IPT Book Reviews

Title: Protocols for the Sex-Abuse Evaluation
Author: Richard A. Gardner
Publisher: Creative Therapeutics, Inc., 1995

Creative Therapeutics, Inc.
155 County Road
Cresskill, NJ 07626-0317
(201) 567-8989
$40.00 (p)

In this 436-page book, Richard Gardner provides a systematic approach for differentiating between true and false allegations of sexual abuse. There are different criteria for evaluating the alleged child victim, the person accused, and the accuser. There are additional criteria for allegations involving females, belated memories, and extrafamilial abuse (day care centers, bus drivers, scout leaders, etc.). The criteria met are counted, but there is no cutoff score. The criteria are not presented as a "test," but rather as a systematic way to examine important factors in a case in order to make the most accurate decision possible. The book contains subject and author indexes and nine pages of references.

In his inimitable fashion, Gardner has again braved the uncertain and the ambiguous to speak with authority and clarity. Throughout the book, Gardner demonstrates his clear-headed compassion for children and adults. Compassion that is muddle-headed and fuzzy-thinking is worse than indifference or even hostility. Misplaced and misdirected compassion can do great damage when under the guise of beneficence which compounds the damage. None of that for Gardner. He understands that the first duty of compassion is to be accurate and responsible. This book is the fruit of his many years of attempting to sort through the claims, counterclaims, rhetoric, and posturing that surrounds allegations of sexual abuse.

In the process of aiming at greater accuracy of decision making, Gardner is not afraid to speak boldly about error, incompetence, folly, and self-proclaimed healers who may be well-intentioned but stupid. He describes a trial in which there was a videotape of an interrogator questioning a two-year-old child with anatomically-detailed dolls. The interrogator was stroking the penis of the doll in a masturbatory fashion while questioning the child about whether the alleged perpetrator had asked her to play with his penis in this way. Gardner played the tape for the judge and said: "Your honor, if you want to know about sexual molestation in this case, you are viewing it with your own eyes. This child is being sexually abused here by this validator. If a teacher or neighbor did this, that person would be brought up on charges, and probably reported to the child protection services. Yet this mother is voluntarily subjecting her child to this kind of sexual and emotional abuse" (p. 13). Throughout this book, when irresponsible behavior damaging to children is exposed, there is no hiding it under a cover of soft circumlocutions.

Gardner knows his work is often criticized for not being ". . . 'scientific' enough and that publication should await further confirmation in scientific studies" (p. 392). He lays claim to the basic position of the true clinician. "The problem is the courts cannot wait the 25 years or more it would take . . . Neither can people who have been accused of sex abuse wait for these results. Courtrooms need guidelines now and these protocols, I believe, can serve this need" (p. 392). This is the boldness engendered by true compassion and courage.

The clinician is always confronted with the reality that choices must be made with incomplete information. There is nothing reprehensible or unscientific about doing so. What is reprehensible is acting in the face of disconfirming evidence or negative evidence for the action taken. Horner, Guyer, and Kalter, (1993) have demonstrated that clinicians do not do much better than chance in making classification decisions about child sexual abuse. This suggests that the persons being unscientific are those making such decisions without attempting any systematic assessment approaches at all. Horner et al. also note that error is minimized by assuming innocence and no abuse.

The criticism that Dr. Gardner's work is not "scientific enough" is wrong. The United States Supreme Court (Daubert v. Merrell Dow, 1993) discusses what is scientific: "the focus, of course must be solely on principles and methodology, not on the conclusions they generate" (p. 2797). What is scientific is not determined by the opinions reached but rather by the process by which those opinions are attained. The principle of falsification and testability is the dispositive element to establish whether there is scientific knowledge. Science does not prove anything but can only disprove what is false. The crucial determinative fact is whether scientific methodology has been used.

Gardner states about his criteria: "These differentiating criteria are based on the principle that the best way to determine whether a child being evaluated has been sexually abused is to compare that child's behavior with (1) children who are known to be abused and (2) children who have provided false accusations. Basically, one wants to know whether the child being evaluated resembles more the genuinely abused child or the one who is promulgating a false accusation" (p. 53-54).

The large and completely credible body of scientific research in decision theory, across the last 40 years, shows that human beings are not very good at processing large amounts of information. We begin to use heuristics, or short cuts, and here the process breaks down rapidly to ever-decreasing validity. This is what causes clinicians to make their initial decisions within 30 seconds to three minutes of the first encounter. After this a large number of biases go into effect. The most serious one is the fact that, having made the initial decision, only confirming, supporting evidence is perceived. Any disconfirming data is ignored, not perceived, or disregarded. Gardner's procedure is a method which controls the way human beings inaccurately process data. It is a process that is understood to be a debiasing technique.

There are 50 years of research demonstrating that the process of observation, assessment, counting, and some form of weighting based on the counting is far superior to clinical interviews alone. There is no more solidly established fact in the science of psychology than this. Therefore, Gardner's procedures will decrease the level of error.

Any concern with improving accuracy of decision making means that Gardner's process must be given respect and acknowledgement. It can, of course, be improved. That is the nature of science. That is the reason for the great outpouring of scientific effort to do exactly the same thing Gardner is doing. One criticism of the book is that there is significant research accumulating on many of Gardner's factors and the book would have been improved by citing the relevant research in each section. This would allow the reader to better assess the strength of the research support for the various factors.

An important contribution is Gardner's concept of distinguishing between behavioral changes and trauma resulting from sexual abuse and what he terms "legal process/therapy" trauma. The latter refers to traumatic psychological reactions that children are likely to suffer after being subjected to stressful interviews and "therapy" in the process of the investigation. Gardner provides time line diagrams which will help the evaluator sort this out.

Anyone who want to improve the accuracy of clinical decisions can benefit from reading this book and adopting the procedure of asking questions dealing with the factors described in the book, keeping track, and delaying judgment until completing assessment of all the information available.

Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.

References

Daubert v. Merrell Dow Pharmaceuticals (1993, June). 61 U.S.L.W. 4805, 113 S Ct 2786.

Horner, T. M., Guyer, M. J., & Kalter, N. M. (1993). The biases of child sexual abuse experts: Believing is seeing. Bulletin of the American Academy of Psychiatry and the Law, 21(3), 281-292.

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