|| Treatment and Prevention of Childhood Sexual abuse: A Child-Generated Model
|| Sandra A. Burkhardt and Anthony F. Rotatori
|| Taylor & Francis, ©1995
Taylor & Francis
1900 Frost Road, Suite 101
Bristol, PA 19007-1598
The goal of this 166-page book by two clinical psychologists is to present a practice-oriented model of intervention for sexually abused children. It takes the approach that a successful intervention strategy is based on information generated by the child as opposed to traditional approaches where the treatment is based on information coming from adults. The authors believe it is essential to understand sexual abuse from the child's perspective. The intervention model is based on research for Sandra Burkhardt's master's thesis and doctoral dissertation.
After presenting an overview of topics related to childhood sexual abuse and addressing the possible developmental factors that make children vulnerable, the authors discuss the social reasoning research by Burkhardt and the implications of children's reasoning about adults. Next, they discuss different types of perpetrators and how children respond to them. The authors then describe their child-generated intervention model. The last chapter deals with the assessment of the child in situations of alleged sexual abuse. The book has 8 pages of references and a short index.
The treatment approach evolves out of Burkhardt's study of social reasoning in children, which was based on child interviews. The interview questions were designed to investigate the child's understanding of parental authority, obedience, punishment, and parent-child conflict. The purpose was to investigate the possible association between social reasoning and
vulnerability to childhood sexual abuse. This information was then used to develop the techniques for prevention and treatment of sexual abuse. The methodology and results of the study are described in detail and several transcripts of the interviews about perpetrators are included.
The authors draw conclusions from the research and note that prevention programs must build on children's natural reasoning abilities in teaching responses to perpetrators. They also realize that protecting children is the responsibility of adults, because there are limits to children's abilities to protect themselves. In treating a sexually abused child, the authors stress the importance of considering children's reasoning about perpetrators.
In the chapter on assessment of child sexual abuse, the authors give recommendations about collecting data for the initial evaluation of a child who has been alleged to have been abused. Although they stress the necessity to remain objective towards all parties, the accused is termed
"the abuser" and the authors state that only 2% to 8% of allegations are false. One table on physical signs and symptoms is from a 1988 article that includes some of the nonspecific physical signs that have been falsified by current research as well as behavioral indicators that are no longer accepted by any knowledgeable professional. Another table contains a wide variety of behavioral, emotional, and physical
"indicators of sexual abuse."
Suggested questions to ask during the physical examination come from Bass and Davis' The Courage to Heal
()() and are highly leading, including asking the child if she was forced to take part in ritual abuse. Anatomical dolls are recommended without reservation and empirically-unsupported suggestions about interpreting drawings are given. There are no cautions about leading and coercive interviews and none of the current and important research addressing this is mentioned.
In conclusion, research described in the book along with the emphasis on considering the child's social reasoning abilities and perceptions is useful but the section on assessment is outdated and misguided. Those interested in Burkhardt's research may want to read this book, but it is not recommended as a guide for evaluating and treating children.
Reviewed by Hollida Wakefield, Institute for Psychological Therapies.