IPT Book Reviews

Title: Child Sexual Abuse: The Initial Effects  Positive Review Positive Review
Authors: Beverly Gomes-Schwartz, Jonathan M. Horowitz, and Albert P. Cardarelli
Publisher: Sage Publications, Inc. 1990

Sage Publications, Inc.
2111 West Hillcrest Drive
Newbury Park, California 91320
$36.00 (c) / $17.95 (p)
  

Description:

This 205 page book is the report of the research program by the Family Crisis Program (FCP) for Sexually Abused Children at Tufts New England Medical Center in Boston.  This research, which was funded by the Office of Juvenile Justice and Delinquency Prevention, had the purpose of providing services to sexual abuse victims and their families while conducting research on 1) the characteristics of sexually abused children, their families, and social environment; 2) the nature of the sexual acts these children experienced and the events that transpired following the disclosure of the abuse; and 3) the effects of the total experience upon the child and his or her family.

Between July 1980 and January 1982, 314 children were referred to the FCP for services.  Of this initial group, 156 were judged appropriate and comprised the research sample.  The researchers attempted to conduct a responsible and useful study.  They tried to recruit a demographically diverse and representative sample, used a variety of measures, many standardized with norms and test validation data, and did an 18-month follow-up.

The book consists of seven chapters describing the project and the results, with appendices containing the data analyses.  The literature on the effects of sexual abuse is briefly reviewed, and the authors point out when their results confirm or fail to support popular theories and beliefs.
  

Discussion:

The research team attempted to screen out false allegations, which is an improvement over studies in which the sole criterion is substantiation by social services.  The original 314 clients had been handled by some other agency before referral to FCP, so the most obvious cases of false allegations were screened out.  Out of this group, 115 were not seen at all, either because they were not appropriate, were referred elsewhere, or because the family refused services.  (Of the families who refused services, 42 did so because they denied that abuse had taken place or that they needed any services.)  Of the 181 children evaluated, abuse could not be substantiated for 25 (14%) after a very thorough evaluation (16 of these were judged to be false and on the other 9 a determination could not be made).  This left a sample of 156 for whom the research team believed sexual abuse was highly likely.

The clinical literature suggests that childhood sexual abuse is invariably traumatic and causes a wide variety of psychological and behavioral problems.  This belief often results in an immediate referral for therapy, sometimes even before the abuse is substantiated or before a careful assessment is done.  However, this literature is characterized by an absence of good research and empirical data.  In contrast, the FCP study is one of the first to use standardized measures with comparisons to general population norms.  Its results and conclusions, therefore, are important and should be considered carefully.

Several of the findings in the FCP project failed to support common beliefs about sexual abuse.  Only 27% of the total sample showed clinically significant psychopathology.  This varied according to the age of the child with 17% of the preschool children, 40% of the 7 to 13 year olds, and 8% of the adolescents designated as seriously disturbed.  The effects ranged from the complete absence of symptoms to pervasive and serious problems.

The authors note that it is impossible to determine exactly how much of the disturbance could be attributed to the sexual abuse since many of the children came from families with multiple problems.  Also, disruption from the disclosure is likely to have added to any trauma experienced by the children.

Evaluations at both intake and follow-up indicated that children who were removed from home because of the abuse were more distressed than those who remained.  Although this may partially be interpreted as suggesting that the more seriously disturbed children were more likely to be removed, this finding raises questions about the frequent choice to remove a child from home when sexual abuse is disclosed.  Child protection services were perceived by families as harmful more often than any other agency involved.  The authors recommend that the child be removed only when absolutely necessary to ensure personal safety.

Another finding which contradicts the common belief is "The Myth of the Mother as 'Accomplice' to Child Sexual Abuse" (Chapter 6).  The literature consistently pictures the mothers of abuse victims as emotionally limited women who respond poorly when confronted with abuse allegations.  They are seen as colluding with the offender and are portrayed as the true culprits when their children are sexually abused.  Protective service workers maintain this belief, which can lead to inappropriate and harmful interventions when mothers show the slightest tendency to deny the allegations.

However, FCP found that most of the mothers responded appropriately to the disclosure.  Most (90%) demonstrated concern for the child and more than 80% took action to protect the child.  The majority did not have serious emotional problems.  Although some fit the stereotype, it was the minority of those in the sample.

Although most service providers maintain that intervention is necessary and counseling the victimized child and the family reduces distress, the findings on this are not clear.  Most of the children showed improvement in behavioral disturbance and self-esteem at the follow-up, but a no-treatment control group was not included.  Also, some of the children received further therapy elsewhere after completing the FCP.  The authors recommend some type of immediate intervention but state that with a young child who shows few overt symptoms, repetitive probing into the details of the sexual experience should be avoided.

An unexpected finding was the high percentage of cases (55%) in which the aggressor used some sort of threat or aggression to gain the child's compliance.  This challenges the notion that most sexual abuse involves gentle seduction.  The most striking finding, according to the authors, was that family members are just as likely to resort to violence as are unrelated offenders.

This is an important study, although there are shortcomings, acknowledged by the authors.  There are no control groups and it is not possible to draw firm conclusions about cause and effect from the correlational data.  There is little information about fathers.  Nevertheless, the research is a great improvement over the literature which has been based on clinical observations and case studies and retrospective studies of adults who seek therapy or answer surveys.

This book is worth reading.

Reviewed by Hollida Wakefield.

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