Treating Incest

A Multiple Systems Perspective

Terry S Trepper, Mary Jo Barrett

• Éditeur: Routledge
• Année: 2014
• ISBN:
  9781317774136
• Édition: 1
• Sujet: Psicologia
• Sous-sujet: Psicologia in industrie e organizzazioni

This timely book provides for the therapist working with cases of intrafamily child sexual abuse both a theoretical background and practical information for the treatment of incest and gives new insight into the complex problems associated with incest. With the enactment of more stringent child abuse reporting laws nationwide and increased public education about the problem, there has been a dramatic increase in the need for incest-related psychotherapy. Treating Incest is an important source of information about the assessment and treatment of the family that will enable clinicians to provide appropriate crisis intervention for families and make informed judgments about referrals, if necessary. The book's central theme is that effective treatment of incest requires a systemic approach because incestuous activity is the product of a problematic family, rather than the cause. The book is divided into two helpful sections: assessment issues and treatment issues and techniques.

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PART I: CONCEPTUAL FRAMEWORK FOR THE ASSESSMENT OF INTRAFAMILY SEXUAL ABUSE

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Vulnerability to Incest: A Framework for Assessment

Terry S. Trepper
Mary Jo Barrett

One of the first tasks in the treatment of intrafamily child sexual abuse is the development of an appropriate assessment scheme by which a family can be evaluated. Without such a scheme, the therapist is unable to adequately assess the complex web of factors typically present in most incest families, nor develop an effective treatment plan.

The purpose of this paper is to present a conceptual framework for assessing the multiple dimensions of intrafamily sexual abuse. For our purposes, the term “intrafamily sexual abuse” is used interchangeably with “incest,” and refers to cases involving parent and child, or Step-parent and step-child sexuality. Also, unless otherwise noted, we will be referring to father and daughter or step-father and step-daughter incest, although we feel our assessment model applies to any sexual abuse within the nuclear family. We purposely limit our discussion to intrafamily sexuality because, practically speaking, these are the cases which by far present most often to clinicians working in the field, not because other forms of child sexual abuse are unimportant nor have a profound impact on the family. And although the assessment framework may be generalizable to extrafamilial sexual abuse, we feel that sex within the family, particularly parent-child, does indeed represent a “special case” of sexual abuse which needs to be studied in its own context.

VULNERABILITY: A FRAMEWORK FOR ASSESSING INTRAFAMILY SEXUAL ABUSE

The assessment model presented in the following pages, although not empirically based, is pragmatic in its approach. This model has been extremely useful in our combined work with hundreds of incest families over the last five years in the Chicago and Northwest Indiana area. Although it is primarily a guide for a focused assessment and treatment plan development, this framework may also be useful as a conceptual base for future research into the nature of intrafamily sexual abuse.

To develop our assessment model, we took into account two realities. First, previous unidimensional models have proven incomplete in explaining intrafamily sexual abuse (Tierney and Corwin, 1983; Conte, 1982). To assess only one dimension, for example the psychopathology of the perpetrator, would be at best incomplete. Second, there is a convergence by writers in the field upon similar descriptions of the factors contributing to incest. Even though many of these clinical descriptors are contradictory (cf. Renshaw, 1982), most likely each is seeing at least a partial component of the “cause” incest. That is, each of these descriptors are correct for some families at some time. Therefore, we wanted to build an assessment model which took all possible contributing factors into account in an organized fashion.

Some writers have recently hypothesized multiple factors contributing to the development of family physical abuse (e.g., Garbriano, 1977; Gelles, 1980; Straus, 1980), and family sexual abuse (e.g., Finkelhor, 1978; Tierney and Corwin, 1983). Our framework, however, is more akin to the vulnerability (Zubin and Spring, 1977; Gottschalk, 1983) or diathesis-stress (Rosenthal, 1971) models increasingly popular in the field of abnormal psychology. These models state that the goal of assessment should not be to isolate the one underlying cause of a disorder, but to identify how vulnerable a person or system is based on many possible contributing factors. At that point the likelihood of expression of the disorder based on the presence of precipitating situations may be more accurately assessed.

The underlying premise of our vulnerability model is as follows: There is no cause of intrafamily sexual abuse. Instead, all families are endowed with a degree of vulnerability based on individual, family, and environmental factors, which may express as incest if a precipitating event takes place and the family's coping skills are low. Although there are many possible factors contributing to a family's vulnerability, the factors described in the following section seems to encompass at least the most commonly hypothesized components.

VULNERABILITY FACTORS

Our model is utilized not only as assessment but also as an ongoing therapeutic tool. Initially, the clinician observes the individual, family, and dyadic interactions based on the vulnerability factors listed below. From these observations, the therapist develops a treatment plan that addresses each of the different factors and their influence upon each other. Interventions then are designed to interrupt the dysfunctional sequences that had previously been established within the family's context.

Family of Origin of Father and Mother

The family of origin of the perpetrator and spouse is viewed by many as contributing to the vulnerability of intrafamily sexual abuse. The parenting and marital styles in incestuous families are cyclical in nature, meaning that if a father or mother were an incest victim, or came from a family where incest occurred, there is an increased likelihood of incest in this family (Rosenfeld, 1979; Renshaw, 1982; Will, 1983). This happens even if surprisingly the abuse were violent or a frightening experience for the parent when it occurred. Other factors include the degree of emotional deprivation or neglect the parent experienced as a child, the expression of conditional love by his or her parents, and whether or not there was abandonment in their family, either actual or emotional (Justice and Justice, 1979; Meiselman, 1978).

During our individual diagnostic sessions, we ask specific direct questions about the parents' own family. These questions focus on the parents experience as children with respect their own abuse, the degree of emotional deprivation or abandonment (including the swings between this and overinvolvement), the expression of conditional love, the style of discipline, and the occurrence of physical abuse. We attempt whenever possible to corroborate the information by having sessions with the extended family.

Personality Factors of Family Members

In evaluating the individual and personality characteristics of the parents and child, we are actually assessing two aspects. First, we evaluate the personality characteristics or psychopathology that may have contributed to the occurrence and maintenance of the incestuous behavior. At the same time, we attempt to assess the impact of the sexual abuse on the individual's psychological functioning. For the father, these would include the degree of sociopathic characteristics, such as lack of impulse control, the need for immediate gratification, and lack of guilt (Summit and Kryso, 1978); the degree of dominance and aggressiveness (Herman and Herschman, 1981); the presence of sexual disorder, particularly secondary erectile dysfunction (Renshaw, 1982); and the need for constant love and adoration (Meiselman, 1978). Of course the presence of obvious psychopathology, such as psychosis, may contribute to vulnerability.

Because we view all members of the family as being involved at some level in intrafamily sexual abuse, we individually assess other family members besides the perpetrator. For the mother, we evaluate the degree of passivity, dependence, and poor self-esteem, along with possible sexual dysfunction such as inhibited sexual desire (Justice and Justice, 1978; Meiselman, 1978). For the daughter we evaluate the degree of passivity, dependence, and sociopathy. In no way, of course, do we suggest the daughter caused her own abuse; we instead are interested in the daughter's individual personality characteristics which may need to change to help ensure no further abuse takes place.

We use both objective and projective personality tests, along with clinical interviews, in our individual evaluations. The MMPI is used to provide information on possible psychopathology, such as sociopathy and depression, and general personality characteristics such as passivity, dependence, and introversion. The TAT is used to provide information on self-esteem, perceptions of role within the family, and need for and ability to provide nurturanee. Finally, the Purdue Sexuality Questionnaire¹ is used with the parents to obtain detailed information on sexual attitudes, behaviors, and possible dysfunctions.

Family System Factors

There are three levels of systemic functioning which is evaluated as possibly contributing to a family's vulnerability: family style, family structure, and communication patterns. Family style may be defined as pervasive and enduring patterns of interaction a family displays. Family structure refers to the organization of a family with regard to roles, hierarchies, rules, and power (Minuchin, 1974). Family communication patterns refers to the degree of the clarity and directness of various forms of communication, including verbal and non-verbal.

Family styles most vulnerable to incest have been outlined by Larson and Maddox (1984) and include the following: (1) Affection Seeking, which is characterized by a great amount of affection exchange, seduction, positive intent, and object connection; (2) Pansexual, characterized by oversexualization of their sexual patterns, where the family is closest when being sexual either openly or symbolically; (3) Hostile-Negative, which is characterized by a family pattern of displacing anger, a desire to hurt each other, and where anger and sexuality are paired; and (4) Violent Rape, where the entire family is organized toward violence, often paranoid, and with flimsy reality testing. Even though the second two styles are the most stereotypic, 94% of Larson and Maddox's population fall into the first two categories.

There are a variety of ways family therapists have conceptualized family structure. One model which we have found useful is Olson's Circumplex (see Figure 1), as it offers both a theoretical framework and assessment instruments with which to work (Olson et al., 1982). In this model two interacting dimensions, cohesion and adaptability, are used to describe family behavior. Cohesion assesses the degree to which family members are separated or connected emotionally to one another, and is displayed as a continuum from disengaged to enmeshed. Adaptability assesses the extent to which a family is flexible and adaptable to change, and is displayed on a continuum from rigid to chaotic.

Families most vulnerable to the development of incest can be present in any of the extreme ranges, but most often appear rigid and enmeshed or chaotic and enmeshed. In the former case, the family has a strict hierarchical nature, with inflexible rules and stereotypic sex roles; in the latter case, family rules change constantly, formal roles fluctuate so to become inappropriate, and the family, experiences a feeling of being leader less. In both cases, the family is isolated from or suspicious of others, looks to itself to satisfy individuals' emotional needs, and rallies when outsiders threaten the sanctity of the system.

A family structure classification more specific to intrafamily sexual abuse was developed by Barrett and her associates, and is based upon the structural family therapy model (Minuchin, 1974; 1981). Most clinicians have narrowly focused on the mother-daughter role reversal as the primary incongruent hierarchy that maintains incestuous relationships. Unfortunately, this view neglects many family hierarchical structures that also maintain and promote intrafamily sexual abuse. The following descriptions, shown in Figure 2, exemplify some of the most common family structures found in those vulnerable to incest:

Father Executive: This commonly seen structure shows the father as the executive in the system, and the daughter reversing roles with mother who is either emotionally or physically absent from the family. Mother may be seen as “one of the children,” but more commonly has withdrawn from the family emotionally. The daughter in this structure assumes the responsibilities heretofore provided by the mother, including child-care for younger siblings, and emotional and sexual closeness with her father. This structure occurs most often in families with dominant-aggressive fathers, with fairly rigid and stereotyped views of male-female relationships.

FIGURE 1. CIRCUMPLEX MODEL: SIXTEEN TYPES OF MARITAL AND FAMILY SYSTEMS

Mother Executive: This structure is most commonly found among step-families and paramours, although not exclusively. The mother is the sole executive, and the father finds himself functioning in many respects as one of the children; that is, has little parental responsibility, and in fact is “p...

Table des matières

• Cover
• Half Title
• The Journal of Psychotherapy & the Family Series
• Title Page
• Copyright Page
• Table of Contents
• Editors
• Acknowledgements
• Treating Incest: A Multiple Systems Perspective
• Editorial Note
• Introduction
• Part I: Conceptual Framework for The Assessment of Intrafamily Sexual Abuse
• Part II: Treatment of Intrafamily Sexual Abuse