Combining cognitive-behavioral therapy and pharmacotherapy in the treatment of pedophilic incest offenders

Treatment programs for incest offenders traditionally do not differentiate between pedophilic and nonpedophilic perpetrators. This oversight has failed to meet the specialized needs of pedophilic incest offenders, who differ from other incest as well as nonfamilial sex offenders in important ways. This paper describes a treatment intervention combining cognitive-behavioral therapy and pharmacotherapy for the specialized treatment needs of the pedophilic incest offender. A case report is presented to illustrate the use of combined treatment and to highlight indicators for this strategy.     

Enhancement of self-esteem among female adolescent incest victims: a controlled comparison

A therapeutic intervention consisting of homogeneous group therapy and sexual education with same-sex therapist/clients was instituted with 15 female incest victims, compared to a matched control group; all the subjects had experienced intrafamilial incest and were court-placed in a Southern California resident facility. A series of behavioral markers and changes in self-esteem are reported by use of pre- and posttests of the Coopersmith Self-Esteem Inventory, behavioral observations by resident professionals, and checklists/daily behavior logs. The latter were evaluated for signs of further victimization of both groups. Findings show that female incest victims in the experimental group showed a significant increase in positive self-esteem as measured by the inventory, and developed a significantly increased knowledge of human sexuality, birth control, and venereal disease when compared to the control group.     

The Incest Taboo and Family Structure

The evolutionary advantage of outbreeding has influenced the family structure and the mating, attachment, and dominance behaviors of all animals. Nature has selected for those species that have evolved family structures with detachment and dominance patterns that create a relatively intact incest barrier. Man inherits from his animal forebears the biological imperative of an incest barrier but brings to it his special complexity of psychology and symbolization--incest barrier becomes incest taboo. We present a discussion of human patterns of speparation-individuation and Oedipal conflict and relate this to the detachment and dominance behaviors of animals. This is an interface between psychoanalysis, family theory, and ethology. In addition, we pursue in detail the asymmetrical operation of the incest taboo within the family: that it is stronger for mother-son than for father-daughter than for brother-sister.     

The jouissance of the other and the prohibition of incest: a Lacanian perspective

The authors describe how Lacan diverged from classical Freudian concepts to arrive at an alternative model of psychoanalysis. In a discussion that also addresses the concept of the mirror stage and Lacan's use of language, the authors show how the Lacanian concepts of jouissance and the prohibition of incest contribute to this model, which can be successfully applied to the psychoanalytic treatment of more seriously disturbed patients. A clinical vignette is presented to illustrate the latter point.     

Primary Care Treatment Integrating Motivation and Exposure for PTSD Symptoms and Hazardous Alcohol Use: A Case Series

Symptoms of posttraumatic stress disorder (PTSD) and hazardous alcohol use are highly comorbid. Research on integrated interventions to address PTSD symptoms and hazardous alcohol use concurrently has demonstrated efficacy, yet integrated treatments are underutilized. Both patient (e.g., stigma, scheduling/logistics) and clinician (e.g., concern about symptom exacerbation and/or treatment dropout) barriers may impede utilization of integrated interventions among those with comorbid PTSD symptoms and hazardous alcohol use. Primary care behavioral health models (PCBH), in which embedded behavioral health providers deliver treatment to individuals with mild or moderate behavioral health symptoms in primary care, may help address treatment barriers by offering accessible behavioral health interventions in a destigmatizing setting. This paper presents two case examples from a randomized controlled trial testing the efficacy of an integrated intervention for PTSD symptoms and hazardous alcohol use developed for and delivered in primary care. Outcome data and session-by-session content for two participants are included, along with discussion of barriers encountered during the course of treatment. Clinician-suggested strategies for navigating barriers to facilitate utilization of integrated interventions for PTSD symptoms and hazardous alcohol use are also discussed.     

Treatment of incest and pedophilic offenders: A pilot study

Twenty-nine incest and 22 heterosexual pedophilic offenders, under sentence, participated in a study of therapeutic outcome. Results showed the two groups were remarkably similar in their pretreatment level of psychosocial functioning. However, pedophiles had a significantly higher recidivism rate than incestuous men. Incest offenders, on the whole, changed most relative to single or married pedophiles. Pedophiles appeared more treatment resistant in dealing with their disturbed family relations, verbal hostility, irritability, and feelings of anger that, in part, underlie their sexual anomaly. At follow-up 36 months later, only 2 incest and 4 pedophilic men had recidivated. The discussion links these findings with earlier research and proposes a multimodal, group-oriented approach to treating sex offenders.     

The use of symmetrical "do" and "don't" requests to interrupt ongoing activities

The results of a modified functional analysis demonstrated that aggression, displayed by a 27-year-old man, was occasioned by the use of "don't" requests to interrupt the client's ongoing and often inappropriate activities (e.g., lying on the floor, pica, inappropriate touching of others). Subsequent analyses demonstrated that aggression was lower when ongoing activities were interrupted with symmetrical "do" requests than with "don't" requests. An intervention utilizing symmetrical "do" requests (i.e., prompting an individual to engage in an incompatible behavior) to interrupt such activities resulted in reduced levels of aggression.     

Differences in Self-Report Among Incest Family Members

A questionnaire study was conducted among incest families to study their perceptions of social background factors, how long the incest relationship lasted, who was involved, the history of incest in the family, emotional and psychological factors, and the consequences of the incest for the family. It was hypothesized that incest offenders, their spouses and incest victims all tend to report the above in a manner that reflect positively upon their own role in the incest relationship. The results showed clear differences in the reposts of the three groups. The paper concludes that such differences in perceptions must be incorporated in family therapy strategies as well as in our knowledge base of incest families.     

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.     

Intergenerational Effects of Incest on Parenting: Skills,Abilities, and Attitudes

Women's perceptions of generational influences of incest on their skills, abilities, and attitudes toward parenting their own children were investigated. Overarching themes that emerged were classified as unbalanced development, disconnected lives, and disowned dramas. Implications for clinical intervention, parent training, and future research are discussed.     

Father-daughter incest families: A theoretical perspective from balance theory and GST

This paper focuses on a theoretical explanation of how marriages adjust and remain intact in father/daughter incest families. It uses concepts of Balance Theory and General Systems Theory to outline a vascillating balance that occurs between fathers-mother-daughters in incest families. Three groups of Incest, Oppositional, and Nonclinical family units were studied using the Structural Analysis of Social Behavior (SASB) circumplex model. The study found support for the use of Balance Theory and the systems principle of homeostasis as a way to understand the interactional dynamics in incest families. Therapeutic interventions are suggested.Curtis A. Levang has spent more than 10 years working with adult offenders at Hennepin County Adult Corrections in Plymouth, Minnesota. He also is in private practice, working with individuals, couples, groups, and families at Passages Counseling Center.     

An Overview of Theory and Research on Hallucinations

Hallucinations occur in a variety of chronic and transient psychotic disorders, but there is very little agreement on either a specific definition of theory of etiology regarding this phenomenon. This lack of consensus makes it difficult to develop appropriate intervention strategies of validate the results of treatment. This article attempts to address the problem by utilizing a model, based on an occupational therapy perspective, which describes the functional deficits associated with different classifications of hallucinations. The focus of specific functional deficits, rather than etiology or other abstract theoretical premises, allows the clinician to determine when and if intervention is appropriate. Furthermore, the model can be utilized to determine the particular intervention strategies best suited to such individual's needs. Included in this paper is a discussion of the literature regarding the definitions and etiology of hallucinations, as well as an overview of the research on intervention techniques. In addition, two case studies are presented in order to clarify the clinical usage of the functional deficit model.     

A Dual-Focus Motivational Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy

Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large cities. The intervention was based on motivational interviewing and targeted both adoption of effective contraception and reduction of alcohol use. Treatment included 4 manual-guided sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. This paper describes the rationale for treatment; the use of motivational interviewing and the transtheoretical model for a dual-focused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Implications for future applications of the intervention are discussed.     

An Objection to Owens' Article on Incest Victims

The use of Rorschach data for research purposes is growing and careful attention to accuracy needs to be maintained. A comment on a recent article's use of the lack of reflection responses to indicate poor self-esteem for incest victims is offered.     

Factors Assisting Female Clients' Disclosure of Incest During Counseling

The purpose of this study was to explore specific behaviors and characteristics of counselors that relate to adult, female clients' disclosure of incest during counseling. A total of 37 female incest victims who had sought counseling within the previous 3 years completed the study. Information about disclosure of incest during counseling and perceptions of counselors' characteristics and reactions were gathered by a structured interview and the modified Barrett-Lennard Relationship Inventory. Results suggest that factors related to initial disclosure and exploration of incest are client readiness, direct questioning by the counselor, specific counselor characteristics, and positive counselor reactions to initial disclosure. Guidelines for assisting clients' disclosure of incest are presented.     

Politicizing Survivors of Incest and Sexual Abuse

Abstract

As both a feminist therapist and a survivor of incest, moving myself beyond therapeutic issues into an area of public education has been crucial to my own healing process. Receiving positive responses to my workshops and discussion groups, it became apparent that using a similar approach with clients who were survivors might be beneficial to their healing. As a member of The Counseling Center for Women, a feminist therapy collective in Israel, I suggested we sponsor a public exhibition and a series of programs of the topic of incest and abuse. The Municipality of Tel Aviv was approached to be its governmental sponsor. Entitled “Silent No More,” the program moved therapists and clients from working in the privacy of therapy to a public forum. What began as an uncomplicated educational program became an emotional process and a politicizing of individuals to help others as well as themselves. Moving from a feeling of shame to a sense of empowerment, the exhibition gave us a new sense of self-esteem and strength in our own abilities and our recovery process.     

No-harm contracts: a review of what we know

Few events in the practice of a mental health clinician can be as devastating as the suicide of a client. Although suicide is a rare occurrence, clinicians face assessment of clients' risk for harming themselves on a regular basis. One well-accepted and widely practiced intervention for suicidal ideation is the use of no-harm contracts (NHC), although opinions about NHCs range from enthusiasm to apathy. The existing research does not support the use of such contracts as a method for preventing suicide, nor for protecting clinicians from malpractice litigation in the event of a client suicide.     

Brief Behavioral Activation Treatment for Depressed Adolescents Delivered by Nonspecialist Clinicians: A Case Illustration

Behavioral activation (BA) can be as effective as cognitive-behavioral therapy for the treatment of depression in adults, but to date there is little research with adolescents. This is problematic given the recognized need to increase access to evidence-based interventions for depression in young people. We have developed a new adaptation of brief Behavioral Activation (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011) specifically for young people: Brief BA for depressed adolescents. In this paper, we use a case example with session-by-session measurement to show how a nonspecialist clinician can deliver this intervention successfully. We discuss the key themes arising from this training case, challenges the clinician faced, and how these were managed through training and supervision.     

Characteristics of male partners of adult female incest survivors

The interpersonal style of male partners of adult female incest survivors was investigated. Two groups of men (partners of incest survivors, n=30; and a control group, n=30) completed the Narcissistic Personality Inventory and the Depressive Experiences Questionnaire. A multivariate analysis of variance failed to support clinically-based hypotheses (a) that partners of incest survivors would exhibit a greater sense of entitlement in interpersonal relationships and (b) that a larger number of men abused in childhood would be in relationship with incest survivors than those not abused. Results point to a need for further controlled quantitative studies of the characteristics of male partners of female incest survivors. This article is based on the Master's Thesis of the first author submitted to the Graduate School of Texas Woman's University.