Family process in the treatment of intrafamilial child sexual abuse

The paper describes the changes in family dynamics that occur throughout the process of family-orientated treatment of families where father–daughter incest or stepfatherr–stepdaughter child sexual abuse has occurred. A detailed step-by-step analysis of the developing family process in incest families during therapy is given. The analysis establishes the nature of the original pattern of family relationships, explores the impact made by crisis intervention on the family structure and then outlines therapy and termination of treatment. Characteristic mechanisms in the family process during therapy are described. A detailed clinical example demonstrates the basic therapeutic moves and the mechanisms involved.     

Trauma and abuse in the case of Little Hans: a contemporary perspective

Newly available interviews with Max and Herbert Graf describe the severe pathology of Little Hans's mother and her mistreatment of her husband and her daughter, who committed suicide as an adult. Reread in this context, the text of "A Phobia in a Five-year-old Boy" provides ample evidence of Frau Graf's sexual seduction and emotional manipulation of her son, which exacerbated his age-expectable castration and separation anxiety, and her beating of her infant daughter. The boy's phobic symptoms can therefore be deconstructed not only as the expression of oedipal fantasy, but as a communication of the traumatic abuse occurring in the home. Through subliminal, indeed unconscious, injunctions conveyed in abusive behavior, parents can confirm the child's worst imaginings and immature views of the world and thereby render the child's oedipal conflicts and fantasies pathogenic.     

Working with child sexual abuse: a systemic perspective on whether children need to tell their therapist details of the abuse for healing to take place

As clinicians working with children who have been sexually abused we have observed that many children choose not to give the therapist a detailed account of their abuse. ^{1 1}‘Children’ refers to children and adolescents.
Our hypothesis is that whether or not children tell their story to the therapist hinges upon several factors: whether they have been believed by their significant (non‐abusing) carer(s); their developmental stage; the therapeutic context; and whether they feel their therapist is available to hear the distressing details of the abuse. We explore this through two case studies and conclude that while children's ability to use therapy is affected by multiple factors – societal, cultural, personal, life histories and beliefs about the value of therapy – telling their therapist the details of their abusive experiences is not necessarily a part of effective therapy.     

Retrospective assessment of childhood sexual and physical abuse: a comparison of scaled and behaviorally specific approaches

This study compared retrospective reports of childhood sexual and physical abuse as assessed by two measures: the Childhood Trauma Questionnaire (CTQ), which uses a Likert-type scaling approach, and the Computer Assisted Maltreatment Inventory (CAMI), which employs a behaviorally specific means of assessment. Participants included 1,195 undergraduate students recruited from three geographically diverse universities. Agreement was high across the two measures in the classification of victim status (92% and 80% for sexual and physical abuse, respectively). However, the CTQ classified more participants as sexually abused than did the CAMI, whereas the opposite trend was found for physical abuse. For child physical abuse, many participants reporting abusive acts on the CAMI scored below the cut-point for physical abuse on the CTQ. Classification differences for both types of abuse were largely unrelated to demographic factors, socially desirable responding, or self-reported withholding of information. The implications of these results are discussed in light of future research using retrospective methods of assessing childhood abuse.     

Countertransference,enactment and sexual abuse

This paper examines the development of a therapeutic relationship with a sexually abused latency girl who, in the course of her two years of four times weekly psychotherapy, was placed in two different foster-homes. It is argued that the child's re-enactment of the abuse in the consulting room allowed her to move from a seductive relationship with the therapist to one characterized by basic trust. This was paralleled by her development of a capacity to think and to tolerate affect states. The use of an imaginary twin by the child and the use of powerful countertransference feelings in the therapist are seen as the main therapeutic tools in the treatment. The premature termination of the treatment – due to the therapist's departure – enabled the child to articulate for the first time her feelings, in the transference, about the trauma and the traumatizing agent. The child's progressing moves in the therapy are also presented.     

Recovered memories of alleged sexual abuse: Lawsuits against parents

Recently there has been increased civil litigation by adults suing parents and others for sexual abuse following the recovering of memories of the abuse through therapy. The memories are recovered with the help of therapists who use concepts such as repression and dissociation to account for the lack of memories and who then use techniques such as hypnosis and survivors' groups. However, the claims of repressed memories of childhood sexual abuse recovered in the course of therapy are unlikely to be supported by empirical data.     

Cognitive processing therapy for chronic PTSD from childhood sexual abuse: A case study

This paper describes a case of chronic Post-traumatic Stress Disorder (PTSD), as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 4th edn; American Psychiatric Association, 1994). The client has a long history of childhood sexual abuse (CSA), as well as repeated sexual victimization as an adult and addiction issues. She presented with significant avoidance symptoms, including a highly restricted range of affect and distinct feelings of detachment from others. These symptoms had been greatly reduced by the end of the 17-week therapy including both individual and group modalities. The paper elaborates on theoretical issues, the Cognitive Processing Therapy model (Resick & Schnicke, 1993) as it was adapted for use with survivors of childhood sexual abuse, the various phases of the therapeutic process, and specific examples of therapeutic change with this particularly complicated case.     

Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.     

Women's disclosure of sexual abuse

Abstract

In this qualitative study of women who have experienced nonconsensual sexual activity, participants were asked to write accounts of their experiences focusing on what motivated them to confide in someone, to whom they confided, what the outcome was, and how it effected them. Participants had to be female and 18 years of age or older, and they had to have been sexually abused at some point in their lives. A total of 10 women participated. Nine of the women wrote about an abusive experience that happened to them as a child, and one wrote about an experience that occurred in adulthood. The participants wrote that they were able to disclose their past sexually abusive experience because they felt safe with the person to whom they confided, they felt they needed help, and the opportunity presented itself. They were more likely to disclose to non-family members than family members, and the majority of the people they disclosed to had a positive reaction. Consequently, most of the women in this study were positively affected by their disclosure. Findings of this study are similar to those of other studies on disclosure and sexual abuse.     

Childhood sexual and physical abuse and the 1-year prevalence of medical problems in the National Comorbidity Survey.

In a population sample (N=5,877; ages 15 to 54), the authors found childhood sexual and physical abuse to be associated with the 1-year prevalence of serious health problems for both men and women. The authors also found that participants' psychiatric disorders partially mediated the effects of physical and sexual abuse on adult health. However, childhood abuse continued to independently influence health status after the authors controlled for psychiatric disorders. Contrary to expectations, individuals who experienced a combination of sexual and physical abuse did not have a higher frequency of health problems than those who experienced either type of abuse alone. Implications for these findings are discussed, including possible mechanisms that may account for the association between childhood abuse and adult health problems.     

Childhood physical and sexual abuse and lifetime number of suicide attempts: a persistent and theoretically important relationship

BACKGROUND: Research to date has indicated that childhood abuse is associated with suicide, though little research has examined the unique contribution of specific types of abuse to suicidal behavior. We predict that childhood physical and violent sexual abuse will have a greater effect on suicide attempts than molestation and verbal abuse. METHODS: The National Comorbidity Survey data were used to test these predictions while controlling for a number of psychiatric and psychosocial variables. RESULTS: As expected, childhood physical and violent sexual abuse showed similar effects on lifetime suicide attempts, which were stronger than the effects of molestation and verbal abuse. LIMITATIONS: This was a cross-sectional, retrospective study, so true causality cannot be shown. Some measurement limitations exist. Additionally, effect sizes were small but still significant. CONCLUSIONS: While all forms of childhood abuse are troubling and create risk for future psychopathology and suicidality, the present study indicates that childhood physical and violent sexual abuse should be seen as greater risk factors for future suicide attempts than molestation and verbal abuse.     

Photography as a therapeutic tool for substance abuse clients who have a history of sexual abuse

Symptoms of sexual abuse among persons in substance abuse treatment facilities may be difficult to recognise since presenting symptoms frequently mirror those associated with substance abuse. Additionally, treatment may be difficult due to a lack of previous verbal processing and shared negative defence mechanisms that are resistant to traditional talking therapy. The use of photography is presented here as a method of treatment initiation and exploration for substance abuse clients who have a history of sexual abuse. The paper reviews rationale, advantages, current applications and practitioner concerns associated with the use of photography as a therapeutic tool.     

Factors to consider in assessing adult litigants' complaints of childhood sexual abuse

Based on limited research, clinical and forensic experience and observations, factors hypothesized to be potentially useful in forensic evaluation of claims of decades-delayed discovery of childhood sexual abuse are delineated. Factors considered include: (1) alleged victim factors, (2) memory factors, (3) therapist/examiner factors, (4) external influences on the abuse account, (5) evidential patterns. Differences among a limited sample of cases seen by the author are described. Present knowledge does not provide a basis for reliable determination of whether a specific recollection is true or false, based only upon the claimant's account. At this time, there is no empirically validated method for discriminating valid from invalid cases. Experts testifying for either side must exercise caution and restraint as it may be premature and even unethical in many cases to propound opinions about the validity or invalidity of the memories.     

Family-of-origin maltreatment, posttraumatic stress disorder symptoms, social information processing deficits, and relationship abuse perpetration

In this study, the authors examined the interrelations among family-of-origin maltreatment variables, posttraumatic stress disorder (PTSD) symptoms, social information processing deficits, and male-to-female psychological and physical intimate relationship abuse perpetration in adulthood among a community sample of 164 men and their partners. In bivariate analyses, higher family-of-origin childhood parental rejection was associated with the perpetration of psychological and physical abuse in adulthood, and childhood exposure to interparental violence was also associated with adult psychological abuse perpetration. Structural equation modeling analyses indicated that when childhood variables and other study variables were considered together, only childhood parental rejection was associated with the abuse perpetration outcomes, and these effects were indirect through PTSD symptoms and social information processing deficits. Results indicate a need for further investigation into the mechanisms accounting for the impact of early maltreatment on the development of abusive intimate relationship behavior.     

Additive impact of childhood emotional,physical, and sexual abuse on suicide attempts among low-income African American women

This study examines the association between exposures to multiple forms of childhood abuse (emotional, physical, sexual) and adult suicidal behavior in a sample of low-income, African American women. We hypothesized a linear relation between childhood abuse and risk for making a suicide attempt, such that the more forms of childhood abuse to which a woman was exposed, the greater her risk would be to make a suicide attempt. Logistic regression analyses revealed that, compared to women who did not report any experiences of childhood abuse, women who experienced one, two, or three forms of abuse were 1.83, 2.29, or 7.75 times more likely to attempt suicide, respectively (all statistically significant). Furthermore, compared to women who reported one or two types of abuse, women who reported all three types of abuse were statistically more likely to attempt suicide. These findings have implications for clinicians working with African American women who report either childhood abuse or exhibit suicidal behavior.     

A prospective study of memory for child sexual abuse: new findings relevant to the repressed-memory controversy

Previous research indicates that many adults (nearly 40%) fail to report their own documented child sexual abuse (CSA) when asked about their childhood experiences. These controversial results could reflect lack of consciously accessible recollection, thus bolstering claims that traumatic memories may be repressed. In the present study, 175 individuals with documented CSA histories were interviewed regarding their childhood trauma. Unlike in previous studies, the majority of participants (81%) in our study reported the documented abuse. Older age when the abuse ended, maternal support following disclosure of the abuse, and more severe abuse were associated with an increased likelihood of disclosure. Ethnicity and dissociation also played a role. Failure to report CSA should not necessarily be interpreted as evidence that the abuse is inaccessible to memory, although inaccessibility or forgetting cannot be ruled out in a subset of cases.     

Satanism as a response to abuse: the dynamics and treatment of satanic involvement in male youths.

Male youths from abusive family environments may be particularly vulnerable to recruitment into satanic cults. Families that are abusive, devalue or invalidate the abused child's feelings, blame the child for the family's problems, and view the world in rigidly moralistic terms create environments in which the youths are likely to identify with the aggressor and label themselves as evil. These youths, who may have poor social skills and feelings of anger, low self-esteem, self-blame, depression, powerlessness, and isolation as a result of the abuse, may use satanic involvement as a means of legitimizing their experience and differentiating from a negatively enmeshed and/or abusive family system. In this paper, the etiological factors and treatment approaches of ten hospitalized boys who had voluntarily involved themselves in repeated group satanic activities during their adolescence are described, and two case illustrations are given. Recommendations for understanding and treating such cases are provided.     

The Towers of Silence: creative and destructive issues for therapeutic teams dealing with sexual abuse

Intra-familial sexual abuse of children is a peculiarly potent area for subsequent inter-agency responses and interventions to become inappropriate, irrational, and damaging. A major component of the damaging responses by the inter-agency system is the mirroring processes which occur between that system and the family.
A case example is presented in some detail to illustrate the ways in which such mirroring processes also effect therapeutic teams dealing with such families. Some therapeutic techniques from an experiential base are described. It is argued that productive therapeutic work can only occur if the mirroring processes within the inter-agency system, and the therapeutic team system, are considered systemically.     

Disclosure of father-child sexual abuse: Dilemmas for families and therapists

Following disclosure of father-child sexual abuse, family members are faced with significant dilemmas related to the abuse disclosure and to the future of familial relationships. The resolution of these dilemmas has an impact on the resulting family structure as well as the therapist's stance, the therapeutic process, and therapeutic goals. This paper presents clinical issues that arise in relation to father/perpetrator and mother responses to the dilemmas they face following their child's disclosure of abuse. Clinical case examples are used to illustrate several resolutions that families reach following disclosure of abuse. The cases illustrate the systemic functioning of families and the impact that family members' decisions have on the therapeutic process.This paper was sponsored in part by a grant from the U. S. Department of the Navy. Names of clients were changed by the author to protect their identities.