Systemic Treatment Of Incest

A Therapeutic Handbook

Terry Trepper, Mary Jo Barrett

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134850297
• Edition: 1
• Topic: Psychology
• Subtopic: Human Sexuality in Psychology
• Index: Psychology

Systemic Treatment of Incest is the first book to take as its primary focus the treatment of incest families. The authors, who have spent a total of 25 years working with incest families, believe that therapy can succeed in halting the abuse without dissolving the family unit. The volume's three sections are based on the authors' three stages of therapy: creating a context for change; challenging behaviors, expanding alternatives; and consolidation.

First published in 1990. Routledge is an imprint of Taylor & Francis, an informa company.

1

Introduction

INCESTUOUS ABUSE AS PSYCHOSOCIAL STRESS

It is self-evident that ongoing incestuous abuse is both a psychosocial stressor and a result of psychosocial stress. Few family problems cause as much disruption and negative consequences for all as intrafamily child sexual abuse. While sex can be one of the closest ways people bond with one another, within a family it can result in chaos. Parent-child sexuality is one of the only universal taboos among world cultures, indicating that there is something inherent in the family relationship which can be devastated by the sexual crossing of generational boundaries.

The Extent of the Problem

It has proven most difficult to accurately estimate the incidence (the number of incestuous cases that have occurred over a period of time) and prevalence (the number of people who have been victims during their lives) of incestuous abuse. Estimates have risen from one child in a million during the 1950s (Weinberg, 1955) to one in three in the 1980s (Herman & Hirschman, 1981). There are many reasons why it is difficult to obtain accurate estimates. These include difficulties in defining incestuous abuse; the problems inherent in obtaining accurate information from clinical samples in retrospective studies; and the potential nonrepresentativeness of samples of families who have come to the attention of the authorities.

In general, we can summarize the extent of the problem as follows:

1. Sibling incest is probably the most common form of incestuous activity, although it is not always abusive (see definitions below) (Finkelhor, 1980b; Kempe & Kempe, 1984).

2. Father-daughter and stepfather-stepdaughter incest accounts for three-fourths of all reported cases of incestuous abuse (Kempe & Kempe, 1984), although only between 1% and 5% of the general population of women were incestuously abused by their fathers (Finkelhor, 1980a; Russell, 1986).

3. Sexual abuse is five times more likely in reconstituted families (Finkelhor, 1980a), and 17% of adult women raised by a stepfather in their first 14 years of life are sexually abused by him before the age of 14 (Russell, 1986).

4. Although it is less common, father-son, mother-son, and mother-daughter incest are being reported in increasing numbers (Chasnoff et al., 1986; Dixon, Arnold, & Calestro, 1978).

5. Some suggest that the large increases in reports of intrafamily child sexual abuse may be more a perception resulting from increased media attention (Bullough, 1985); however, recent evidence suggests that the incidence of incestuous abuse may have more than quadrupled since the turn of the century (Russell, 1986).

Although there is much diversity in estimates of the incidence and prevalence, and some disagreement whether there are more actual cases or not, what is clear is that incestuous abuse is not an uncommon occurrence and is, in fact, a large part of a great many families’ life experience. Therapists should not be among those who view incestuous abuse as a rare and relatively unimportant phenomenon.

Effect on Individuals and Families

Most clinicians justify therapy for incest victims and families based on the assumption that incest leads to long-term psychological and family problems. While this contention is intuitive, the empirical evidence is not overwhelming (Constantine, 1981; Henderson, 1983). There have unfortunately only been a handful of studies attempting to examine the consequences of incest, and many of these have serious methodological flaws (cf. Scott & Stone, 1986).

What we do know about the effects of incestuous abuse on individuals and families can be summarized as follows:

1. Severe psychopathology for victims. Although somewhat counterintuitive, most incest victims are not severely psychologically impaired in adulthood (Gagnon, 1965; Meiselman, 1978; Owens, 1984; Tsai, Summers, & Edgar, 1979). This does not mean that many women's lives are not devastated by the experience; only that the assumption that severe psychopathology will be present in an adult “survivor” cannot be made without further assessment. Not surprisingly, studies using clinical samples are more likely to find psychological problems than those using nonclinical samples.

2. Negative perception of the experience. Most adult women incest “survivors” report the experience being negative and traumatic (Herman, Russell, & Trocki, 1986; Russell, 1986), and only a tiny fraction report the experience being positive (Russell, 1986).

3. Common long-term effects. The most common negative long-term effect for women is a response-inhibiting sexual dysfunction (Becker et al., 1984). Other commonly cited effects include low self-esteem, a tendency to use denial as a defense mechanism, and difficulty developing close interpersonal relationships, especially with men (Owens, 1984). Of course, individual clinical manifestations may be far more serious, including borderline personality disorder and psychosis (Barnard & Hirsch, 1985).

4. Factors relating to the severity of long-term effects. The more “sexual” the abuse, the more physical abuse associated with it, and the closer the relationship (i.e., if the offender is the father versus an uncle) all correlate with increased likelihood of long-term negative consequences (Russell, 1986). These negative effects can be mediated by their emotional and cognitive responses at the time of the incident (Tsai, Summers, & Edgar, 1979) or, ironically, by the presence of a supportive family during this period (Fromuth, 1986).

5. Effects on the rest of the family. Although thorough empirical studies on the long-term effects of incest on the family have not been done, clinical experience has shown that incestuous families suffer inexplicable pain and suffering as a result of the incest and/or its discovery. Nonoffending mothers may feel guilt, shame, anger, and mistrust; nonabused siblings feel shame, anger, fear of the offending parent, and can even display jealous feelings for the “special” relationship that has developed between the offending parent and the victim. The family system as a whole displays secretiveness, denial, a withdrawing into itself, increased coercion among its members to “keep the secret,” and individual members often begin to display behavioral symptoms such as acting out and substance abuse.

Effects on the Therapist

A not well-documented but important concern is the stress experienced by most therapists working with incestuous families. Although therapy is a stressful business in general, “abuse therapists” experience problems specific to this field which, if unaddressed, can lead to rapid “burnout.”

Training. A common complaint among therapists working with incest families is their lack of formal training to deal with the complexities of incest (Dietz & Craft, 1980). In our view, a successful incest therapist is one who feels comfortable dealing with incestuous families; is well trained in individual and family therapy theory and techniques; has special training in human sexuality and treatment of sexual disorders; has had formal coursework in family abuse and violence; and, of course, has had training and supervision specifically in the treatment of incestuous abuse. While these would seem minimum requirements for any other “specialty” area, they are almost utopian expectations for incest treatment today. However, without such training, therapists are certain to become quickly overwhelmed and frustrated.

Support of agencies. Although there are a few specialized incest treatment programs around the country (e.g., Giaretto, 1982), most services are provided by therapists within agency settings. The problems inherent in mental health service delivery, such as relatively low pay, large case loads, unrealistic administrative requirements, and so forth, are exacerbated when treating incestuous families. We have known agencies where over 30 abuse cases were seen in a week by individual therapists; where individual case files and notes for every member had to be taken after each family session; where the many extra hours spent in contact with welfare, court, and school personnel for each case were not counted toward the therapist's work load; and even an agency where the therapist was not permitted to continue treatment beyond 12 sessions under any circumstances, even if the cessation of continued abuse could not be guaranteed!

Values of the therapist. Few areas are as emotion-laden as incest and incestuous abuse. The most powerful of the sexual taboos has been broken: incest and having sex with children (and in the case of father-son, uncle-nephew, etc., the homosexuality taboo). Therapists, being human, are subject to the same strong emotional reaction to the breaking of these taboos as other people; however, therapists are expected to go beyond these feelings and in an unbiased way “treat” people they may despise. Unless therapists can come to terms with their own values associated with incestuous abuse, they may be unable to effectively treat incest families; worse yet, they may unconsciously “abuse” the clients by acting out their own unresolved hostilities (Trepper & Traicoff, 1983). We would suggest that part of the training for abuse therapists be a formal values-clarification process dealing with feelings about sexual abuse and family sexuality.

Therapists who were abused. Although an underresearched area, it is well known by those of us working in the field that a good many “abuse therapists” grew up in incestuous families and were the victims of sexual abuse. Those therapists who have experienced such abuse and successfully worked it through can provide a deep and empathic feeling for these families, have much to offer from their own experience, and can make some of the finest therapists. At the same time, those who have not worked through their own abuse or do not acknowledge the “interface issues” with the families may render themselves ineffective. Because of the potentially high number of therapists for which this may apply, we think it is essential for programs treating incestuous families to carefully screen therapists for those who were abused and may want to be abuse therapists to resolve their own family experiences. Therapy for the therapist may be an appropriate alternative.

Resistant families. Resistance to therapy, while an extremely common occurrence, still provides therapists with a great deal of stress. Incestuous families are notoriously resistant for a variety of reasons. And although the first stage of our treatment program deals specifically with managing such resistance, therapists who are particularly susceptible to stress associated with resistance may wish to reexamine their desire to work with abusing families.

BELIEF SYSTEMS

One of the first tasks we ask of our families is to consider their belief system surrounding sexual abuse. We contend that our underlying belief systems contribute to our behavior, if not in a one-to-one relationship then at least concomitantly. For example, we discuss with families how a belief system that tolerates the subjugation of women and children is an important contributing factor to sexual abuse. In training our therapists to work with incest families, we also ask them to consider their belief systems about incest families.

Thus one of the first tasks for therapists reading this book is to evaluate their belief systems, values, and feelings about incest families. To do this will help identify those values and attitudes that may impede effective therapy, allowing the therapist to obtain additional training and supervision, or to make the decision not to treat incest families at all.

To help the therapist accomplish this self-evaluation, we will describe 10 commonly held beliefs about incest and incest therapy. These beliefs, although not all-encompassing, are examples of widely held views. Next, we will present the therapeutic ramifications of each of these beliefs. Finally, because we feel it is essential that the reader knows the values underlying our treatment model, we will present our view of each belief and how it impacts our therapy with incest families.

Ten Commonly Held Beliefs

There are regional and cultural predispositions to incest. A common belief exists that certain regions of the country and subcultural groups are more prone to incest than others. For example, many have heard the jokes about Appalachian families. Inherent in these jokes is the acceptance of the stereotype that Southeastern mountain families are more prone to incest than the rest of us. We have also heard the same said for blacks, hispanics, the poor, rural families, and so on. Unfortunately, at this time we do not have adequate or reliable reporting systems available to accurately gauge if there are indeed these predispositions. For example, it is well known that reported child abuse is a mostly lower-class phenomenon; however, many therapists agree this is as much an artifact of the social service and mental health delivery systems as it is a reflection of truth (Finkelhor, 1984). Given the fact that all states in the country report increasing numbers of abuse cases from both rural and urban, poor and rich, black and white, it appears that the existence of a great incest haven is totally illusory.

Many therapists inadvertently accept the subcultural stereotypes of incest families. This leads to surprise, and sometimes disgust, when families present who do not fit into these categories. We have heard of a therapist who told a “pillar-of-the-community family” that had been referred because of incestuous abuse that she “could expect that from the families from____________(a local community of transplanted Southern families) but not from here!” Of course, this type of stereotyping is clinically inappropriate and may ultimately impede her ability to work with incest families.

We feel there may be societal, community, and even larger cultural influences on families vis-a-vis their attitudes toward sexual abuse that may increase their vulnerability to incest, but these must be understood for each individual family and community. Of course, being from a community which is more tolerant of incest does not mean the family from that community accepts those values. And certainly, there is no evidence that being from a specific region of the United States makes a family more incestuous than any others.

2. Parents who have sex with their children are more emotionally disturbed than most people. This is the therapeutic variation of the popular view that incestuous parents are evil, deranged, morally decadent, and so on. As will be discussed in Chapter 6, it is not at all a given that incestuous parents are more diagnosably disordered than other parents of families who present for outpatient counseling (Meiselman, 1978). It is rare, for example, to find offending parents to be psychotic or to exhibit any other serious psychopathology. In fact, therapists new to working with incest families are consistently surprised at the apparent “normalcy” of the individuals involved. Still, some argue that the incestuous behavior itself is ipso facto evidence of psychological disturbance, and that if DSM-III-R (APA, 1987) does not have incestuous behavior as a diagnosis, future revisions certainly should.

We have found that, although most offending parents do not easily fit into DSM diagnostic categories, some important intrapsychic and emotional patterns exist for many of the fathers. To assume them to be “crazy” is not particularly useful; however, to individually assess them on a wide range of possible intrapsychic and interpersonal dimensions is essential. At the same time, we remain cognizant that sometimes diagnosis is just the clinical way of chastizing. “He's sick” is not really very different from “He's evil.” We prefer to understand the whole, complete individual and the complex of feelings, behaviors, attitudes, and social interactions he displays under varying circumstances. A diagnosis of “He's sick!” is easier, but ultimately not useful clinically.

3. Most incest perpetrators were themselves victims. It is widely held that abused children, both physically and sexually, are likely to themselves become abusing parents. It turns out that this is simply not true. The best estimate made so far is that there is an approximately 30% intergenerational transmission rate for abuse (Kaufman & Zigler, 1987). This means that approximately two-thirds of abused children will not be expected to abuse their children. Further, there appear to be important mediating factors that can reduce the likelihood of the intergenerational abuse, such as family love and support, the family's ability to reduce stress, and an awareness of their own potential for abuse (Kaufman & Zigler, 1987).

An important ramification of acceptance of this myth is that therapists will view the daughter as an almost inevitable abuser in the future (or, a variation we have heard, she will certainly marry a...

Table of contents

• Front Cover
• Half Title
• Brunner/Mazel Psychosocial Stress Series
• Title Page
• Copyright
• Dedication
• Contents
• Editorial Note by Charles R. Figley, Ph.D
• Preface
• Acknowledgments
• 1. Introduction
• 2. The Multiple Systems Model
• Section I
• Section II
• Section III
• Appendix: Purdue Sex History Form (Karen Lee Fontaine)
• Bibliography
• Name Index
• Subject Index