Child abuse and domestic violence.

Case Presentation MR, a bright, chatty 6-year-old boy, disclosed physical and sexual abuse by his father. There is a history of domestic violence in the home, which he shares with his 7-year-old sister and his mother. The children witnessed their father hitting their mother, choking her, pushing her against the wall, and kicking her in the stomach on several occasions while she was pregnant with her third child. MR heard his father say that he wished his mother would die. Once during a physical assault when MR tried to pull his father off his mother, his father slapped him. His mother delivered a stillborn baby, after which MR’s behavior declined. He threatened to kill himself by cutting his wrists to be in heaven with the deceased baby. He attempted to choke his sister and to hurt the family dog and described hearing voices telling him to do bad things. MR reported that his father got into the bathtub with him every day and “washed” MR’s private area with soap and water. At times, his father grabbed MR’s penis forcefully enough to cause pain. He said that his father asked him to touch and kiss his (father’s) penis. His father pulled his ear, slapped him on his buttocks and face, and hit him with a belt. MR said that his father did a lot of things and that he didn’t remember them all. MR’s mother said that she told the father to leave the apartment. According to her, when he left, the boy became depressed, cried frequently, did not eat, and had difficulty sleeping. For a while, she let the father visit, but when he continued to abuse her and the children, she stopped the visits. After she got an Order of Protection, the father said that if she ever used it against him, he would kill her. Despite the problems, MR’s mother continues to have difficulty separating emotionally from the children’s father. MR is doing better in therapy, although he often asks to sleep over at the clinic where he is being treated.