Transforming Trauma: A Guide to Understanding and Treating Adult Survivors of Child Sexual Abuse
Publication Year: 1995
Practitioners helping adult survivors of child sexual abuse need to be aware of the thought processes of offenders. The premise of Anna Salter's major book is that those who do not recognize an internalized perpetrator when they hear one will often be frustrated by the tenacity of the survivor's self blame. Primarily oriented towards treating adult survivors, this invaluable book will also be useful for treating sex offenders. It includes discussion of crucial issues such as: what clinicians who treat survivors need to know about sex offenders; the different ways sadistic and nonsadistic offenders think and the resulting different `footprints' they leave in the heads of survivors; how trauma affects survivors' world-views;
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: What Do We Know about Sex Offenders and What Does it Mean?
- Compulsivity and Repetitiveness
- Sex Offenders: Specialists or Generalists?
- Nonsexual Offenses
- Incest Offenders: Are They Really Sex Offenders?
- Age of Onset
- Who are They?
- Chapter 2: The Deviant Cycle
- Sexual Assault: Accident or Plan?
- Sexual Offending as an Addiction
- Components of the Deviant Cycle
- Thinking Errors
- Discussion and Implications for Clinicians and Survivors
- Chapter 3: Sadistic versus Nonsadistic Offenders and Their Effects on Victims
- Sadistic Offenders
- Chapter 4: Apology and Forgiveness in the Context of the Cycles of Adult Male Sex Offenders Who Abuse Children
- What Constitutes an Apology and What is its Intended Effect?
- Hopes often Expressed by Adult Survivors and Child Survivors of Abuse
- Hopes often Expressed by Offenders
- Hopes often Expressed by Therapists
- Are Positive Outcomes Realistic in the Context of Offending Cycles?
- Belief Systems Producing Continuous or Inhibited Cycles
- The Senses Cycle and Affective Flashbacks
- Themes Commonly Found in Apology Statements That Feed into Thinking Errors Implanted by the Offender during the Abuse
- Should Apology Be Linked to Forgiveness?
- When is an Apology Real and What Can Be Done to Increase the Chances of a Positive Outcome for the Adult Survivor?
- Timing in the Context of the Offender's Change Process
- Suggestions for Apology Sessions
- Conclusions and Ground Rules
- Chapter 5: Footprints on the Heart: Effects of Child Sexual Abuse on Emotions
- Historical Perspective
- Revictimization and its Relationship to Depression and Anxiety
- Etiology of Anxiety and Depression in Adult Survivors of Child Sexual Abuse
- Posttraumatic Stress Disorder
- Chapter 6: Sex Offenders in the Head: Effects of Child Sexual Abuse on Victim Thinking
- A Trauma-Based Worldview: Meaning, Malevolence, and Mastery
- Cognitive Distortions
- Chapter 7: Managing Chronic Pain
- Avoidant Techniques
- Medicating Pain
- Chapter 8: Links between Offenders and Victims: Summing up
- Chapter 9: Crossing Open Ground: Trauma and Transformation
- What is Therapy and What is Not?
- Live Affect
- Safety and the Therapeutic Relationship
- Telling the Tale
- Hearing the Tale
- Reducing and Managing Chronic Pain
[Page ii]For Corey
Copyright © 1995 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photo-copying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Library of Congress Cataloging-in-Publication Data
Salter, Anna C.
Transforming trauma : A guide to understanding and treating adult survivors of child sexual abuse / Anna C. Salter; with chapter by Hilary Eldridge and Jenny Still.
1. Adult child sexual abuse victims—Rehabilitation. 2. Child sexual abuse. 3. Child molesters. I. Title.
RC 569.5.A28S25 1995
This book is printed on acid-free paper.
06 07 10 9 8
Sage Production Editor: Tricia K. Bennett
Typesetter: Janelle LeMaster
Anna C. Salter's last book, Treating Child Sex Offenders and Victims: A Practical Guide, established her as an important thinker in the area of sex offender treatment. The popularity of that book (in its 12th printing at the time of this writing) reflected Dr. Salter's awareness of the need for practical, yet research-based information on the treatment of sexual abusers.
Those of us who know Anna often wondered, “What would happen if someone this bright and this open to complexity were to write on adult survivors?” It was a reasonable question, on one level, because Anna has worked with survivors for years. On another level, however, the question was unacceptable because we needed her where she was—writing and synthesizing knowledge on the treatment of one of society's most pressing social problems. I personally asked Anna on multiple occasions to write more on sex offenders, to continue to share her extensive knowledge base with the vast majority of clinicians who have contact with, but tend to undertreat, sex offenders.
Luckily for all of us, Anna ignored my (and, no doubt, others') request. She has written another book, but not a book on sexual abusers per se. Instead, she has applied her understanding of victims and perpetrators to produce a fascinating text on the treatment of adult sexual abuse survivors.
[Page x]This latest effort comes to us at an interesting time. Of late, our culture has become especially preoccupied with false accusations, false memories, and other issues that clearly deserve attention but that do not resolve the larger problem of child abuse and its effects. There appears to be a creeping, subtle question: What if most abuse reports are merely hysteria, or the products of badly done therapy? Because those adults who allege childhood sexual victimization often have psychological problems and attend therapy, how credible can they be? If it is true that children confuse fantasy and reality, how do we know anything really bad is even going on? If the media are right, and there are false memories of abuse everywhere, how many memories of abuse are true in the first place?
These questions reflect, in part, the fact that the primary source of information the public has about abuse is victims and survivors. Yet such “self-report” is subject to easy attack by those who seek to either protect themselves from a charge of sexual abuse or discount the likelihood of sexual abuse per se. In many cases, because there are no witnesses to child maltreatment other than the victim and the perpetrator, the final judgment may come down to who is more credible—an adult without obvious psychological dysfunction who mounts a convincing defense, or an accuser who is either very young or already suffering psychological effects?
There is, however, another source of information on whether abuse is common and likely to be deleterious to its victims. Beyond the reports of abuse victims or survivors, we have the voluminous and detailed admissions and confessions of convicted sex offenders. In my experience, no one who has listened to the stories of self-admitted pedophiles comes away from the experience unaffected. When faced with the actual incarnate source of the victim's pain, it is much harder to pretend (or assert) that sexual abuse is less than a tremendous evil. This second body of information directly informs the book before you.
Although we continue to struggle with a system that often works to deny the extent or importance of child abuse as a social problem, we continue to make progress on the clinical front. [Page xi]Books on the treatment of adults abused as children have become increasingly sophisticated and useful. There has been a growing recognition that therapy for child abuse trauma is not an entry-level activity but rather something that requires specialized training, supervised experience, and both intellectual and empathic resources. In this sense, the “backlash” has done us an inadvertent service: By challenging clinicians on so many fronts, it has forced us to examine our assumptions, question our techniques, monitor our peers, and challenge any complacency we might have developed. By exposing us to harsh evaluation, society's response to abuse-focused therapy and therapists has forced us to become better at what we do. Like the abuse survivors we serve, we are faced with the choice of folding up our tents and leaving (at the various levels in which that can occur), or capitalizing on the opportunity to become smarter and stronger. Although the jury is still out, my bet is on the latter.
It is from this complex system of therapeutic challenge, alienation, and growth that Anna Salter's new book emerges. Building on the insights of her last volume and her considerable clinical experience, Dr. Salter refines what we know and provides new tools and perspectives. This new book constantly acknowledges the micro and macro social environments in which the abuse occurred and the survivor lives, and incorporates this awareness into therapeutic theory and practice.
Most important, Dr. Salter moves us into important new areas by crossing the bridge between the experience of the victim and the psychology of the perpetrator. By tracking the ways in which the abuser's grooming of the victim, gratification of distorted needs, and abuse-justifying cognitive processes become imprinted on the victim, Dr. Salter helps us to understand aspects of the survivor's experience and injury that heretofore may have eluded us. By exposing us to the actual thinking processes of the repetitive sex offender, she reminds us that the work we do has its basis in almost unspeakable acts, rather than faddishness or the malevolent influence of self-help manuals.
Anna Salter reminds us of another world—the world of the sexual predator. This information is bound to be disconcerting, if [Page xii]not disheartening, to those who have not encountered this domain because it highlights the essential narcissism and willingness to harm of those who sexually abuse children. But this information is critical to the provision of abuse-focused therapy because it tells us why and how the survivor is traumatized. It is as if we have been treating oppressed expatriates of a foreign country without any understanding of what that country is, how its government works, or what impacts it has on its subjects. Dr. Salter offers us the travel guide, as much as we might not always want to read it.
In a field of several recent good books on understanding and treating sexual abuse survivors, Anna Salter offers something truly new. At times dispassionate and scientific, at other times impassioned and lyrical, Dr. Salter keeps the reader moving, if not on edge. As if challenging extant social forces that seemingly require conservatism in the face of adversity, she emphasizes the art as much as the science of therapy, and surprises us, in the end, with something akin to poetry. This is an important book, and our field is exceedingly lucky to have it.
With Transforming Trauma, Anna Salter establishes a milestone in the expanding consciousness of sexual victimization. By choosing to relate therapeutically with the offender as well as the victim, she provides the essential crossover viewpoint between victim/survivor experience and the impositions of the intruder. This book makes it clear that it is not enough to study one polar aspect of the victim-perpetrator syncytium. In fact, we can learn from Dr. Salter that the destinies of overpowering adult and annihilated infant are so intertwined that it is only an artificial intellectualization that teases them apart. Until now, we have dared look only at pieces of the victimization picture puzzle, like gathering corners, frames, and central clusters without risking the difficult moves that would integrate the several fragments into a coherent picture. Transforming Trauma puts these pieces together.
Human society, no less than the professionals in charge, and hardly different from the victims and offenders themselves, has depended on excuses and clever devices to scatter the pieces of the victimization agony into trivialized, tolerable shards. As the puzzlemaker dices a meaningful image into intriguingly shaped, potentially interlocking bits, so have all of us succeeded in atomizing the abuse experience. We have done this like a dissociating child, not in a conscious preference for ignorance but in the relentless avoidance of insufferable pain. An integrated consciousness [Page xiv]of victimization allows for a picture of conjoint human savagery and vulnerability that shatters civilized notions of a just and fair society. Such consciousness offends the conscience of all of us wise fools who are charged to address human nature and who have consistently missed the point. Child sexual abuse, in its partially recognized dimensions, is already an intolerable mote in the eye of an idealistic society. Framing those dimensions more coherently, as Anna Salter has so carefully and compassionately accomplished, will move some to understand, many to wonder, and some to retaliate.
Through most of this century, child sexual abuse was either simply ignored or elaborately reconstructed. Either it didn't really happen and all children tended to imagine it, or occasional miscreant kids followed their wishful thinking into seductive conquest. In that psychological wonderland the real experience of survivors and offenders alike was obscured by professional mythology. Both aspects of the myth were created and maintained not from a reflection of a child's vulnerability but through refraining by self-protective and empowered adults. By accepting the thinking errors of child predators, the wise elders cast the children as predators and liars, attractive nuisances capable of destroying the noble destiny of men with their siren song of irresistible innocence. With the “discovery” of parental child abuse and through the feminist revolution of the 1960s and 1970s, the picture was abruptly reframed: Children can't help it and adults are entirely answerable for any form of maltreatment. Unlike the gender parity assumed for other forms of child abuse, children became defined as daughters, and abusers were presumed to be fathers. The victim-perpetrator dichotomy defined by the protective service and rape crisis models left boy victims and nonfamily offenders in relative obscurity. Boy victims and their chicken hawk predators were the concern of vice cops. A corollary group of sexual exploitation and sex ring specialists was ignored and sometimes erased in the rush to concentrate on incest. Cracks appeared in the solidarity of the CPS-feminist efforts as one side pushed family reunification and treatment while the other demanded incarceration for father-rapists.
[Page xv]Even as sociologists and journalists succeeded in exposing the awful prevalence of child sexual abuse, there was no coherent interest in the demographics and ecology of an adult society populated by a substantial bloc of invisible survivors. Those survivors who chose to reveal themselves were defined by the mind-set of whatever service system they happened to select. In rape crisis centers, they were victims of crime who should empower themselves through collective protest and court reform. Strong women were welcome, but there was no audience for the inner voice of a helpless, hungry child. Traditional psychotherapeutic systems defined that hidden child as borderline character pathology. Twelve-step addiction programs and human potential groups defined “inner children” while pioneers in the treatment of dissociative disorders discovered “child alters.” The more exotic and complicated the concepts of dissociation and multiplicity became, the more such ideas were shunned by conservative psychiatrists and incest specialists alike. Senior psychiatrists labeled multiple personality as an iatrogenic fraud. Women's advocates resented the emergence of a “treatment industry” that turned victimized women into mental patients hugging teddy bears. But in all service sectors there was a common recognition of something unexpected: Many survivors had managed at some time not to know of their history of childhood trauma.
The foregoing summary is at risk of irresponsible stereotyping. It is presented in hopes of illustrating the conceptual chaos generated by the unexpected and fragmentary discovery of child sexual abuse. The explosive awareness was unanticipated but hardly unprecedented. It was the century-old censure of previous discoveries that had reinforced a preference for deliberate ignorance, or nescience. Real science, valid consciousness, and reasonable conscience, all of which are named after the root to know, are all distorted and misguided where they are infused with nescience, that which is proclaimed as unspeakable, officially not to be known.
Is it any wonder, then, that the painful experience of the victimized child has not yet achieved parity with the discomfort of adults who are forced to share it? Is it not important that the [Page xvi]child's voice is stifled both by an offender who hides from his own offending and a society that offends by hiding its own capacity for perversity? We are willing dupes for the blandishment of offenders: We have always welcomed their reasonable explanations and applauded the discretion of silent children.
As many of us are unprepared for the depth of our societal ignorance, so are we nonplussed by the entrenched power in society to punish impertinent knowledge. It should not be surprising that well-meaning professors and lab-bound researchers have joined with insulted parents to champion the preexisting backlash. They all denounce the therapeutic upstarts who treat recovered memories of abuse as real. We who once attacked the perpetrators of sexual abuse as the enemies of the people are now fair game as the greater enemy, accused of perpetrating an international hysteria in our relentless hunt for victims and for victim-related pathology.
In this topsy-turvy, Chicken Little gaggle of claims and counterclaims, accusations and counteraccusations, one fact should stand unquestioned: There is and always has been more power and credibility afforded to those who deny sexual abuse than to those who claim it is real and dangerous. And because sexual abuse is mostly a private, one-on-one contest of grotesquely unbalanced power, there is no “trustworthy” or “objective” testimony to prove beyond a reasonable doubt that it exists. We have advanced too many ideas among too many fields in too short a time to present a coherent diagnosis. And although the competing idealogues among survivor advocates abandon one another in search of their own peculiar truth, a wider diversity of more confident adults achieves an unlikely resonance in voicing a simple, kill-the-messenger solution: Banish the therapeutic upstarts who have coached the complaints.
Unlike an initiate, who may look at the cover to guide in the assembly of all the pieces in the picture puzzle box, society has never had access to the picture, only the pieces. Unlike the puzzlemaker, who prints both the fractured puzzle and the congruent solution, there is no trusted proprietor of the real design for sexual victimization. We have arrived at our different pictures by ignoring [Page xvii]the spaces within our partial solutions. Adult society as a whole stands in judgment against our errors without offering to help in bridging the obvious gaps.
Among all these divisive players and disillusioned observers, there is only one proprietor of the picture, only one group that has direct, experiential access to the solution. If anyone has seen the picture before cutting it apart, it is the cunning designers of the puzzle. Throughout history, a few adults have wreaked havoc among the whole of society to create a multitude of disenfranchised victims. This elite corps is not the mental health upstarts and not the feminist revolutionaries; it is the child molesters. They are the ones who know the picture and they are the ones who can obscure it, even from themselves. We could learn from offenders if we would only risk challenging our own prejudicial avoidance and deciphering their deliberate misconceptions.
In recent years, there has been a growing body of knowledge among offender therapists who have managed to work uphill against the wrath of victim advocates. Despite divided sympathies and mutual estrangement, some offender therapists and victim advocates have found rapprochement in daring to talk with one another and with their opposite clienteles. These crossover therapists propose a revisionist, more ambitious aggregation of our divergent views of the picture: Neither the offender nor the victim has an objective, fly-on-the-wall view of the victimization process. The offender brings an idealized, self-fulfilling prophecy to the encounter with a preselected, noncomplaining victim. The child becomes something of a partner by incorporating the intruder's deceptive scenario. Just as there is no fingerprint definition of the typical pedophile, there is no single portrait to identify the victim. To understand the misconceptions and the assaulted identity of the victim/survivor, we must recognize the footprints on the soul that are the stamp of the misguided trespasser.
Anna Salter is one of those intrepid crossover therapists. Although she has no protective sympathy for the acts of the child molester, she achieves a painful awareness of the chimerical complexity of their self-fulfilling drives. She has confronted and defined the chimera of abuse through her gut-wrenching therapeutic [Page xviii]immersion in the life experience of every sort of victim and offender. She has also tasted and spit back the wrath of the backlash in a courtroom assault on her professional integrity.
At this point in our recent and troubled history, no one can or should claim to be the universal and undisputed custodian of the truth. We have no right to presume that the FMS Foundation consists mainly of false deniers any more than that organization can brand all recovered memories as false. Such presumptions are not scientific, merely mutually antagonistic, and the smoke of that battle can only help the real child predators to maintain their cover in both camps.
The only way to escape the smoke is to rise above it in the persistent search for objective truth. The many colors of our partial enlightenment must be integrated into a coherent outlook. The spectrum of credibility and the dividing line between deceiver and deceived have never been more indistinct nor more deliberately blurred.
Dr. Salter has sought to look at every visible shade of the spectrum and to illumine the imposing shadows. If there are many colors of light in the spectrum of science, there is a greater complexity of darkness hiding in the blind spot of our continuing nescience.
Transforming Trauma is aptly named. By taking us into the dark side of offenders, beyond our bright, collective idealism, and by acknowledging the footprints such offenses leave on the untrammeled innocence of children and on our own wishful naïveté, Dr. Salter helps transform murky and unutterable horror into a source for enlightenment. By defining the smelter of entrapment, she forges new keys to release.
A backlash book of the moment condemns the treatment of trauma as the making of monsters. Transforming Trauma brings together exquisite clinical and scientific illustration to unmake the monsters each of us may have imagined. The proven child molesters are not so hideous and cunning that we dare not confront them. They are a ragtag band of opportunists who either can continue to hide in the deliberate ignorance they help to sustain or allow us to find the missing pieces that could blow their cover. [Page xix]Dr. Salter has opened the window to such enlightenment and widened the door to more effective, more empathic treatment of survivors and offenders alike. I hope the much-maligned “treatment industry” as well as the larger world of skeptical onlookers will be equally inspired by her efforts.[Page xx]
I would like to thank the following colleagues who graciously took the time to read and critique the manuscript: Ellen Bass, John Briere, Jon Conte, Laura Davis, Rob Freeman-Longo, Steven Kairys, Cynthia Monahon, Tony Morrison, Lloyd Sinclair, and Regina Yando. They are all busy and talented folk whose generosity with their time and expertise were gifts that strengthened this book.
I would like to especially thank Roland Summit, who, in the middle of a frantic schedule, read this manuscript carefully on planes and in motel rooms all the way to Hong Kong and sent back detailed, thoughtful notes on nearly every page. This book is immeasurably enriched by his clinical acumen.
I would like to express my appreciation to Andrew Garrod, who edited this book as well as my first. Andrew brought to the task not only a precise command of good English but an unusually good grasp of the subject matter. He also brought a high level of professionalism and dedication. This book is clearer and more gracefully written for his help.
I would like to thank the Bay Foundation, whose support at a crucial time was pivotal. In particular, I would like to thank Fred Bay, whose assistance with a variety of projects over the years has been singularly helpful.
I would like to thank my secretary, Judy MacNeil, a woman of many talents, who has been simultaneously secretary, research assistant, [Page xxii]travel agent, bookkeeper, and loving baby-sitter. In the midst of chaos, she is always calm, supportive, and warm.
I would like to thank Tumpale Kilindu, my research assistant, for her competence and her carefulness.
Finally, I would like to thank George Vaillant for his wisdom.
Epilogue: Thoughts on Survivors and Safety: An Essay[Page 303]
The propane torch swings in front of Deb's face, a metal penis spitting fire. “Are you afraid, bitch, are you afraid? How'd you like to get a taste of this, bitch?” He follows her, flicking it at her hair, her skin. The unsaid words follow her, too. She keeps recognition from her eyes, keeping them flat, slightly harried, a little distracted. She swings back to the ship's galley, waving the torch away, casually, dismissingly, and kneads the dough. “Biscuits,” she says just as silently, “I have biscuits to make, and now look at this silly interruption.” She glances at the clock, brushing her hair back with a floured hand. “Eleven o'clock already, and I barely finished breakfast.”
Nancy Lieberman rides the subway to Harlem to play pick-up ball. “Look at that white girl. Where you think she's going?”
“Looking for trouble, that's all I see. Looking for trouble.”
“Well, she's gonna find it. You go looking for trouble in this world, you're gonna find it.”
Nancy Lieberman clutches her basketball and stares at the gum wrapper on the dirty subway floor, barely glancing at the man nodding off next to her. Over and over she says to herself, [Page 304]weaving a shawl, a prayer, a litany, “Nobody's gonna mess with me. I've got basketball to play.”
Deb moves toward the torch wielder, a bold move. He backs up and she moves around him for more salt. Whose reality will win? Is she cowering victim, deliciously fearful prey? Is he a big, bad, scary rapist, or is he a little boy waiting for the best cook the ship ever had to feed him strawberry shortcake for lunch? A brother teasing a younger sister (“Just kidding, you know. No reason to get upset.”)? Or a rapist leaving his calling card? It is being decided now what will happen when the dinner dishes are done, and she walks through the halls, trailing her fingers on the warm metal walls, past the empty storeroom, as women everywhere walk every night. The torch flicks off. The answer is in.
She is 15 years old, a sophomore in high school. She has been set up by a local senior with a date, a college basketball star. She and her friend think God is on their side. He and his friend are southern polite to her parents, “A party at the beach. Yes, ma'am, back early. For sure. Eleven, no later.” But there are no other women at the party, just a motel room full of basketball players, one of whom is already down to his underwear.
Now, don't start screaming. You'll get hurt for sure. Figure it out, girl, figure it out. A walk on the beach, definitely a good idea. “No, I can't have sex with you. I'm a virgin. I don't have sex with anybody. No, I don't believe that's what my friend is doing right now.”
Keep it casual. Keep that shoulder-rolling-good-buddy-gait. She punches him on the arm, a kid's gesture, a male gesture. He quizzes her crossly. Is she really a virgin? He has qualms, it seems, about gang raping a virgin. Some combination works. It's decided. She and he collude. She's not feeling well, something she ate. They turn back. She and her friend are going home.
Only the very strong and the very weak can ignore camouflage. The grizzly rarely tries to melt into the scenery, and minnows live by luck alone. For the rest of us, it pays not to look like someone's idea of lunch, and sometimes, just sometimes, women get by by pretending it isn't lunchtime at all. Reality is a consensual experience, and every woman knows there are times that a gesture will define it. Was it the floured hand pushing back the [Page 305]errant strand of hair that rescued Deb? Was it Lieberman's rounded back hunched over the basketball? A woman doesn't sit like that, only some crazy basketball nut. Was it the punch in the shoulder or the male walk, that lurching forward, shoulder-rolling gait the teen mimicked that brought her safe to harbor? She didn't have the upper body mass to pull it off, but even a trace of that walk would register, without needing recognition by the conscious mind.
Women cling to that chance to define reality. “You could die,” I tell the battered woman in front of me. “You have to understand you could die.” “You don't understand, Anna,” she tells me. The moment I leave him he's a shadow outside my door.”
The naive and the hopeful will scoff. Call the police. Take out a restraining order. One woman did, against the battering husband who threatened to burn her family and their home if she stayed away. A few days later her parents' barn burned, killing all the animals. “No proof,” the police said. “Nothing we can do.” She moved back in. For women, safety is always relative, never absolute.
Where does safety lie? Wherever you know enough to survive. I am a safe woman on a basketball court, playing with men half a foot taller and twice my weight. I know how to block out for the rebound, how to brace for the pick I set. I know when to swing in front of a driving player and when to step aside and try to pick his pocket from behind. I know, too, who will go through me and who will go around. My powerful, quick, athletic ex-spouse dislocated his shoulder the first time he joined in.
Philippe Petit, the great French aerialist, is a safe man on a high wire.
He stretches out on his cable and contemplates the sky. There he gathers his strength, recovers the serenity he may have lost, regains his courage and his faith…. The cable is limpid. Your body is silent. Together, they are motionless. Only your leg quivers. You would like to cut it off, to turn your body into a single human wire. But already it no longer belongs to you, is no longer a part of you… you close your eyes and see only a magnificent gray wire. (Petit, 1985, pp. 69–70)
[Page 306]Sometimes, switch the frame ever so slightly and you're not safe at all. We were all nervous waiting for Momad, a group of novices waiting for a pro. When he arrived, he threw a practiced eye on all our gear, on the knots and the slings and the ropes and the pitons, checking them all with a glance, and moved off up the mountain like a ferret. No sooner had we reached him than he was off, leaving us scrambling to set up a belay, and hoping, dear God, he didn't fall before we were tied in. At the top, I asked how often he fell, given his speed. “No,” he said, “I fell once, and I didn't like it, so I never fell again.” I was dumbfounded. This was a world-class climber, a man in the record books for first ascents on this mountain and that.
But he later died while cleaning the inside of a huge vat, working as climbers often do on a high job, thinking he was safe. The sludge became dislodged and fell in an avalanche on a man who could tell an unsafe piton with a look, whether a harness was tied properly at a glance, whether an avalanche was brewing by ways he could not even name—the warmth of the sun on his face that day, the texture of the snow, the single rumbling sound easily discounted—but on a man who did not know the warning signs on the inside of a vat, who did not live with the texture of sludge, the changing temperatures inside a metal can.
And sometimes safety lies in a touch of grace, unowned. In therapy, one can sometimes hear these grace notes resounding across decades. My client's embezzling mother got caught, and the family, too proud to ask for help, never had heat and electricity at the same time again. This child lost 40 pounds that year and would have lost more, but for the teacher who needed her help at recess. “I hate to ask you, because I know you want to play. But I could really use some help erasing the boards, marking these papers.” Somehow, the money was always enough for lunch. My client was in her forties before she understood.
Does safety lie in being visible or invisible? Well, it depends. It has been hypothesized that shark attacks on surfers in California are triggered by the configuration that a paddling surfer makes when viewed from below, something alarmingly like a seal. Surfers would be better off looking like surfers, but then [Page 307]again, seals would be better off looking like surfers, too. For my client and her teacher, safety lay in the child being visible and not knowing it, beside a teacher dressed in camouflage. For the sexually abused 4-year-old whose father tells her how much she wants him to fuck her, safety will forever after lie in being visible, in being known, for when she was not, she got hurt. Let people project onto you, and God knows what will happen. Nothing good.
But for the child whose sadistic father closes the curtains when he sees her use the window to dissociate, to leave the abuse behind, safety will forever lie in camouflage, in invisibility. The mother of Henry C. Lucas, the serial killer, asked him as a small child if he loved the family mule. He said he did and so she got the shotgun and killed it. Whatever else that did to Henry Lucas, it also made him appreciate emotional invisibility. Let people know who you really are, what you really care about, and they will kill it. Where does safety lie?
I asked my adult survivors to imagine a safe place. I know they and I will be going into unsafe rooms with unsafe people, into spaces and times they lost memory rather than remember. “A safe place,” I say. “And we will use it for solace in the hard times.” And sometimes they look blank and I have to say, “Well, can you think of times, of places, of people where you felt a little less afraid?”
Sometimes they can, and in those spaces one can see where safety lies. A woman, raped at age 7 by a 14-year-old brother who kept telling her she was his girlfriend and supposed to like it, finds safety only as a catcher in a softball game—all those pads in front, a net in back, and all those people out there so everybody can see what is going on. So that's it. That's where safety lies, in being seen by one and all, in public places with strangers all around.
But another, forced as an elementary school child to choose which instrument her sadistic father would use to torture her while her mother tied her legs apart and held her hands, finds safety in the image of a tiny speck of a boat on an ocean thousands of miles across. No one could possibly know where she is, and if her father did, the water is so calm for hundreds of miles around [Page 308]that she could see him coming. She keeps high-powered rifles on board just in case. He knew her, you see. He knew what hurt her and he used that knowledge to make it worse. Ah, I see it now. Safety lies in not being seen, in being as close to nonexistent in the world as one can manage. Where does safety lie?
But safety must be more than not being starved or beaten or raped or killed, although for many it would be a start. Can one find safety in therapy? Certainly the therapist can. What could be better? Intimacy without risk, without even exposure, a high-intensity emotional connection wearing a safety harness. I stay firmly planted in my seat while my client skirts chasms, peers in black holes, tap dances on a high wire.
And what of safety for my client? If safety is invisibility, this man has surely found it in my office, for we have sat together six times and I have yet to see a glimpse of him. He watches me intently. A raised eyebrow alone is enough to steer him. Who do I want him to be? He's amenable. He brings in reading lists to show me his intelligence, his dedication, his sincerity. I am impressed. Why, then, won't I tell him what to do, who to be? In desperation he plays, he thinks, a high card. It would be easier, he says shyly, if his therapist weren't so feminine, so attractive. Actually, I say, I don't think it would make any difference at all.
He has not done the “stilling,” that great quieting of mind and spirit when one locks the door to one's house and faces the gorilla living there, when one lets go of the outside world, sits down at the kitchen table, and looks around. What do I have? What do I really have? The way the afternoon sun slants through the chair arms, the way the lily leans hard against the vase, this moment, this breath, this ragged hole in my heart, that one, where the edges flap so gently. These are what I have. He has not noticed the silence, how it rushes in when the talking stops. He has not stood his ground and stopped lurching for the phone, for another task, another event, another person—all fodder to stuff in that hole that only seems to grow the more it's filled. He has not stopped his hand in midclutch and just watched it, without judgment, without impatience, until the fingers slowly soften and let go. No, he has done no stilling.
[Page 309]He makes another run instead. “I was very surprised,” he says, “that you didn't tell me last time when I asked, that I was abused as a child. And when I questioned you whether my current relationship was love or addiction, you wouldn't say I'd like to take advantage of your expertise, you know.” And behind the aggressive fawning, I hear the anger curling at the edges of his voice. “Goddamn you, goddamn you,” he is saying. “Just tell me what you want. I can be it. I know I can.”
I must always disappoint. “Does it matter what you label it?” I say. “Whatever you call it, aren't you still left with the feelings?” I have leapt aside again, as I will each time he spins to face me, for I need to be so close beside him he cannot even see me. Is this man safe? Not here or anywhere. He thinks if he could just get hold of me, could grab my shirt and bury his head, he would be. But true safety for him is an eel of a therapist, and I am worn out from trying to be slippery.
But if he cannot find me, I cannot find him either. I am trying to find a radio station that won't tune in. I think if I hear his voice just once I will be able to recognize it, find it again, but in these many weeks, I haven't heard it once. Perhaps I am asking too much, I say. Perhaps I need to listen for a phrase, a word, a syllable that is his own. I listen harder—and stay poised to jump.
So what is safe in this world? Who is safe and who is not? Is a smiling man who is never angry safe? Hardly. Is someone who wants only to please you safe? You'll find him living in your skin. Beyond the lily leaning on the vase, it's a dicey world out there.
In the end, I think I know little of safety, after all—only 57 varieties of risk. But I catch glimpses of her now and then, in a woman's floured hand, a teacher's grace. She brings no fireworks when she comes, sets off no cannons. A mousy guest, she's not one to inspire a toast or draw a rave review: She comes as simply as the breaking of your last remembered fever, as gently as the covers that defined your childhood sleep. One thing's for sure, she's a fickle guest. A nomad, she can leave in the night with the sound of a ringing phone, or move out so slowly it takes years to figure out she's gone.
[Page 310]“Do you know what my plans are?” the client said. “I'm trying to string together as many days in a row, like beads on a string, in which nothing bad happens.” The days when nothing bad happens. Better yet, the days without fear that something bad will happen. Days our mousy guest resides. I dream of her. I've lost my taste, over the years, for the more theatrical guests.
Stay a while, I coax. String a few more beads. When you are here, “For a moment in the central of our being/The vivid transparence that you bring is peace” (Stevens, 1969, p. 380).1Note
1. From Collected Poems by Wallace Stevens. Copyright © 1942 by Wallace Stevens. Reprinted by permission of Alfred A. Knopf, Inc.
References[Page 311]1977). The components of rapists' sexual arousal. Archives of General Psychiatry, 34 (8), 895–903. http://dx.doi.org/10.1001/archpsyc.1977.01770200033002, , , & (1978). Differentiating sexual aggressiveness with penile measures. Criminal Justice and Behavior, 5(4), 315–332. http://dx.doi.org/10.1177/009385487800500404, , , & (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16(2), 153–168., , , , & (1984). The treatment of child molesters. Unpublished manuscript. (Available from G. G. Abel, Behavior Medicine Institute, 5790 Kingston Cross, Stone Mountain, GA 30087), , , , , & (1987). Self-reported sex crimes of nonincarcerated paraphiliacs. Journal of Interpersonal Violence, 2(1), 3–25. http://dx.doi.org/10.1177/088626087002001001, , , , , & (1981). Identifying dangerous child molesters. In R.Stuart (Ed.), Violent behavior: Social learning approaches to prediction, management, and treatment (pp. 116–137). New York: Brunner/Mazel., , , & ([Page 312]1985). Sexual offenders: Results of assessment and recommendations for treatment. In M. R.Ben-Aron, S. J.Huckle, & C. D.Webster (Eds.), Clinical criminology: The assessment and treatment of criminal behavior (pp. 191–205). Toronto: M & M Graphic Ltd., , & (1990). The nature and extent of sexual assault. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 9–21). New York: Plenum., & (1983). Sexual assault among adolescents. Lexington, MA: Lexington Books.(1985). A systems theory conceptualization of incest. Family Process, 24, 79–87. http://dx.doi.org/10.1111/j.1545-5300.1985.00079.x(1980). Young male prostitutes: A psychosocial study. Archives of Sexual Behavior, 9(5), 399–426. http://dx.doi.org/10.1007/BF02115941(1993). Dissociative experiences and disorders among women who identify themselves as sexual abuse survivors. Child Abuse & Neglect, 17(5), 677–686. http://dx.doi.org/10.1016/0145-2134%2893%2990088-M, , & (1984). Differential erection response patterns of sexual child abusers to stimuli describing activities with children. Behavior Therapy, 15(1), 71–83. http://dx.doi.org/10.1016/S0005-7894%2884%2980042-8, & (1991). Male adolescent sexual assaulters: Clinical observations. Journal of Interpersonal Violence, 6(4), 446–460. http://dx.doi.org/10.1177/088626091006004004, & (1984). Adult mental health sequels of child sexual abuse, physical abuse and neglect in maternally separated children. Canadian Journal of Community Mental Health, 3(1), 15–26., & (1986). Sexual abuse in childhood: Psychosocial outcomes and implications for social work practice. Journal of Social Work and Human Sexuality, 4, 33–47. http://dx.doi.org/10.1300/J291v04n01_07, & (1987). Juvenile prostitution and child sexual abuse: A controlled study. Canadian Journal of Community Mental Health, 6(1), 5–26., & (1990). Stimulus control of sexual arousal: Its role in sexual assault. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 115–142). New York: Plenum.([Page 313]1979). Deviant sexual arousal in rapists. Behaviour Research and Therapy, 17(3), 215–222. http://dx.doi.org/10.1016/0005-7967%2879%2990036-6, , & (1989). The child molester: An integrated approach to evaluation and treatment. New York: Brunner/Mazel., , , & (1993). Beginning to heal. London: Cedar., & (1988). Incest. In V. B.Van Hasselt, R. L.Morrison, A. S.Bellack, & M.Hersen (Eds.), Handbook of family violence (pp. 187–205). New York: Plenum., & (1986). Adolescent sexual offenders: Demographics, criminal and sexual histories, and recommendations for reducing future offenses. Journal of Interpersonal Violence, 1(4), 431–445. http://dx.doi.org/10.1177/088626086001004003, , & (1993). Assessing suspected child molesters. Child Abuse & Neglect, 17(1), 169–194. http://dx.doi.org/10.1016/0145-2134%2893%2990016-X, & (1986). Level of postassault sexual functioning in rape and incest victims. Archives of Sexual Behavior, 15(1), 37–49. http://dx.doi.org/10.1007/BF01542303, , , & (1982). Incidence and types of sexual dysfunctions in rape and incest victims. Journal of Sex and Marital Therapy, 8(1), 65–74. http://dx.doi.org/10.1080/00926238208405813, , , & (1992). A review of the long-term effects of child sexual abuse. Child Abuse & Neglect, 16(1), 101–118. http://dx.doi.org/10.1016/0145-2134%2892%2990011-F, , , , , & (1937). The reaction of children to sexual relations with adults. American Journal of Orthopsychiatry, 7, 500–518. http://dx.doi.org/10.1111/j.1939-0025.1937.tb05293.x, & (1952). A follow-up report on children who had atypical sexual experience. American Journal of Orthopsychiatry, 22, 825–837. http://dx.doi.org/10.1111/j.1939-0025.1952.tb01985.x, & (1970). Bristol floods 1968: Controlled survey of effects on health of local community disaster. British Medical Journal, 3(70), 454–458. http://dx.doi.org/10.1136/bmj.3.5720.454(1987). Factors in the current adjustment of young adult daughters of alcoholic and problem drinking fathers. Journal of Abnormal Psychology, 96(4), 305–312. http://dx.doi.org/10.1037/0021-843X.96.4.305, & ([Page 314]1975). Incest as a causative factor in antisocial behavior: An exploratory study. Contemporary Drug Problems, 4(3), 323–340., & (1994). Memories of child sexual abuse: A response to Lindsay and Read. Applied Cognitive Psychology, 8, 379–387. http://dx.doi.org/10.1002/acp.2350080407, & (1975). An enquiry among a group of pedophiles. Journal of Sex Research, 11(3), 242–255. http://dx.doi.org/10.1080/00224497509550899(1983). Sexual intimacy between psychotherapists and patients. Professional Psychology, 14, 185–196. http://dx.doi.org/10.1037/0735-7028.14.2.185, , & (1984, April). The effects of childhood sexual abuse on later psychological functioning: Defining a post-sexual abuse syndrome. Paper presented at the Third National Conference on Sexual Victimization of Children, Washington, DC.(1989). Therapy for adults molested as children: Beyond survival. New York: Springer.(1992a). Child abuse trauma: Theory and treatment of the lasting effects. Newbury Park, CA: Sage.(1992b). Methodological issues in the study of sexual abuse effects. Journal of Consulting and Clinical Psychology, 60(2), 196–203. http://dx.doi.org/10.1037/0022-006X.60.2.196(1993). Self-reported amnesia for abuse in adults molested as children. Journal of Traumatic Stress, 6(1), 21–31. http://dx.doi.org/10.1002/jts.2490060104, & (1988). Symptomatology in men who were molested as children: A comparison study. American Journal of Orthopsychiatry, 58(3), 457–461. http://dx.doi.org/10.1111/j.1939-0025.1988.tb01606.x, , , & (1986). Suicidal thoughts and behaviours in former sexual abuse victims. Canadian Journal of Behavioural Science, 18(4), 413–423. http://dx.doi.org/10.1037/h0079962, & (1987). Post sexual abuse trauma: Data and implications for clinical practice. Journal of Interpersonal Violence, 2(4), 367–379. http://dx.doi.org/10.1177/088626058700200403, & (1988a). Multivariate correlates of childhood psychological and physical maltreatment among university women. Child Abuse & Neglect, 12(3), 331–341. http://dx.doi.org/10.1016/0145-2134%2888%2990046-4, & (1988b). Post sexual abuse trauma. In G. E.Wyatt & G. J.Powell (Eds.), Lasting effects of child sexual abuse (pp. 85–99). Newbury Park, CA: Sage., & ([Page 315]1988c). Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse & Neglect, 12(1), 51–59. http://dx.doi.org/10.1016/0145-2134%2888%2990007-5, & (1990). Augmenting Hopkins SCL scales to measure dissociative symptoms: Data from two nonclinical samples. Journal of Personality Assessment, 55(1–2), 376–379. http://dx.doi.org/10.1207/s15327752jpa5501&2_35, & (1993). Childhood sexual abuse: Long-term sequelae and implications for psychological assessment. Journal of Interpersonal Violence, 8(3), 312–330. http://dx.doi.org/10.1177/088626093008003002, & (1989). Sexual abuse histories and sequelae in female psychiatric emergency room patients. American Journal of Psychiatry, 146(12), 1602–1606., & (1986a). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99(1), 66–77. http://dx.doi.org/10.1037/0033-2909.99.1.66, & (1986b). Initial and long-term effects: A review of the research. In D.Finkelhor (Ed.), A sourcebook on child sexual abuse (pp. 143–179). Newbury Park, CA: Sage., & (1964). Observations after sexual traumata suffered in childhood. Excerpta Criminologica, 11, 5–8.(1987). Childhood sexual and physical abuse as factors in adult psychiatric illness. American Journal of Psychiatry, 144(11), 1426–1430., , , & (1979). Adaptive strategies and recovery from rape. American Journal of Psychiatry, 136(10), 1278–1282., & (1983). Out of the shadows: Understanding sexual addiction. Minneapolis, MN: Compcare.(1988). Behavioral sequelae of physical and/or sexual abuse in adolescents. Child Abuse & Neglect, 12(2), 181–188. http://dx.doi.org/10.1016/0145-2134%2888%2990026-9, & (1989). Self-esteem in abused chemically dependent adolescents. Child Abuse & Neglect, 13(3), 327–334. http://dx.doi.org/10.1016/0145-2134%2889%2990072-0, & (1993). Child witnesses: Translating research into policy. Social Policy Report: Society for Research in Child Development, 7(3), 1–30., & (1987). Children's eyewitness memory. New York: Springer-Verlag. http://dx.doi.org/10.1007/978-1-4684-6338-5, , & (1990). The grooming process in father-daughter incest. In A. L.Horton, B. L.Johnson, L. M.Roundy, & D.Williams (Eds.), The incest perpetrator: A family member no one wants to treat (pp. 88–98). Newbury Park, CA: Sage., & ([Page 316]1979). A descriptive study of incarcerated rapists and pedophiles. Report to the Solicitor General, Government of Canada, Ottawa., , & (1990). Dissociative symptoms in relation to childhood physical and sexual abuse. American Journal of Psychiatry, 147(7), 887–892., & (1986, May). Differential long-term effects of child sexual and physical abuse. Paper presented at the Fourth National Conference on Sexual Victimization of Children, New Orleans, LA.(1987). The effects of sexual abuse on children: A multidimensional view. Journal of Interpersonal Violence, 2(4), 381–390. http://dx.doi.org/10.1177/088626058700200404, & (1980). Relapse: Strategies of prevention and prediction. In W. R.Miller (Ed.), The addictive behaviors (pp. 291–321). Oxford, UK: Pergamon., , & (1983). Samuel Pepys and post-traumatic stress disorder. British Journal of Psychiatry, 143, 64–68. http://dx.doi.org/10.1192/bjp.143.1.64(1987). Development of a situational competency test for sex offenders. Unpublished manuscript. (Available from David M. Day, California Department of Mental Health, 1600 Ninth Street, Sacramento, CA 95814), , , & (1969). Protecting the child victim of sex crimes committed by adults. Denver, CO: American Humane Association.(1980). The pro-incest lobby. Psychology Today, 13(10), 11–12, 15–16.(1987). More on psychiatrist-patient sexual contact. American Journal of Psychiatry, 144(5), 688–689., , , & (1982). The sexual victimization of children. Jefferson, NC: McFarland.(1983). Case reports: The sexual exploitation of victims by helping professionals. Victimology, 6, 92–98.(1979). The white album. New York: Simon & Schuster.(1974). Pilgrim at Tinker Creek. New York: Bantam Books.([Page 317]1993). Recall of abuse in childhood and three measures of dissociation. Child Abuse & Neglect, 17(4), 477–485. http://dx.doi.org/10.1016/0145-2134%2893%2990022-W, & (1983, November). Incest victims years after: Methods and techniques for treatment. Paper presented at the annual meeting of the National Association of Social Workers, Washington, DC.(1985). Diagnosis and treatment of traumatic stress among women after childhood incest. In C. R.Figley (Ed.), Trauma and its wake (Vol. 1, pp. 356–377). New York: Brunner/Mazel., & (1993). A follow-up study of behavior problems associated with child sexual abuse. Child Abuse & Neglect, 17(6), 743–754. http://dx.doi.org/10.1016/S0145-2134%2808%2980005-1, , , & (Identifying and breaking patterns of adult male sexual offending—Implications for assessment, intervention and maintenance. In M.Cardoza, D.Fisher, & B.Print (Eds.), Sex offenders: Towards improved practice. London: Whiting and Birch. http://dx.doi.org/10.1177/026455058703400103(in press).1991a, August). Multivariate impacts of parental incest, physical maltreatment, and substance abuse. Paper presented at the annual meeting of the American Psychological Association, San Francisco., & (1991b). Studying the long term effects of sexual abuse: The Trauma Symptom Checklist (TSC) scales. In A. W.Burgess (Ed.), Rape and sexual assault: A research handbook (Vol. 3, pp. 57–74). New York: Garland., & (1992). Sexual abuse trauma among professional women: Validating the Trauma Symptom Checklist-40 (TSC-40). Child Abuse & Neglect, 16(3), 391–398. http://dx.doi.org/10.1016/0145-2134%2892%2990048-V, and (1882). On concussion of the spine: Nervous shock and other obscure injuries of the nervous system in their clinical and medico-legal aspects. London: Longmans, Green.(Eth, S., & Pynoos, R. S. (Eds.). (1985). Post-traumatic stress disorder in children. Washington, DC: American Psychiatric Press.1990). Sexual abuse by paternal caretakers: A comparison of abusers who are biological fathers in intact families, stepfathers, and noncustodial fathers. In A. L.Horton, B. L.Johnson, L. M.Roundy, & D.Williams (Eds.), The incest perpetrator: A family member no one wants to treat (pp. 65–73). Newbury Park, CA: Sage.([Page 318]1990). Symptom differences in acute and chronic presentation of childhood post-traumatic stress disorder. Child Abuse & Neglect, 14(3), 439–444. http://dx.doi.org/10.1016/0145-2134%2890%2990015-L, , & (Father knows best. (1992, July). Reader's Digest, p. 27.1994). The experience of “forgetting” childhood abuse: A national survey of psychologists. Journal of Consulting and Clinical Psychology, 62(3), 636–639. http://dx.doi.org/10.1037/0022-006X.62.3.636, & (1985). A controlled, correlational study of the psychological functioning of female paternal incest victims. Unpublished doctoral dissertation, University of Missouri, St. Louis.(1933/1949). Confusion of tongues between adults and the child. International Journal of Psychoanalysis, 30, 225–230.(1980). Parent-child relationshps, childhood sexual abuse, and adult interpersonal behavior in female prostitutes. Unpublished doctoral dissertation, California School of Professional Psychology, Los Angeles.(1990). The cognitive sequelae of incest. In R. P.Kluft (Ed.), Incest related syndromes of adult psychopathology (pp. 161–182). Washington, DC: American Psychiatric Press.(1979). Sexually victimized children. New York: Free Press.(1984). Child sexual abuse: New theory and research. New York: Free Press.(1986). A sourcebook on child sexual abuse. Newbury Park, CA: Sage.(1988). The trauma of child sexual abuse: Two models. In G. E.Wyatt & G. J.Powell (Eds.), Lasting effects of child sexual abuse (pp. 61–82). Newbury Park, CA: Sage.(1986). High-risk children. In D.Finkelhor (Ed.), A sourcebook on child sexual abuse (pp. 60–88). Newbury Park, CA: Sage., & (1989). Sexual abuse and its relationship to later sexual satisfaction, marital status, religion, and attitudes. Journal of Interpersonal Violence, 4(4), 379–399. http://dx.doi.org/10.1177/088626089004004001, , , & (1993). Treatment of rape victims. Journal of Interpersonal Violence, 8(2), 256–276. http://dx.doi.org/10.1177/088626093008002006, , & ([Page 319]1969). The life of Charles Dickens. London: J. M. Dent and Sons.(1985). Children traumatized by catastrophic situations. In S.Eth & R. S.Pynoos (Eds.), Post-traumatic stress disorder in children (pp. 73–99). Washington, DC: American Psychiatric Press.(1985). Incidence of self-reported sex crimes among incarcerated rapists and child molesters. Unpublished manuscript.(1975). Rapists speak for themselves. In D. E. H.Russell (Ed.), The politics of rape: The victim's perspective (pp. 243–256). New York: Stein and Day.(1967). Erotic preference in pedophilia. Behaviour Research and Therapy, 5, 339–348. http://dx.doi.org/10.1016/0005-7967%2867%2990025-3(1990). Courtship disorder. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 195–207). New York: Plenum.(1993). Toward a testable developmental model of pedophilia: The development of erotic age preference. Child Abuse & Neglect, 17(2), 315–324. http://dx.doi.org/10.1016/0145-2134%2893%2990051-6, & (1988). Behavior problems in sexually abused children: An adaptational perspective. In G. E.Wyatt & G. J.Powell (Eds.), Lasting effects of child sexual abuse (pp. 171–191). Newbury Park, CA: Sage.(1967). The self and the ideal self: Methodological study of pedophiles. Psychological Reports, 20, 699–706. http://dx.doi.org/10.2466/pr0.1918.104.22.1689, , & (1983). The long term psychological impact of childhood sexual abuse. Unpublished doctoral dissertation, Auburn University, Auburn, GA.(1986). The relationship of childhood sexual abuse with later psychological and sexual adjustment in a sample of college women. Child Abuse & Neglect, 10(1), 5–15. http://dx.doi.org/10.1016/0145-2134%2886%2990026-8(1989). Long-term psychological correlates of childhood sexual abuse in two samples of college men. Child Abuse & Neglect, 13(4), 533–542. http://dx.doi.org/10.1016/0145-2134%2889%2990057-4, & (1989). Sex offender recidivism: A review. Psychological Bulletin, 105(1), 3–30. http://dx.doi.org/10.1037/0033-2909.105.1.3, , & ([Page 320]1965). Female child victims of sex offenses. Social Problems, 13(2), 176–192. http://dx.doi.org/10.2307/798902(1986). Psychiatrist-patient sexual contact: Results of a national survey, I: Prevalence. American Journal of Psychiatry, 143(9), 1126–1131., , , , & (1975). Wife battering: A preliminary survey of 100 cases. British Medical Journal, 1(5951), 194–197. http://dx.doi.org/10.1136/bmj.1.5951.194(1965). Sex offenders: An analysis of types. New York: Harper & Row., , , & (1981). Identification and treatment of incest victims. In E.Howell & M.Bayes (Eds.), Women and mental health (pp. 481–496). New York: Basic Books.(1992, June). On being the chosen one in a malevolent family environment. Paper presented at a conference titled Psychological Trauma: Maturational Processes and Therapeutic Interventions, Boston.(1982). Integrated treatment of child sexual abuse. Palo Alto, CA: Science and Behavior Books.(1988). Treatment of adult survivors of childhood abuse. Walnut Creek, CA: Launch Press.(1991). The healing power of play: Working with abused children. New York: Guilford.(1986). Long-term effects of sexual victimization in childhood: An attributional approach. Journal of Consulting and Clinical Psychology, 54(4), 471–475. http://dx.doi.org/10.1037/0022-006X.54.4.471(1994). A cross-validation study of the Trauma Symptom Checklist: The role of mediating variables. Journal of Interpersonal Violence, 9(1), 12–26. http://dx.doi.org/10.1177/088626094009001002, , , & (1985a). Credibility problems in multiple personality disorder patients and abused children. In R. P.Kluft (Ed.), Childhood antecedents of multiple personality (pp. 1–19). Washington, DC: American Psychiatric Press.(1985b). Post-traumatic symptoms in incest victims. In S.Eth & R. S.Pynoos (Eds.), Post-traumatic stress disorder in children (pp. 157–168). Washington, DC: American Psychiatric Press.([Page 321]1990). Applying to adult incest victims what we have learned from victimized children. In R. P.Kluft (Ed.), Incest related syndromes of adult psychopathology (pp. 55–74). Washington, DC: American Psychiatric Press.(1993). Human vectors of trauma: Illustrations from the Marquis de Sade. In J. M.Goodwin (Ed.), Rediscovering childhood trauma: Historical casebook and clinical applications (pp. 95–111). Washington, DC: American Psychiatric Press.(1994). Credibility problems in sadistic abuse. Journal of Psychohistory, 21(4), 479–496.(1992). Earth in the balance: Ecology and the human spirit. Boston: Houghton Mifflin.(1964). Der exhibitionismus. Kriminalstik in Österrich, 18, 557–562.(1980). The totalitarian ego: Fabrication and revision of personal history. American Psychologist, 35(7), 603–618. http://dx.doi.org/10.1037/0003-066X.35.7.603(1990). Posttraumatic stress disorder in a nonclinical and nonstudent sample of adult women sexually abused as children. Journal of Interpersonal Violence, 5(2), 217–228. http://dx.doi.org/10.1177/088626090005002006, & (1990). Childhood sexual abuse: Long-term effects on psychological and sexual functioning in a nonclinical and nonstudent sample of adult women. Child Abuse & Neglect, 14(4), 503–514. http://dx.doi.org/10.1016/0145-2134%2890%2990099-F, , , & (1979). Men who rape: The psychology of the offender. New York: Plenum.(1977). Rape: A sexual deviation. American Journal of Orthopsychiatry, 47(3), 400–406. http://dx.doi.org/10.1111/j.1939-0025.1977.tb01246.x, & (1982). The child molester: Clinical observations. In J. R.Conte & D. A.Shore (Eds.), Social work and child sexual abuse (pp. 129–144). Binghamton, NY: Haworth., , & (1982). Undetected recidivism among rapists and child molesters. Crime & Delinquency, 28(3), 450–458. http://dx.doi.org/10.1177/001112878202800305, , & (1983). Identifying determinants of risk of sexual victimization of youth. Child Abuse & Neglect, 7, 17–24. http://dx.doi.org/10.1016/0145-2134%2883%2990025-X, & (1977). Multiple overt incest as family defense against loss. Family Process, 16(1), 105–116. http://dx.doi.org/10.1111/j.1545-5300.1977.00105.x, & ([Page 322]1952). Psychiatry and the law. New York: Norton., & (Haley, J. (Ed.). (1985). Conversations with Milton Erickson: Changing individuals. New York: Triangle Press.1982, January 17). A judge's remarks: A look at the case. Milwaukee Journal, p. 1.(1980). A research scale for the assessment of psychopathy in criminal populations. Personality and Individual Differences, 1, 111–119. http://dx.doi.org/10.1016/0191-8869%2880%2990028-8(1981). Male and female adolescent prostitutes. Washington, DC: Huckleberry House Sexual Minority Youth Services Project, Youth Development Bureau, U.S. Department of Human Services., , & (1969). I'm OK, you're OK. New York: Harper & Row.(1850/1986). The scarlet letter. New York: Bantam.(1993, August). Serial murder and sexual repression. Playboy, 78, 147–150.(1983). Is incest harmful?Canadian Journal of Psychiatry, 28(1), 34–40.(1978). The aggressive sexual offender. In I. L.Kutash, S. B.Kutash, & L. B.Schlesinger (Eds.), Violence: Perspective on murder and aggression. San Francisco: Jossey-Bass.(1990, April). Sexual abuse related attributions: Probing the role of “traumagenic factors.” Paper presented at the annual meeting of the Western Psychological Association, Los Angeles., , , & (1981). Father-daughter incest. Cambridge, MA: Harvard University Press.(1990). Sex offenders: A feminist perspective. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 177–193). New York: Plenum.(1992). Trauma and recovery. New York: Basic Books.(1987). Recovery and verification of memories of childhood sexual trauma. Psychoanalytic Quarterly, 4(1), 1–14. http://dx.doi.org/10.1037/h0079126, & (1989). Personality and object relational pathology in young adult children of alcoholics. Psychotherapy, 26(4), 504–509. http://dx.doi.org/10.1037/h0085469([Page 323]1978). Sixty battered women. Victimology, 2, 460–471., & (1989). Just before dawn. Boise, ID: AlexAndria Associates.(1988). Serial murder. Newbury Park, CA: Sage., & (1977). Psychologists' attitudes and practices regarding erotic and non-erotic physical contact with patients. American Psychologists, 32(10), 843–849. http://dx.doi.org/10.1037/0003-066X.32.10.843, & (1976). Stress response syndromes. New York: Aronson.(1983). Treating sexually abused children and their families. Palo Alto, CA: Consulting Psychologists Press., & (1977). Early sexual experience and prostitution. American Journal of Psychiatry, 134(12), 1381–1385., & (1979). Characterological versus behavioral self-blame: Inquiries into depression and rape. Journal of Personality and Social Psychology, 37(10), 1798–1809. http://dx.doi.org/10.1037/0022-3522.214.171.1248(1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press.(1983). A theoretical perspective for understanding reactions to victimization. Journal of Social Issues, 39(2), 1–17. http://dx.doi.org/10.1111/j.1540-4560.1983.tb00138.x, & (1983). Victims' reactions to aid: The role of perceived vulnerability. In A.Nadler, J. D.Fisher, & B.DePaulo (Eds.), New directions in helping: Applied perspectives in help-seeking and -receiving (Vol. 3, pp. 21–42). New York: Academic Press., , & (1984). Youth prostitution. In A. W.Burgess (Ed.), Child pornography and sex rings (pp. 127–146). Lexington, MA: Lexington Books., , & (1983). Psychosocial adjustment of women who were sexually victimized in childhood or adolescence. Canadian Journal of Community Mental Health, 2(2), 71–82., & (1989). Cognitive restructuring. In D. R.Laws (Ed.), Relapse prevention with sex offenders (pp. 207–215). New York: Guilford.(1989). Apparently irrelevant decisions in the relapse process. In D. R.Laws (Ed.), Relapse prevention with sex offenders (pp. 47–55). New York: Guilford., & ([Page 324]1991). Stress, coping, and adjustment in female adolescent incest victims. Child Abuse & Neglect, 15(3), 293–305. http://dx.doi.org/10.1016/0145-2134%2891%2990073-M, & (1985). Date rapists: Differential sexual socialization and relative deprivation. Archives of Sexual Behavior, 14(3), 218–232. http://dx.doi.org/10.1007/BF01542105(1985). The impact of parolees' perceptions of confidentiality on the reporting of their urges to interact sexually with children. Unpublished doctoral dissertation, New York University.(1973). A survey of physicians' attitudes and practices regarding erotic and non-erotic contact with patients. American Journal of Psychiatry, 130(10), 1077–1081., , & (1954). The family constellation and overt incestuous relations between father and daughter. American Journal of Orthopsychiatry, 24, 266–279. http://dx.doi.org/10.1111/j.1939-0025.1954.tb02017.x, , & (1989). Psychodynamic psychotherapy of borderline patients. New York: Basic Books., , , & (1983). Rights consciousness and victimization prevention: Personal defense training and assertiveness training. Journal of Social Issues, 39(2), 153–168., , & (1959). Either/or. Garden City, NY: Anchor.(1986, May). Impact of child sexual abuse: Recent research findings. Paper presented to the Fourth National Conference on the Sexual Victimization of Children, New Orleans, LA., Amick- , , , & (1989). Victim and crime factors associated with the development of crime-related post-traumatic stress disorder. Behavior Therapy, 20(2), 199–214. http://dx.doi.org/10.1016/S0005-7894%2889%2980069-3, , , , , & (1987). Criminal victimization: Lifetime prevalence, reporting to police, and psychological impact. Crime & Delinquency, 33(4), 479–489. http://dx.doi.org/10.1177/0011128787033004005, , , , & (1990a). Incest and subsequent revictimization: The case of therapist-patient sexual exploitation, with a description of the sitting duck syndrome. In R. P.Kluft (Ed.), Incest related syndromes of adult psychopathology (pp. 263–287). Washington, DC: American Psychiatric Press.([Page 325]1990b). On the apparent invisibility of incest: A personal reflection on things known and forgotten. In R. P.Kluft (Ed.), Incest related syndromes of adult psychopathology (pp. 11–34). Washington, DC: American Psychiatric Press.(1990). Classifying sexual offenders: The development and corroboration of taxonomic models. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 23–52). New York: Plenum., & (1985). Classification of sex offenders: Perspectives, methods, and validation. In A. W.Burgess (Ed.), Rape and sexual assault: A research handbook (pp. 223–293). New York: Garland., , & (1984). Retraining adult sex offenders: Methods and models. Orwell, VT: Safer Society Press.(1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55(2), 162–170. http://dx.doi.org/10.1037/0022-006X.55.2.162, , & (1993). Relationship of child sexual abuse to depression. Child Abuse & Neglect, 17(3), 393–400. http://dx.doi.org/10.1016/0145-2134%2893%2990062-A, , , & (1956). Experiences of 500 children with adult sexual deviation. Psychiatric Quarterly Supplement, 30(Part 1), 91–109.(1975). The illusion of control. Journal of Personality and Social Psychology, 32(2), 311–328. http://dx.doi.org/10.1037/0022-35126.96.36.1991(1990). Sexual anomalies and the brain. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 103–113). New York: Plenum.(1991). Incidence and impact of sexual abuse in a child outpatient sample: The role of direct inquiry. Child Abuse & Neglect, 15(4), 447–453. http://dx.doi.org/10.1016/0145-2134%2891%2990028-C, , & (1987). Child molesters: A behavioral analysis for law enforcement. In R. R.Hazelwood & A. W.Burgess (Eds.), Practical aspects of rape investigation: A multidisciplinary approach (pp. 201–256). New York: Elsevier.([Page 326]Laws, D. R. (Ed.). (1989). Relapse prevention with sex offenders. New York: Guilford.1992). False negatives in sexual abuse disclosure interviews: Incidence and influence of caretaker's belief in abuse in cases of accidental abuse discovery by diagnosis of STD. Journal of Interpersonal Violence, 7(4), 532–542. http://dx.doi.org/10.1177/088626092007004008, & (1980). The belief in a just world: A fundamental delusion. New York: Plenum.(1978). Just world research and the attribution process: Looking back and ahead. Psychological Bulletin, 85(5), 1030–1051. http://dx.doi.org/10.1037/0033-2909.85.5.1030, & (1979). Juvenile male sexual assaulters. American Journal of Psychiatry, 136, 1194–1196., , & (1986). Hunting humans: Inside the minds of mass murderers. New York: Pocket Books.(1967). Death in life: Survivors of Hiroshima. New York: Simon & Schuster.(1963). Psychological effects of the atomic bomb in Hiroshima: The theme of death. Daedalus, 92, 462–497.(1985). Post-traumatic stress disorders in women who experienced childhood incest. Child Abuse & Neglect, 9(3), 329–334. http://dx.doi.org/10.1016/0145-2134%2885%2990028-6, & (1993). The reality of repressed memories. American Psychologist, 48(5), 518–537. http://dx.doi.org/10.1037/0003-066X.48.5.518(1984). Distortions in the memory of children. Journal of Social Issues, 40(2), 51–67. http://dx.doi.org/10.1111/j.1540-4560.1984.tb01093.x, & (1983). Juvenile sexual offenses in the history of adult rapists and child molesters. International Journal of Offender Therapy and Comparative Criminology, 27(2), 150–155. http://dx.doi.org/10.1177/0306624X8302700207, & (1981). Inappropriate behavior development in the sexual offender. Law and Order Magazine, 19, 21–23., & (1984). Contextual family therapy with the victims of incest. Journal of Adolescence, 7, 319–327. http://dx.doi.org/10.1016/0140-1971%2884%2990012-5, & (1989). The attraction to sexual aggression scale: Part 2. Journal of Sex Research, 26, 324–354. http://dx.doi.org/10.1080/00224498909551519(1991). Treating the sexual offender. Newbury Park, CA: Sage.([Page 327]1988). Identifying and treating the sexual repercussions of incest: A couples therapy approach. Journal of Sex and Marital Therapy, 14(2), 142–170. http://dx.doi.org/10.1080/00926238808403914(1987). Incest and sexuality: A guide to understanding and healing. Lexington, MA: Lexington Books., & (1994). The relationship between preabuse factors and psychological symptomatology in sexually abused girls. Child Abuse & Neglect, 18(1), 63–71. http://dx.doi.org/10.1016/0145-2134%2894%2990096-5, , & (1989a). Feeding the PIG: The problem of immediate gratification. In D. R.Laws (Ed.), Relapse prevention with sex offenders (pp. 56–62). New York: Guilford.(1989b). How to handle the PIG. In D. R.Laws (Ed.), Relapse prevention with sex offenders (pp. 227–235). New York: Guilford.(1980). Determinants of relapse: Implications for the maintenance of behavior change. In P. O.Davidson & S. M.Davidson (Eds.), Behavioral medicine: Changing health lifestyles (pp. 410–450). New York: Brunner/Mazel., & (1989). The sex offender treatment and evaluation project: California's relapse prevention program. In D. R.Laws (Ed.), Relapse prevention with sex offenders (pp. 247–267). New York: Guilford., , , & (1989a). Elements of high-risk situations for sex offenders. In D. R.Laws (Ed.), Relapse prevention with sex offenders (pp. 35–46). New York: Guilford., & (1989b). Understanding and preventing relapse in sex offenders. In M.Gossop (Ed.), Relapse and addictive behavior (pp. 96–106). Beckenham, Kent, UK: Routledge., & (1991). Early onset and deviant sexuality in child molesters. Journal of Interpersonal Violence, 6(3), 323–335. http://dx.doi.org/10.1177/088626091006003005, , & (Marshall, W. L., , & Barbaree, H. E. (Eds.). (1990). Handbook of sexual assault: Issues, theories, and treatment of the offender. New York: Plenum.1978). The Pollyanna principle: Selectivity in language, memory, and thought. Cambridge, MA: Schenkman., & ([Page 328]1990). Psychological trauma and the adult survivor: Theory, therapy, and transformation. New York: Brunner/Mazel., & (1988). Post-traumatic stress disorder in sexually abused children. Journal of the American Academy of Child and Adolescent Psychiatry, 27(5), 650–654. http://dx.doi.org/10.1097/00004583-198809000-00024, , , , & (1978). Incest: A psychological study of causes and effects with treatment recommendations. San Francisco: Jossey-Bass.(1990). The untouched key: Tracing childhood trauma in creativity and destructiveness. New York: Doubleday.(1976). Blaming the victim of child molestation: An empirical analysis. Unpublished doctoral dissertation, Northwestern University, Evanston, IL.(1980). The addictive behaviors. In W. R.Miller (Ed.), The addictive behaviors: Treatment of alcoholism, drug abuse, smoking and obesity. New York: Pergamon.(1987). Beloved. New York: Plume.(1991). Attributions of female adolescent incest victims regarding their molestation. Child Abuse & Neglect, 15(4), 477–483. http://dx.doi.org/10.1016/0145-2134%2891%2990031-8(1919). War neuroses and shell shock. London: Oxford Medical Publications.(1981). Incest and the dysfunctional family system. In P. B.Mrazek & C. H.Kempe (Eds.), Sexually abused children and their families (pp. 167–177). New York: Pergamon., & (1981). The effects of child sexual abuse: Methodological considerations. In P. B.Mrazek & C. H.Kempe (Eds.), Sexually abused children and their families (pp. 235–245). New York: Pergamon., & (1993). Child sexual abuse and adult mental health. Journal of Interpersonal Violence, 8(3), 429–431. http://dx.doi.org/10.1177/088626093008003011(1988). Current psychological functioning of child sexual assault survivors. Journal of Interpersonal Violence, 3(1), 55–79. http://dx.doi.org/10.1177/088626088003001005, , Amick- , , , , , & (1990). Assessment and modification of cognitive distortions in sex offenders. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 331–342). New York: Plenum.([Page 329]1940). Shell shock in France, 1914–1918. Cambridge, UK: Cambridge University Press.(1989). Expert testimony in child sexual abuse litigation. Nebraska Law Review, 68(1 & 2), 1–145.B., , , , , & (1976). Children of disaster: Clinical observations at Buffalo Creek. American Journal of Psychiatry, 133(3), 306–312.(1984). Multiphasic Sex Inventory manual. Tacoma, WA: Author., & (1985). Post-traumatic stress disorder in children with cancer. In S.Eth & R. S.Pynoos (Eds.), Post-traumatic stress disorder in children (pp. 123–132). Washington, DC: American Psychiatric Press.(1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60(3), 409–418. http://dx.doi.org/10.1037/0022-006X.60.3.409(1988). Serial killers. New York: Doubleday.(1883). Injuries of the spine and spinal cord without apparent mechanical lesion, and nervous shock, in their surgical and medico-legal aspects. London: J. & A. Churchill.(1988). Alcohol-related problems, marital disruptions and depressive symptoms among adult children of alcohol abusers in the United States. Journal of Studies on Alcohol, 49(4), 306–313., & (1983). Perceptions of vulnerability to victimization. Journal of Social Issues, 39(2), 41–62. http://dx.doi.org/10.1111/j.1540-4560.1983.tb00140.x(1984). The relationship between childhood sexual victimization and adult depression among Afro-American and white women. Unpublished doctoral dissertation, University of California, Los Angeles.(1988). Child sexual abuse and later psychological problems. In G. E.Wyatt & G. J.Powell (Eds.), Lasting effects of child sexual abuse (pp. 101–117). Newbury Park, CA: Sage.(1981). Self-blame and depressive symptoms. Journal of Personality and Social Psychology, 41(2), 253–259. http://dx.doi.org/10.1037/0022-35188.8.131.52, , & ([Page 330]1985). On the high wire. New York: Random House.(1990). Relapse prevention with sexual aggressors: A method for maintaining therapeutic gain and enhancing external supervision. In W. L.Marshall, D. R.Laws, & H. E.Barbaree (Eds.), Handbook of sexual assault: Issues, theories, and treatment of the offender (pp. 343–361). New York: Plenum.(1989). Identification of risk factors through clinical interviews and analysis of records. In D. R.Laws (Ed.), Relapse prevention with sex offenders (pp. 77–87). New York: Guilford., , , & (1987). Precursors to sexual offenses. In Proceedings of the First Annual Meeting of the Association for the Behavioral Treatment of Sexual Aggressors, Newport, OR., , , , & (1988). Relapse prevention: A method of enhancing maintenance of change in sex offenders. In A. C.Salter (Ed.), Treating child sex offenders and victims: A practical guide (pp. 131–170). Newbury Park, CA: Sage., , , & (1983). Relapse prevention with sexual aggressives: A self-control model of treatment and maintenance of change. In J. G.Greer & I. R.Stuart (Eds.), The sexual aggressor: Current perspectives on treatment (pp. 214–239). New York: Van Nostrand Reinhold., , , & (1986). Sexual intimacy between therapists and patients. New York: Praeger., & (1979). Sexual intimacy in psychology training: Results and implications of a national survey. American Psychologists, 34(8), 682–689. http://dx.doi.org/10.1037/0003-066X.34.8.682, , & (1986). Victim responses by rapist type: An empirical and clinical analysis. Journal of Interpersonal Violence, 1(1), 73–98. http://dx.doi.org/10.1177/088626086001001005, , & (1991). Identifying critical dimensions for discriminating among rapists. Journal of Consulting and Clinical Psychology, 59(5), 643–661. http://dx.doi.org/10.1037/0022-006X.59.5.643, & (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford.(1990). Disturbances of “self” in victims of childhood sexual abuse. In R. P.Kluft (Ed.), Incest related syndromes of adult psychopathology (pp. 113–131). Washington, DC: American Psychiatric Press.([Page 331]1985). Children traumatized by witnessing acts of personal violence: Homicide, rape, or suicide behavior. In S.Eth & R. S.Pynoos (Eds.), Post-traumatic stress disorder in children (pp. 19–43). Washington, DC: American Psychiatric Press., & (1985). An assessment of conflicting views on mental health: The consequences of traumatic events. In C. R.Figley (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder (pp. 173–215). New York: Brunner/Mazel.(Queen's Bench Foundation. (1976). Rape: Prevention and resistance. San Francisco: Author.1977). The assessment and treatment of child molesters: A review. Canadian Psychological Review, 18(3), 204–220.(1984). Stimulus control of rapists and non-sex offenders' sexual arousal. Behavioral Assessment, 6(2), 169–176., & (1988). Penile responses of child molesters and normals to descriptions of encounters with children involving sex and violence. Journal of Interpersonal Violence, 3(3), 259–274. http://dx.doi.org/10.1177/088626088003003001, & (1984). Sexual arousal to nonsexual violence and sadomasochistic themes among rapists and non-sex-offenders. Journal of Consulting and Clinical Psychology, 52(4), 651–657. http://dx.doi.org/10.1037/0022-006X.52.4.651, , & (1993). Assessing treatment efficacy in outcome studies of sex offenders. Journal of Interpersonal Violence, 8(4), 512–523. http://dx.doi.org/10.1177/088626093008004006, , , & (1983). Procedures for reducing inappropriate sexual arousal: An evaluation review. In J. G.Greer & I. R.Stuart (Eds.), The sexual aggressor (pp. 267–289). New York: Van Nostrand Reinhold., & (Rada, R. T. (Ed.). (1978). Clinical aspects of the rapist. New York: Grune & Stratton.1984). Sexually aggressive males: Characterological features and sexual responsiveness to rape depictions. Unpublished doctoral dissertation, Auburn University, Auburn, GA.(1950). On consummated incest. Journal of Psychoanalysis, 31, 42–47., & ([Page 332]1934). The importance of sexual attacks on children less than fourteen years of age for the development of mental disease and character anomalies. Acta Psychiatrica et Neurologica, 9, 351–434.(1993). The celestine prophecy: An adventure. New York: Warner.(Remembering “repressed” abuse. (1992). APS Observer, 5(4), 6–7.1993). The psychological impact of rape. Journal of Interpersonal Violence, 8(2), 223–255. http://dx.doi.org/10.1177/088626093008002005(1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology, 61(6), 984–991. http://dx.doi.org/10.1037/0022-006X.61.6.984, , , , & (1988). Sexual homicide: Patterns and motives. Lexington, MA: Lexington Books., , & (1986). Sexual killers and their victims: Identifying patterns through crime scene analysis. Journal of Interpersonal Violence, 1(3), 288–308. http://dx.doi.org/10.1177/088626086001003003, , , , & (1990). A follow-up of rapists assessed in a maximum-security psychiatric facility. Journal of Interpersonal Violence, 5(4), 435–448. http://dx.doi.org/10.1177/088626090005004001, , & (1973). Exhibitionism, sexual violence and pedophilia. British Journal of Psychiatry, 122, 705–710. http://dx.doi.org/10.1192/bjp.122.6.705(1988). Validating the components of a taxonomic system for rapists: A path analytic approach. Bulletin of American Academy of Psychiatry and the Law, 16(2), 169–185., , , & (1979). Incidence of a history of incest among 18 female psychiatric patients. American Journal of Psychiatry, 136(6), 791–795.(1989). Multiple personality disorder: Diagnosis, clinical features, and treatment. New York: John Wiley.(1988). Pillars of flame. New York: Harper & Row.(Rossi, E. L. (Ed.). (1980). The nature of hypnosis and suggestion: The collected papers of Milton H. Erickson on hypnosis. New York: Irvington.[Page 333]1993). The process of coping with incest for adult survivors: Measurement and implications for treatment and research. Journal of Interpersonal Violence, 8(3), 363–377. http://dx.doi.org/10.1177/088626093008003005, & (1994). Posttraumatic stress disorder in a clinical sample of adults sexually abused as children. Child Abuse & Neglect, 18(1), 51–61. http://dx.doi.org/10.1016/0145-2134%2894%2990095-7, , , & (1980). The stranger beside me. New York: Norton.(1987a). The psychosocial adjustment of women who were sexually and physically abused during childhood and early adulthood: A focus on revictimization. Unpublished master's thesis, University of Manitoba, Canada.(1987b, June). The sexual victimization of women: The link between child abuse and revictimization. Paper presented at the annual meeting of the Canadian Psychological Association, Vancouver, BC.(1980). The best kept secret: Sexual abuse of children. New York: McGraw-Hill.(1984). Sexual exploitation: Rape, child sexual abuse, and workplace harassment. Beverly Hills, CA: Sage.(1986). The secret trauma: Incest in the lives of girls and women. New York: Basic Books.(1988). Treating child sex offenders and victims: A practical guide. Newbury Park, CA: Sage.(1992). Epidemiology of child sexual abuse. New York: Lawrence Erlbaum.(1990). Correlates of sexual offenders: Psychopathology, empathy and life stress. Unpublished manuscript., , & (1991, March). Prevalence, case characteristics, and long-term psychological correlates of child rape among women: A national survey. Paper presented at the annual meeting of the American Orthopsychiatry Association, Toronto, Canada., , , , (1992). Child sexual assault as a risk factor for mental disorders among women: A community study. Journal of Interpersonal Violence, 7(2), 189–204. http://dx.doi.org/10.1177/088626092007002005, , , , & ([Page 334]1989). Disclosure of child sexual abuse. For better or for worse. Psychiatric Clinics of North America, 12(2), 455–469.(1983). Through women's eyes: Defining danger in the wake of sexual assault. Journal of Social Issues, 39(2), 63–80. http://dx.doi.org/10.1111/j.1540-4560.1983.tb00141.x, & (1990). A review of the literature on the long-term effects of childhood sexual abuse. In R. P.Kluft (Ed.), Incest related syndromes of adult psychopathology. Washington, DC: American Psychiatric Press.(1984). Factors associated with a history of childhood sexual experience in a nonclinical female population. Journal of the American Academy of Child Psychiatry, 23(2), 215–218. http://dx.doi.org/10.1097/00004583-198403000-00015, & (1974). Mortal lessons: Notes on the art of surgery. New York: Simon & Schuster.(1966). Live or die. Boston: Houghton Mifflin.(1993). Impact and treatment issues for victims of childhood sexual abuse by female perpetrators. In M.Elliott (Ed.), Female sexual abuse of children: The ultimate taboo (pp. 15–38). London: Longman., & (1981). Nisa: The life and words of a !Kung woman. New York: Vintage Books.(1981). Sexual child abuse as an antecedent to prostitution. Child Abuse & Neglect, 5, 407–411. http://dx.doi.org/10.1016/0145-2134%2881%2990050-8, & (1983). Searching for meaning in misfortune: Making sense of incest. Journal of Social Issues, 39(2), 81–101. http://dx.doi.org/10.1111/j.1540-4560.1983.tb00142.x, , & (1989). The relationship between sexual abuse and substance abuse among psychiatrically hospitalized adolescents. Child Abuse & Neglect, 13(3), 319–325. http://dx.doi.org/10.1016/0145-2134%2889%2990071-9, , & (1942). Effects of incest on the participants. American Journal of Orthopsychiatry, 12, 666–673. http://dx.doi.org/10.1111/j.1939-0025.1942.tb05960.x, & (1975). Personality characteristics of exhibitionists. Diseases of the Nervous System, 36, 600–603., & (1991). How children tell: The process of disclosure in child sexual abuse. Child Welfare League of America, 70(1), 3–15., & ([Page 335]1990). Trauma, dissociation, and hypnosis. In R. P.Kluft (Ed.), Incest related syndromes of adult psychopathology (pp. 247–261). Washington, DC: American Psychiatric Press.(1988). Long-term psychological sequelae of child sexual abuse: The Los Angeles Epidemiologic Catchment Area Study. In G. E.Wyatt & G. J.Powell (Eds.), Lasting effects of child sexual abuse (pp. 135–154). Newbury Park, CA: Sage., , , , & (1969). The collected poems of Wallace Stevens. New York: Alfred A. Knopf.(1953). The interpersonal theory of psychiatry. New York: Norton.(1986). Background information regarding child sexual offenders (Training brochure). Washington, DC: Child Pornography and Protection Unit (CPPU), U.S. Customs Service Headquarters.(1983). The child sexual abuse accommodation syndrome. International Journal of Child Abuse and Neglect, 7, 177–193. http://dx.doi.org/10.1016/0145-2134%2883%2990070-4(1988). Hidden victims, hidden pain: Societal avoidance of child sexual abuse. In G. E.Wyatt & G. J.Powell (Eds.), Lasting effects of child sexual abuse (pp. 39–60). Newbury Park, CA: Sage.(1962). Rape and social structure. Pacific Sociological Review, 5(1), 48–53. http://dx.doi.org/10.2307/1388279(1993). Reported history of physical and sexual abuse in relation to dissociation and other symptomatology in women psychiatric inpatients. Journal of Interpersonal Violence, 8(4), 545–555. http://dx.doi.org/10.1177/088626093008004009, & (1984). Marital therapy in the treatment of incest. Social Casework, 65(4), 195–202.(1989). Positive illusions: Creative self-deceptions and the healthy mind. New York: Basic Books.(1988). Illusion and well-being: A social-psychological perspective on mental health. Psychological Bulletin, 103(2), 193–210. http://dx.doi.org/10.1037/0033-2909.103.2.193, & (1985a). Children traumatized in small groups. In S.Eth & R. S.Pynoos (Eds.), Post-traumatic stress disorder in children (pp. 47–70). Washington, DC: American Psychiatric Press.(1985b). Psychic trauma in children and adolescents. Psychiatric Clinics of North America, 8(4), 815–835.([Page 336]1987). Childhood trauma and the creative product: A look at the early lives and later works of Poe, Wharton, Magritte, Hitchcock, and Bergman. Psychoanalytic Study of the Child, 42, 545–572.(1990). Too scared to cry. New York: Harper & Row.(1994). Unchained memories: True stories of traumatic memories, lost and found. New York: Basic Books.(1979). Optimism: The biology of hope. New York: Simon & Schuster.(1986). Post-traumatic decline: A consequence of unresolved destructive drives. In C. R.Figley (Ed.), Trauma and its wake: Traumatic stress, theory, research, and intervention (Vol. 11, pp. 5–19). New York: Brunner/Mazel.(1989). Systemic treatment of incest. New York: Brunner/Mazel., & (1985). Post-traumatic stress disorder: History of a concept. In C. R.Figley (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder (Vol. 1, pp. 5–14). New York: Brunner/Mazel.(1979). Childhood molestation: Variables related to differential impacts on psycho-sexual functioning in adult women. Journal of Abnormal Psychology, 88(4), 407–417. http://dx.doi.org/10.1037/0021-843X.88.4.407, , & (1993). The wisdom of the ego. Cambridge, MA: Harvard University Press.(1965). Dream barker and other poems. New York: AMS Press.(1987). Psychological trauma. Washington, DC: American Psychiatric Press.(1991). Childhood origins of self-destructive behavior. American Journal of Psychiatry, 148(12), 1665–1671., , & (1991). Verbal aggression by parents and psychosocial problems of children. Child Abuse & Neglect, 15(3), 223–238. http://dx.doi.org/10.1016/0145-2134%2891%2990067-N, , , & (1968). Slaughterhouse five. New York: Dell.(1988). Self-mutilation: Theory, research and treatment. New York: Guilford., & ([Page 337]1987, February). The nature of grooming behavior used by sexual offenders in father-daughter incest. Paper presented at the Western Criminology Association, Las Vegas, NV.(1991). Self-report of crimes committed by sex offenders. Journal of Interpersonal Violence, 6(3), 286–300. http://dx.doi.org/10.1177/088626091006003002, & (1955). A study of girl sex victims. Psychiatric Quarterly, 29, 1–27. http://dx.doi.org/10.1007/BF01567435, , , & (1988). Treating the effects of sexual abuse on children. In G. E.Wyatt & G. J.Powell (Eds.), Lasting effects of child sexual abuse (pp. 227–247). Newbury Park, CA: Sage., & (1992). Adult memories of childhood abuse: Preliminary findings from a longitudinal study. APSAC Advisor, 5(3), 19–22.(1993, October). Recovered memories of abuse in women with documented child sexual victimization histories. Paper presented at the annual meeting of the American Society of Criminology, Phoenix, AZ.(Recall of childhood trauma: A prospective study of women's memories of child sexual abuse. Journal of Consulting and Clinical Psychology.(in press-a).What does it mean to forget child sexual abuse? A reply to Loftus, Garry and Feldman. Journal of Consulting and Clinical Psychology.(in press-b).1992). The serial killers. London: Virgin., & (1965). The maturational processes and the facilitating environment. New York: International Universities Press.(1994). Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse. Child Abuse & Neglect, 18(1), 37–50. http://dx.doi.org/10.1016/0145-2134%2894%2990094-9, , & (1983). A survey of incarcerated sexual offenders. Canadian Journal of Criminology, 25(4), 379–390.(1975). Some determinants of perceived control. Journal of Personality and Social Psychology, 31, 282–294. http://dx.doi.org/10.1037/h0076305(1976). Casual attributions and personal control. In W. J. H.Harvey, W. J.Ickes, & R. F.Kidd (Eds.), New directions in attribution research (pp. 23–52). Hillsdale, NJ: Lawrence Erlbaum.([Page 338]1991). Depression and suicidal ideation in sexually abused children. Child Abuse & Neglect, 15(4), 505–511. http://dx.doi.org/10.1016/0145-2134%2891%2990034-B, , & (1980). Rape and physical violence. Cambridge, UK: Institute of Criminology.(1985). The sexual abuse of Afro-American and White-American women in childhood. Child Abuse & Neglect, 9(4), 507–519. http://dx.doi.org/10.1016/0145-2134%2885%2990060-2(1992). Differential effects of women's child sexual abuse and subsequent sexual revictimization. Journal of Consulting and Clinical Psychology, 60(2), 167–173. http://dx.doi.org/10.1037/0022-006X.60.2.167, , & (1960). Aggression and forbiddenness in voyeurism. Archives of General Psychiatry, 3, 305–319. http://dx.doi.org/10.1001/archpsyc.1960.01710030091012(1976). The criminal personality: A profile for change. New York: Jason Aronson., & (1966). Children not severely damaged by incest with a parent. Journal of the American Academy of Child Psychiatry, 5(1), 111–124. http://dx.doi.org/10.1016/S0002-7138%2809%2962041-0, & (
About the Author[Page 351]
Anna C. Salter is in private practice in Lebanon, New Hampshire, and on the adjunct faculty of Dartmouth Medical School in the Departments of Pediatrics and Psychiatry. Prior to entering private practice in 1988, she was on the full-time faculty of Dartmouth Medical School in Psychiatry and Maternal and Child Health. She was Director of Parents in Distress Program, Assistant Director of the Children at Risk Program, Co-Director of the Parenting Clinic, Director of Psychosocial Education for the Pediatric Residency Program, and Director of Child Psychiatry Inpatient Consultation. She has also developed a training curriculum for the National Institute of Corrections that has been used nationwide to develop sex offender treatment specialists. She lectures and consults throughout the country and abroad on sex offenders as well as on adult and child victims of sexual abuse. She is the author of Treating Child Sex Offenders and Victims: A Practical Guide (Sage, 1988).[Page 352]
About the Contributors[Page 353]
Hilary Eldridge, Dip. SW, CQSW, is Clinical Director of the Faithfull Foundation, a child protection agency that provides a range of therapeutic facilities for child and adult survivors of sexual abuse and their families, engages in assessment and intervention with sex offenders, and has a major role in the training of professional groups in work with sexual abuse. After completing postgraduate training at Leicester University School of Social Work, Ms. Eldridge worked as a probation officer for 13 years, specializing in work with sexual abuse. Ms. Eldridge is a member of the National Executive Committee of NOTA (National Association for the Development of Work With Sex Offenders) and has published material relating to sexual abuse, including a relapse prevention manual titled Maintaining Change.
Jenny Still, Dip. App. Soc. Studs, CQSW, qualified as a social worker in 1974. She has specialized in working with child abuse since 1977 as a practitioner, consultant, teacher, and then as Head of a Special Unit (Child Protection) for the National Society for Prevention of Cruelty to Children. As a Senior Lecturer at the University of London (Institute of Child Health), she was responsible for setting up and running the government-sponsored national training program on child sexual abuse. She was a cofounder of the Gracewell Clinic, set up in 1988 to provide an intensive residential assessment and therapy program for sex offenders, and has worked extensively with offenders, children who have been sexually abused, and their nonoffending parents and families. She is now Deputy Clinical Director with Gracewell's successor organization, the Faithfull Foundation.