments:   Dear all,
There should be more research in neurological and brain imaging to distinguish the impact of different kinds of abuse and neglect on psychological and Neuro-Cognitive development.The following researcher have done significant works. Please look these up.
Child maltreatment appears to be the single most preventable cause of mental illness and behavioral dysfunction in the US. Child abuse and neglect can cause disrupted development leading to delays in, deficits of, or failures of multisystem achievements in motor, emotional, behavioral, language, psychosocial, social, and cognitive skills (for review see De Bellis, 2001). There is evidence that these disruptions persistent into adulthood and are accompanied by neurobiologic stress response dysregulation (DeBellis & Thomas, 2003). Individuals with child maltreatment histories are more likely to manifest multiple health risk behaviors and serious medical illnesses (Felitti et al., 1998), have greater rates of psychiatric impairment (Edwards, Holden, Felitti, & Anda, 2003) and medical utilization (Swenson & Spratt, 1999; Walker et al., 1999), higher rates of developmental disorders (Cicchetti & Lynch, 1995), impaired attachment (Hanson & Spratt, 2000), greater risk for violent crimes (Deykin & Buka, 1997), substance use disorders (De Bellis, 2002), more school discipline problems and suspensions (Eckenrode, Laird, & Doris, 1993), poor long-term intellectual and academic achievement (Perez & Widom, 1994), and greater likelihood of becoming a teenage parent (Anda et al., 2002; Hillis et al., 2004). Despite the fact that sexually abused children suffer adverse outcomes, there are few published studies examining the developmental and the psychobiological consequences of sexual abuse. Childhood sexual abuse is strongly associated with experiencing multiple other forms of adverse childhood experiences (Dong, Anda, Dube, Giles, & Felitti, 2003). These poor developmental outcomes may be caused by dysregulation of biological stress systems and adverse brain development (De Bellis et al., 1994a; De Bellis et al., 1999b; De Bellis et al., 1999c; De Bellis et al., 2002b; De Bellis & Keshavan, 2003; De Bellis, Lefter, Trickett, & Putnam, 1994b
Posted by:   Dra. Vera Regina Jardim Ribeiro Marcondes Fonseca
Posted on:   2020-02-08 16:55 PM
Comments:   QUESTION: Is there any research data indicating any success in prevention programmes?
Thre are a lot of studies and meta-analyses on the issue of prevention programs effectiveness. The success certainly depends on local factors.
One of these studies can be reached at:
Other, concerning AUSTRALIA programs:
I paste below the presentation of the text:
The purpose of each Research Brief from the National Child Protection Clearinghouse's Child Abuse Prevention: What Works? project is to document research concerning the effectiveness of different types of child maltreatment prevention programs. The Child Abuse Prevention: What Works? project is based on research undertaken for the Child Abuse Prevention Issues Paper no. 24 (Holzer, Higgins, Bromfield, Richardson, & Higgins, 2006). The types of programs detailed in the Child Abuse Prevention: What Works? project are: parent education programs; home-visiting programs; personal safety programs; community-focused programs (for example, universal media campaigns); therapeutic programs for children; and family preservation programs.
Posted by:   Dra. Vera Regina Jardim Ribeiro Marcondes Fonseca
Posted on:   2020-02-08 16:49 PM
Comments:   QUESTION MADE BY Dr. Gaetano Pellegrini:
How do you define "abuse" in the different countries. Which is the cultural influence ? The emotional abuse is not scored, only the physical abuse.
This point can be one at the razor’s edge: on one hand, there is the threat to physical integrity of the child, considering the assimetry between adults and children. On the other hand, if we push too an strict definition, we could leave some parents without means to deal with extreme situations. Besides what is considered “correct” we also have to deal with such dilemma.
Posted by:   Prof. Dr. med. Mali A. Mann
Posted on:   2020-02-09 11:10 AM
Comments:   Child maltreatment is defined according to socially accepted norms that are largely dictated by culture. As a result, some immigrant and refugee families may have different views of child rearing and child maltreatment based on the accepted practices in their country of origin compared with the views of western societies. Physical punishment is still a common and socially acceptable practice in many countries.
There is one survey by the International Society for the Prevention of Child Abuse and Neglect that undertook a global survey of informed individuals in 2012. Although physical abuse (e.g., beatings, burnings) and sexual abuse (e.g., incest, sexual touching) were considered to be abuse in almost all countries (97% each), only 53% of respondents indicated that physical punishment was considered to be abusive in their country. Other forms of maltreatment were not necessarily viewed as abusive, such as: emotional abuse (90% in the Americas, 67% in Asia and 56% in Africa), exposure to pornography (100% in the Americas and 56% in Africa)
Witnessing intimate partner violence (IPV) (90% in the Americas, 75% in Europe, 56% in Asia and 33% in Africa).
There are countries that do not have national laws or policies on child maltreatment, nor could they identify a government agency mandated to respond to cases of suspected child maltreatment at the national, state or local level. In countries with a child welfare system in place, standards of service, care and intervention conceivably could be varied.
As a result, some immigrants individuals, refugee and immigrant families from countries with dissimilar laws and systems to those of Western Countries may have no experience or understanding of child welfare, services or authorities. This may be further compounded by a number of individual, family and systemic factors.
Among many challenges, language and cultural barriers among newly immigrant parents and their difficulty to understand the host country's health care and child welfare professionals are among many factors that adds to this complex problem.
Lack of awareness, understanding or agreement with the host country's norms and laws pertaining to child-rearing can add to the challenge.
Lack of comprehension of Immigration policies that discourage victims to seek help is another important issue.
Socioeconomic stress during resettlement, caused by poverty, housing problems, social isolation, employment issues are among many of these problems. Discrimination in the community or workplace can be an added factor.
Lack of awareness and access to culturally specific services is another factor. Barriers to health care access services. Some of these culture believe that physical and mental health issues should stay within the family and that difficulties within the family should be dealt with within family.
Posted by:   Ms. Rhoda Bawdekar
Posted on:   2020-02-05 10:40 AM
Comments:   Replies from Mali Mann:

1-Talking about parental abuse and the following split…….

Response: one of our goal in the treatment should help the abused patient to integrate the split off aspect of an abusive parent with the healthier part.
Idealization is one of the defenses that commonly could be employed by the abused subject.The deep structural changes and great growth in the hand of skilled psychodynamic oriented psychotherapist can happen despite patient's areas of developmental arrest and deficit.
therapeutic goal can be obtained by therapist adapting to the patient’s needs and allow more dependency than is ordinarily considered appropriate.
the second part of the question has to do with helping teenager not to act out aggression.
Adolescents are prone to severe emotional upheaval and and prone to act out. Abused adolescents are at a higher risk to act out their aggression.
The importance of early detection can not be over emphasized.
The abused child and adolescent take on a protective stance for the abusing parents. It is risky for the child to make the abusing parent’s abuse far worse of an abuse. Besides, abused children do not think of themselves as having been victimized.

2-Second one has to do with Institutional responsibility ….about congress meeting places and hotels.
This is news to me.
I am sorry to say that I can not answer this question in all honesty. If this observation has been the person’s personal experience who raised this very important question, it should be taken very seriously indeed.
It is regrettable that it had happened.

3-The third question seems to assume that emphasis on the 'Abused Child’ making the victim pathological ones.
Like I said in my talk, child abuse is any non-accidental physical and emotional harm inflicted on a child by a parent or other care taker intentionally, deliberately and aggressively in anger.
As Martin, has noted, “ Maltreatment of children is a spectrum. Physical assault, neglect, nutritional or emotional neglect and deprivation are points on that spectrum and overlap considerably. Martin.H.P had written a book on helping the battered child and his family. Please look him up.
I am wondering if the person who is asking this question means the role of provocation on the half of the child?
Literature implies that even normal parents may abuse a particularly irritating or difficult child.
Martin states that the aggressive child “perpetuates the notion that many of these children would invite abuse from the most normal parents.
There is a question that some children are constitutionally or temperamentally so difficult that some parents resort to excessive measure in order to mange the child.

4- The person who raised a question from Ontario, Canada about the notion of having the duty to report……...
We can discuss this further not in this format. it is not so simple to come up with a black and white answer, yes we Should report and if we do not we should be guilty or ashamed for our wrong doing and not reporting!!
It is rather obvious that legally there is an obligation to report. I am afraid I can not expand on this because there seems to be an assumption that I am supposed to be reminded that Legally i should know to report. There seems to be a further assumption as if the panelist is portrayed as being against reporting. I believe it is counter-productive to take up the question on this platform. in fact this question is an important one that deserves proper amount of time to be devoted to the idea of reporting and not reporting.
Perhaps you could have asked 'has there been any cases that are in the grey area and have not been reported for reasons that have not been articulated & if so, what factors played into it?
I will be happy to discuss it in person, and my email address and phone number is listed.

Posted by:   Dr. Gaetano Pellegrini
Posted on:   2020-01-31 14:57 PM
Comments:   I would like to ask you how do you define "abuse" in the different countries.

I wonder also which are the cultural influences?

Is the emotional abuse scored, as the physical abuse?

Thank you very much
Posted by:   Ms. Jennifer Davids
Posted on:   2020-02-07 14:23 PM
Comments:   As I said in the webinar, emotional abuse is sometimes disbelieved by social services. there are criteria for it- character assassination, projection into the child of unwanted aspects of the abuser, verbal violence etc, neglect.
Posted by:   Prof. Dr. med. Mali A. Mann
Posted on:   2020-02-03 10:52 AM
Comments:   I need to respond the question that was raised " how do we define child abuse in different cultures"
There is a unified agreement by World Heath Organization that ideally all countries in the World will go along with the definition and make necessary changes that ought to happen since it presents Human Right violation.
Posted by:   Ms. Jennifer Davids
Posted on:   2020-02-07 14:21 PM
Comments:   Although there is a generally agreed definition of child abuse, there are many kinds of abuse from physical to sexual to emotional and more recently what I am addressing digital abuse- see my handout for webinar. There is also ritualistic abuse- see Sinason's work. I would say abuse implies a violation of rights and boundaries. Jennifer Davids London
Posted by:   Prof. Dr. med. Mali A. Mann
Posted on:   2020-02-03 10:48 AM
Comments:   Both emotional, physical, digital abuse and neglect are harmful, injurious and damaging to the individuals who are subjected to it.
We do not see with naked eyes emotional scars left in the psychiatry. It stays there, like a foreign body and attached memories resurface during the course of therapy.
we ought to know enough how to work with trauma. PTSD symptomatology stays for a long time and forever until with the help of metallization therapy and gradual transformative work, therapeutic gain comes about.
As far as cultural factors is concerned and how it influence the definition of child abuse, there are body of literature that demonstrate what Westerner define as child Abuse could be a standard practice of child rearing in other cultures.
Child labour, child bride, female genital mutilation, Sexual initiation of virgins, violence against girls students, child trafficking, forced adoption and other kinds of practice are examples of child abuse. These kind of practice is sanctioned and not reported as criminal activities.
Posted by:   Dr. Emily Bilman
Posted on:   2020-02-26 18:15 PM
Comments:   I just posted an unsigned question to Dr. Mann.
dr. Emily Bilman
Posted by:   Dra. Valeria Nader
Posted on:   2020-01-31 01:31 AM
Comments:   Dear panelists? Do you think is there anything we analysts Can do to prevent child abuse? Thank you. Valeria
Updated By:   Lic. Silvia Wajnbuch
Updated On:   2020-01-31 01:37 AM
Posted by:   Ms. Jennifer Davids
Posted on:   2020-02-07 14:29 PM
Comments:   I think we need to go beyond the couch and think about the effects of poverty. We know that there is more domestic and child abuse in poor communities.

Re prevention I think education and community support is vital- such programmes have to be developed in culturally sensitive ways to address self-esteem and different ways of parenting.

The role of schools and any third, as I said in the webinar, can be crucial to provide a different safe setting for the child or adolescent to disclose such abusive experiences.

Fonagy's concept of epistemic trust is informative here.

Re digital abuse we need to become aware of the effects of screen use on us and the addictive quality of the internet as well as the different kind of disinhibited way of relating digitally through emails, texts, instagram etc.
Posted by:   Prof. Dr. med. Mali A. Mann
Posted on:   2020-02-03 10:32 AM
Comments:   Yes, I believe we can first learn how to detect child abuse and neglect and use our psychoanalytic understanding and insight to help both abused and abusing parents and individuals to heal and break out of a repetitious cycle.
There have been studies in which there have been more careful observations of mothers and their children have found a stronger link between abused in childhood and being an abusive parent. In a survey of such studies, Joan Kaufman and Edward Zigler psychologists at Yale, concluded that 30% is the best estimate of the rate at which abuse of one generation is repeated in the next. Abuse denial is quite common and is a source of trouble later in life. Another common theme that we need to be mindful of is related to the insistence that victim is the responsible party.
Like many other mental health professional, medical and legal systems who encounter abused cases, psychoanalysts also ar not immune and play a crucial role in detecting and at times if it is fully proven with evidence, we should report to social agencies and law authorities.
Posted by:   Dr. Emily Bilman
Posted on:   2020-02-26 18:12 PM
Comments:   Thank you Prof. Mann for your evidence-based explanation of child abuse. I would like to know whether there have been studies on what triggers the dire consequences of deviation in abused in transgenerational children? Do you think that genetic factors and the trauma that influence the genes are important in this negative transmission linked to thanatos?
Posted by:   Dra. Vera Regina Jardim Ribeiro Marcondes Fonseca
Posted on:   2020-02-01 23:58 PM
Comments:   Just to cite a few possibilities a psychoanalyst has to helping prevent child abuse:
1-Participating in inter-disciplinary meetings (either open to families or only to professionals), explaining our view about the impact of trauma in the development of the mind and about the potential for transmission and multiplication of deleterious effects through groups and generations.
2-Creating study groups about the subject in our societies.
3- Treating our patients (either children or adults) is also a step towards preventing them to becoming themselves an abuser.
Posted by:   Ms. Rhoda Bawdekar
Posted on:   2020-01-30 15:02 PM
Comments:   I wanted to ask whether how the knowledge we have acquired
from the effect of the Holocaust on the 2nd generation
can help us in solving the transgenerational conflicts
in child abuse? Is there any research in this area?
Thank you for your answer.

Best Regards,
dr. Emily BILMAN
Posted by:   Ms. Jennifer Davids
Posted on:   2020-02-07 14:37 PM
Comments:   This is a very important and profound question. And I think the answer is yes to some degree. We are beginning to understand the complexities of such transmission. The work of the ghosts is described and formulated by Selma Fraiberg ( G hosts in the Nursery)and Haydee Faimberg. The latter has written a book on the subject which I recommend: The Telescoping of the Generations. But it does not deal with child and adolescent patients per se, only adults. there may be some literature from Israel about this topic. I will do some research and see if anything pertinent comes up.
Posted by:   Dr. Emily Bilman
Posted on:   2020-02-26 18:33 PM
Comments:   Thank you for the bibliographical reference, Ms. Davids. Please let me know of other books if and when you know of them. I am particularly interested in transgenerational transmission due to the influence of the educational and cultural background of the families and the children which is an important factor to consider in child abuse. But, in this respect the abuse can lay dormant during a whole generation and then, be triggered again in another more violent form which should be better treated and reported as soon as it is discovered. dr. Emily Bilman
Posted by:   Prof. Dr. med. Mali A. Mann
Posted on:   2020-01-31 01:36 AM
Comments:   Dear Emily,
You are raising a very important question. I am unaware of a formal research that is being done. However, I believe the following reference could be useful for you to read.
Genealogy 2018, 2(4), 49;
Transgenerational Transmission of Holocaust Trauma and Its Expressions in Literature
by Bina Nir
Department of Communication, The Academic College of Emek Yezrael, Yezrael Valley 1930600, Israel
Received: 24 September 2018 / Accepted: 14 November 2018 / Published: 19 November 2018
Download PDF
Abstract: Trauma is a central concept in the historiography of the Holocaust. In both the historiographical and the psychoanalytical research on the subject, the Holocaust is perceived not as a finite event that took place in the past, but as one that continues to exist and to affect the families of survivors and the Jewish people. In the 1950s–1960s, evidence began emerging that Holocaust trauma was not limited to the survivors themselves, but was passed on to the next generation born after the Holocaust and raised in its shadow. It is possible to see the effects of growing up in the shadow of the Holocaust and transgenerational transmission of trauma in many aspects of the second-generation children’s lives. In this article, I examine the representations of these symptoms in David Grossman’s novel See Under: Love, which deals with the subject of the Holocaust through the perspective of Momik, a child of Holocaust survivors. Grossman teaches us that writing itself has the potential to heal. He also shows us that every one of us contains both victim and aggressor, and that, under certain circumstances, the “Nazi beast” may awaken within each of us.

If I find other research paper, i sure will post it.
One of the studies shows that if individual treatment as well as multi system model of intervention are offered, 33% of individuals break away from the repeating the cycles.
Mali Mann, Chair of Inter-Committee on Child Abuse/IPA

Posted by:   Dr. Emily Bilman
Posted on:   2020-02-26 19:20 PM
Comments:   Thank you, Dr. Mann.
Posted by:   Lic. Silvia Wajnbuch
Posted on:   2020-01-29 19:57 PM
Comments:   Dear all,
Thank you for attending the IPA's webinar: Child Abuse, Detection and Treatment and welcome to the discussion group.

We hope that you enjoyed the session and found the presentations useful. If you would like to watch the webinar again, you can access the recording in this page.

If you are reading this, it is because you would like to continue discussing the themes raised during this webinar.

You are invited to leave your comments, questions and opinions. All comments will be moderated, and we ask all contributors to abide by our community standards. Please note, you can choose to subscribe to be notified when new comments have been published. The discussion will be closed after three months.

Best regards.
Silvia Wajnbuch – [email protected]
IPA Webinar Coordinator and Moderator of this discussion group.


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