Attributions are the cognitive processes by which the child attempts to make sense out of the abuse experience. Abuse-specific attributions consist of the child's causal explanation for "why" the abuse happened. Two main types of children's attributions have been identified in the literature: self- blame and other/perpetrator-blame attributions.

Because recent research has found children's attributions of self-blame and perpetrator-blame to operate independently, authors have concluded that clinicians should treat children's self-blame and perpetrator-blame attributions as separate factors when designing interventions. The purpose of this study was to understand how clinicians who work with sexually abused children are clinically conceptualizing, determining, and addressing sexually abused children's self-blame and perpetrator-blame attributions. The research employed a qualitative interview design. Participants consisted of 10 licensed clinicians who worked with sexually abused children between the ages of 8 and 15. Interviews were transcribed and analyzed by the researcher. The goal of analysis was to understand clinicians' clinical conceptualizations and to provide a narrative description that explains how children's attributions are conceptualized and addressed by clinicians.

Five themes were identified that describe how clinicians address children's abuse-specific attributions: individually tailored treatment, therapeutic listening, developmental factors, challenging erroneous attributions, and addressing anger. Clinicians reported addressing the child's perpetrator/other and self-blame attributions as if they were separate factors. Consistent with previous research findings, clinicians did not voice any assumptions that targeting self-blame attributions would lead to increases in perpetrator-blame attributions. The manner in which children's attributions were targeted was very individual to each situation and varied depending on the child's developmental level and reported attributions. Problematic self-blame attributions were more frequently targeted by clinicians.

Standardized instruments for determining attributions were infrequently utilized by clinicians. Clinicians were able to determine attributions during the course of treatment. Three issues that clinicians discussed when describing their clinical conceptualizations and approaches to working with sexually abused children included the child's safety, interventions that addressed the abuse and/or impact of the abuse, and the view that the child had an identity apart from the abuse.