Primary Prevention of Child Sexual Abuse: Alternative, Non-Child Directed Approaches

James J. Krivacska^*

ABSTRACT: Child sexual abuse prevention programs have traditionally directed efforts at children.  However, sound prevention efforts may eventually depend more on programs aimed at adults.  Alternative approaches based upon the etiology and the sustaining and maintaining factors of abuse are discussed.  Such programs may include education about normal sexual development, efforts to increase the inhibitions against abuse for potential abusers, and therapeutic interventions for adults who are sexually aroused by children.
  

Recently, authors have called for methods of child sexual abuse prevention other than programs directed at children (Finkelhor, 1986; Gilbert, Berrick, Le Prohn, & Nyman, 1989; Tharinger, Krivacska, Laye-McDonough, Jamison, Vincent, & Hedlund, 1988; Trudell & Whatley, 1988).  Outside of recognizing the need for such programs, however, there has been little effort to outline what form such alternative prevention efforts should take.

Sound prevention programming is based upon a theory of the etiology and the sustaining and maintaining factors for the condition to be prevented (Bickman, 1983; Morell, 1981; Rappaport, 1987).  One of the most widely discussed theories of child sexual abuse is David Finkelhor's Four Preconditions Model of Child Sexual Abuse (1984).  Finkelhor claims that sexual abuse results from a perpetrator sequentially overcoming each of four obstacles to the sexually abusive act.  For an act of sexual abuse to occur four preconditions must be met:

Precondition I — The perpetrator must be motivated to sexually abuse a child;

Precondition Il — The perpetrator must overcome internal inhibitions against such abuse;

Precondition Ill — The perpetrator must overcome external inhibitions to abuse; and

Precondition IV — The perpetrator must overcome the child's resistance.

Finkelhor suggests that child sexual abuse may be prevented by intervening in any one of these four preconditions.  Most prevention efforts, however, have been targeted at Precondition IV — the child's resistance.  In fact, Finkelhor lists six factors which contribute to the child's resistance under this precondition, only two of which are typically addressed in child sexual abuse prevention (CSAP) programs.  Consequently, from the perspective of this model, prevention efforts have been narrowly focused.

Is Finkelhor's model the most appropriate one for conceptualizing child sexual abuse?  Finkelhor's model explains more how sexual abuse takes place than why the inclination for an adult to sexually abuse a child develops in the first place (Krivacska, in press-b).  Indeed, absent the motivation to sexually abuse a child, none of the other preconditions serve any purpose.  On the other hand, the sequential approach inherent in the Four Preconditions Model ignores the relative weight the perpetrator may give to internal and external inhibitions.

Finkelhor's model has been reconceptualized to give greater significance to the first precondition, motivation to sexually abuse a child, as well as allow for weighting different degrees of inhibitions among the remaining three preconditions (Krivacska, in press-a & b).  Sexual abuse may be viewed as a phenomena which occurs at the intersection of two continua.  The first continuum describes the degree of motivation to sexually abuse a child.  The second continuum relates to the degree of inhibitions which may exist and which may include internal and external inhibitions as well as the child's resistance.  What is more important than the sequential progression of overcoming each of the preconditions or inhibitions is the cumulative effect of the inhibitions.  Sexual abuse will occur when the level of motivation on the motivation continuum exceeds the combined levels of inhibitors on the inhibitory continuum (Krivacska, in press-a & b).

Prevention efforts then, can aim at increasing the strength of the inhibitory factors or decreasing the strength of the motivational factor.  Since the current literature deals extensively with the issue of sexual abuse prevention programs directed at children, such programs will not be considered here.  Rather, alternative approaches to the prevention of child sexual abuse through the enhancement of inhibitory factors will be discussed along with an analysis of the etiology of sexual attraction to children and approaches to preventing the development of motivation to sexually abuse a child.
  

Alternative Approaches to Enhancement of Internal Inhibitors

The inhibitory factors may be broken into internal and external inhibitors as described by Finkelhor (1984).  Internal inhibitions relate to the individuals' personal awareness of the inappropriateness of the sexual contact and their willingness and/or ability to control their impulses towards children.  There is evidence that sexual abusers rationalize their conduct and attempt to provide justification for their sexual activity with children (de Young, 1988) (e.g., under the guise of sex education).  For some perpetrators then, direct assault upon their rationalizations may be necessary.  For others who recognize the inappropriateness of their behavior but are nevertheless unable to control it, additional interventions are needed.

One such approach (which would be relatively inexpensive to implement) would be to publicize the use of sexual abuse prevention programs in schools (Krivacska, in press-b).  According to Finkelhor (1984), one of the presumptions of a sexually abusive relationship is that children will keep the secret due to their lack of understanding of what sexual abuse is and/or their right to refuse such contact as well as their feelings of blame or guilt.  To the extent to which sex abuse prevention programs increase children's knowledge about sexual abuse and their right to refuse sexually abusive approaches, and decrease their guilt or blame for its occurrence, children become much more likely to report abusive acts.  Publication of this may inhibit perpetrators who might now fear disclosures.

Parent education forums on child sexual abuse may also increase internal inhibitions if any perpetrators or potential perpetrators are in the audience.  Open discussion of the potential effects of sexual abuse on children and their families, as well as the increased likelihood of disclosure and subsequent apprehension, may raise internal inhibitions. (Krivacska, in press-b).

Public advertising may also serve an important role.  Figures 1 through 4 illustrate public campaign ads (Child Abuse Information Center, 1989) designed to educate perpetrators and potential perpetrators about the effects of sexual abuse, to warn them of the potential consequences if and when they are discovered and to urge them to seek confidential professional help.  Such ads may again confront perpetrators with their rationalizations as well as increase their realization of the dangers of discovery.  As illustrated in the sample ads in Figures 1 through 4, such campaigns may stress that children cannot consent to sexual activity, that such activity is inappropriate and may lead to psychological trauma, and that the consequences to the abuser, if caught, would be substantial.  Such campaigns should also include information about where abusers might get help for their problem.

Public schools may also promote internal inhibitions against sexual abuse by incorporating into courses on Human Sexuality a discussion of sexual abuse, its potential effects, and the need for anyone who may be experiencing sexual attraction to children to seek out and obtain confidential counseling.  Given that sexual attraction to children typically arises first in adolescence, this may be the most appropriate time to begin this type of preventive instruction. Helfer (1982) and Holmes (1987) both describe programs directed at teens which have as one of their goals reduction of the likelihood that the teens will become sexual abusers.
  

Alternative Approaches to Enhancement of External Inhibitors

A number of efforts may increase external inhibitors of sexual abuse.  External inhibitors stop sexual abuse through environmental constraints upon the act (Finkelhor, 1984) . The presence of another person who might witness the act, the lack of private time with the child, or the likelihood of discovery are all examples of external inhibitors.  Perhaps more important than the mere presence of the external inhibitor is its perception by the perpetrator.  What many might view as a powerful external inhibitor against abuse (e.g., the potential for discovery when a sexual molestation is attempted in a public restroom) may be rationalized by the perpetrator and not be viewed as risky.  Thus, attempts must be made to increase not only the real levels of external inhibitors but also the perception of those inhibitors by perpetrators.

One approach which is becoming popular in several states is the introduction of safeguards or precautions in the hiring, recruiting, and supervision of paid and volunteer staff by state agencies and institutions which service children.  New Jersey, for example, requires criminal background checks for sexual offenses for all employees of public schools who come into contact with children.  Therefore, those who have a previous known history of sexual contact with children are precluded from situations in which abuse is most likely to occur.

Buildings in which children are housed may be surveyed to identify structural features of the building which may promote sexual abuse.  For example, rooms which are totally windowless and which can be locked from the inside should be modified (Holmes, 1987), and policies which protect both students and staff from sexual abuse or false allegations instituted (e.g., policies requiring the presence of another adult whenever a staff member must drive a child home).
  

Alternative Approaches to Increasing Children's Resistance

There are several factors inherent in the child which may promote or sustain abuse as described under Finkelhor's fourth precondition.  Parents may increase their child's resistance to abuse by developing a relationship with their child which would encourage disclosure of abuse.  Parent education, then, may inhibit abuse by impacting on the child's resistance to abuse.  Such parent education may include discussions of normal childhood sexuality and how to talk to children about sex.  Parents who can openly and appropriately discuss sex with their children will undermine the secrecy, mystery and confusion which maintains the secrecy of the sexually abusive relationship.

Parent training may also include discussions of what child sexual abuse is, what its impact on a child might be, and how parents may prevent it as well as respond if their child is abused.  The selection of babysitters, choice of day care centers, and how to evaluate child-adult relationships in which a child may be involved may also be presented.  Such educational efforts, however, must not promote unhealthy over-cautiousness or suspiciousness.  Rather, such training would help parents recognize situations which require further investigation.

Thus, parents might be taught how to respond if they find their child suddenly reluctant to be alone with a particular babysitter, or a previously valued adult.  Parents would be encouraged not to immediately conclude that sexual abuse caused the behavior change, but rather to recognize that this is one of several possibilities.  Regardless of whether sexual abuse is the basis for the child's behavior, such behavioral changes suggest difficulty with the child-adult relationship, discussion and resolution of which should help their child.  If abuse is uncovered, the parents need to understand how their reactions will affect their child and learn how to minimize the harmful effects of the abuse.  There is evidence, for example, that not all sexually abusive interactions harm youngsters (Bernard, 1982; Daugherty, 1986; Nelson, 1982; Tsai, Feldman-Summers, & Edgar, 1979).  Many negative effects are caused by the reactions of adults, particularly the parents and the criminal justice system, to the disclosure of abuse (Bernard, 1982; Summit & Kryso, 1982).

Related to this is the problem of adult response to abuse disclosures.  Negative consequences are frequently associated with disclosure of sexual abuse.  Thus, the child's perception of what will happen if he or she tells may encourage secrecy about sexual abuse (Besharov, 1981; Helfer, 1982; Nelson, 1985; Schultz & Jones, 1983).  Most sexual abuse cases are handled through the criminal justice system, which increases the stress placed upon a child and family, and which may result in additional social consequences of disclosure.  Berrick (1988), for example, described some comments by parents who were asked how they would respond if they discovered a neighborhood child had been sexually abused: "I'd never let my child play with that kid again," "I'd make the little friend comfortable, but then would tell my daughter not to play with the little friend anymore or go play at the friend's house" (p. 551).

Such factors may make it less likely that a child will report sexual abuse (Schultz & Jones, 1983).  In fact, a perpetrator may threaten these outcomes to sustain the abuse (suggesting to the child that the child would not be believed or that the child would be taken from home and that everyone would find out about it).

Responses to child sexual abuse cases should both recognize the rights of the accused and reduce the traumatic impact of a disclosure.  The currently popular use of multidisciplinary teams and the increased availability of options for responding to reports of child sexual abuse, including alternatives to prosecution, may make reporting less of a double edged sword (Besharov, 1981; Schultz & Jones, 1983).  Professionals responsible for responding to and treating sexually abused children must also recognize that not all abuse is traumatic or damaging.  They must be careful not to promote psychological iatrogenesis through their presumption of trauma (Besharov., 1981; Money, 1988b).
  

Alternate Approaches To Reduction of Motivation To Sexually Abuse

Given motivation to sexually abuse a child, Finkelhor's model explains the factors which combine and interact to permit sexual abuse.  But his theory does not adequately explain how motivation to sexually abuse a child develops.  To find the answer to this question, we must turn to the research on paraphilias and the development of sexual deviations.  John Money, Director of the Psychohormonal Research Unit of John Hopkins University and Hospital has developed a theory of sexual development which describes how normal sexuoerotic functioning as well as how pathological sexuoerotic functioning may evolve (1986).

Childhood is a critical period for the development of a normal and healthy sexuality.  It is during this period that an individual's lovemap is formed.  For Money the lovemap is a template upon which is designed the image of the idealized lover as well as the form and expression by which the child, as an adult, will manifest a romantic and erotic relationship with that lover.  Stored during childhood, the lovemap is first manifested in the dreams and fantasies of adolescence, then reinforced during adolescence through masturbation, and eventually fully emerges in adulthood through the actions, feelings and behaviors with the love partner.

Recognition and acceptance of childhood sexuality and its expression enhances the development of lovemaps in a manner not unlike how promotion of language development in the young child results in the normal development of language capability.  As a fundamental developmental process, lovemap formation may be distorted or damaged by virtue of adult reactions to childhood sexual explorations and feelings.

Under optimum conditions, prenatally and postnatally, a lovemap differentiates as heterosexual.  Age-concordant, gender-different, sexuoerotic rehearsal play in infancy and childhood is prerequisite to healthy, heterosexual lovemap formation.  Deprivation and neglect of such play, may induce pathology of lovemap function, as also may prohibition, prevention and abusive punishment and discipline.  Conversely, exposure too abruptly to socially tabooed expressions of sexual-eroticism may traumatize lovemap formation.

Lovemap pathology manifests itself in full after puberty.  The three categories of pathology are hypophilia (also referred to as sexual dysfunction), hyperphilia (erotomania), and paraphilia (legally known as perversion).  In all three there is a cleavage between love and lust in the design of the lovemap.  In hypophilia, the cleavage is such that lust is dysfunctional and infrequently used, whereas love and love-bonding are intact.  In hyperphilia, lust displaces love and love-bonding, and the genitalia function in the service of lust alone, typically with a plurality of partners, and with compulsive frequency.  In paraphilia, love and love-bonding are compromised because the genitalia continue to function in the service of lust, but according to the specifications of a vandalized and redesigned lovemap (Money, 1986, p. xvi).

According to Money, pedophilia (i.e., sexual attraction towards children) is considered an inclusion paraphilia (Money, 1984, 1988a; Money & Weinrich, 1983).  As a prerequisite to eroto-sexual arousal and orgasm, the image or actual eroto-sexual activity of a prepubescent child is required for the pedophile.  For example, pedophilia may develop from a childhood experience such as a child being discovered by a parent, masturbating with one of his friends, and being subsequently severely punished for this normal expression of childhood sexual curiosity.  The images associated with that contact may become imprinted in the lovemap because of the salience of the adult response, and re-emerge during adolescent masturbatory fantasies where they are reinforced and strengthened.  As an adult, the images imprinted upon the individual's lovemap may be those of prepubescent male children.

There is considerable support for the universality of childhood sexuality.  Numerous studies have documented the existence of childhood sexuality in cultures in which its expression is not proscribed or punished (Constantine & Martinson, 1982; Currier, 1982; Gunderson, Melås & Skår, 1982; Malinowski, 1929; Mead, 1928; Money, 1986; Spiro, 1965).

Accepting the presence of childhood sexuality, a view of human sexuality which is developmental in nature, and the existence of a theoretical relationship between manifestations of sexual interest in children by adults and traumatized sexual development during that adult's childhood, provides guidance for prevention efforts.  Such efforts may be divided into two approaches.  First, one may intervene with adults who are currently manifesting sexual arousal patterns towards children.  Second, efforts may be directed at children to prevent the later development of abnormal sexual arousal patterns.

The latter includes education of parents, teachers, and adults in general as to the existence of childhood sexuality, and the normalcy of childhood behaviors such as masturbation, mutual masturbation, viewing of the genitals of other children, exhibitionism, and consensual genital sex play with same-aged children.  Parents can be encouraged to give their children age appropriate sexuality education including teaching children about the sexual parts of their bodies, their functions, and the normalcy of feelings associated with sexuality (Bernstein, 1978; Kenny, 1989; Krivacska, in press-b; Money, 1986).

Efforts at encouraging the development of a healthy and normal sexuality in children and adolescence will not bear fruit relative to the prevention of child sexual abuse for a generation.  Of immediate concern is the presence of adults who are currently motivated to sexually abuse children and what to do to reduce the likelihood of such individuals acting on their inclinations.  Described earlier were approaches to increasing internal and external inhibitions, including suggestions that these individuals seek counseling.

Numerous approaches to the treatment of pedophilia have been attempted.  To date, these sexual deviations have been found to be resistant to treatment (Wakefield & Underwager, 1988).  However, traditionally, such treatments have been imposed upon individuals who have been apprehended and incarcerated for repeated sexual encounters with children.  This group may represent a biased sample in terms of the severity or intensity of eroto-sexual response to children.

Additionally, other personality factors may increase the likelihood of these individuals being apprehended, but which may decrease the potential for treatment effectiveness.  Also, drug-related research has shown some promise, particularly the use of Medroxyprogesterone Acetate (MPA - marketed under the name Depo-Provera) in the treatment of sexual disorders (Money, 1983, 1988a; Money & Bennett, 1981) as has behavior therapy (Wakefield & Underwager, 1988).  Efforts at successful treatment models, both drug and non-drug, must be increased so as to provide treatment options.

Two factors impede progress in this area.  First, public misunderstanding of the nature of paraphilias, in particular pedophilia, has resulted in an overriding interest in punishing the perpetrator.  This reaction is, in part, based upon a perception of the volitional nature of sexual attraction to children.  Claims that male domination in society, the pervasiveness of pornography, the portrayal of children as sex objects through advertisements, and the degree of power and control adults, particularly males, manifest over children, all contribute to sexual abuse (Finkelhor, 1984), further promote this perception of volitional control over sexual arousal patterns.  Also contributing to this perception are suggestions that anyone can be an abuser, and that punitive measures, or threats thereof, will prevent abuse.

Patterns of sexual arousal, however, are generally established by early adolescence and firmly ingrained into the individual's sexual response pattern by the end of adolescence (Money, 1986).  In either event, sexual attraction to children precedes any of these other factors.  Though in some ways these other factors may raise or lower other internal or external inhibitions against abuse, they are nevertheless unrelated to the emergence of sexual arousal patterns in which children become the preferred love object.  Apprehension, conviction, incarceration, and subsequent release of pedophiles does little to alter their sexual proclivities.  They are likely to repeat their patterns of behavior if they are untreated (Wakefield & Underwager, 1988).

The second factor which impedes attempts to prevent sexual abuse by reducing motivation to sexually abuse a child within the current adult population has to do with confidentiality of treatment (Krivacska, in press-b).  Several approaches described earlier include the presentation of treatment options and counseling services to those who feel sexually attracted to children and encourage them to seek treatment prior to becoming sexually abusive.

There remains, however, a significant stumbling block to the seeking of therapy.  Mandatory reporting laws require therapists (in contradiction of therapist-client privilege) to immediately report any suspicions of sexual abuse.  Thus, individuals seeking counseling to address their tendencies to abuse children are virtually guaranteed apprehension, conviction and incarceration if they disclose or seek counseling for any abusive behavior that has occurred (although this would not be true if the individual has not yet acted on the behavior tendencies).

Critical to any attempt at reducing the motivation to sexually abuse children in the current adult population is confidential treatment of abusers.  While one may argue that by providing such treatment to abusers their victims remain unrecognized and untreated it is also true that in the absence of that individual seeking treatment, their victims would still likely remain anonymous.  If such individuals remain untreated, however, they are likely to abuse many more victims.  There is, in fact, precedence for such an approach.

Besharov (1981) reported on the use of a "Confidential Doctor System" in use in the Netherlands and Belgium, which was developed and introduced in the early 1940s in order to respond to and treat child abuse.  This program has been successful, with compulsory intervention rarely required.  A side effect of confidential treatment may be an increase in the willingness for children to acknowledge abuse which they have experienced.  Some children or victims of sexual abuse may resist obtaining treatment because of the mandatory reporting requirements and their desire to keep the abuse confidential either for their own protection or that of the abuser, whom they may love and not wish to see get into trouble (Nelson, 1985).
  

Summary

Prevention of child sexual abuse may eventually depend more on programs directed at adults than programs directed at children.  Such programs may include education about normal sexual development and normal sexuality for parents in order to encourage the normal sexual development of children so as to preclude the evolution of deviant expressions of sexuality in adulthood.  Programs directed at adults may also include approaches which will increase both the internal and external inhibitions against abuse for those who may be so inclined, as well as attempt to directly intervene with adults who are sexually aroused by children.  With respect to the latter, provision of confidential treatment for adult abusers is essential.
  

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