||Therapy for Adults Molested as Children
||Springer Publishing Company © 1989
Springer Publishing Company
New York, New York 10012
This 219 page book consists of ten chapters and two
short appendices on psychological testing. The author is a
treatment pioneer in post-sexual trauma and the book was written for
psychotherapists who work with adults molested as children.
Dr. Briere uncritically accepts the conclusions of
many published studies that "sexual abuse is commonly associated
with serious psychological pain and suffering — trauma that may
persist over the years unless specifically resolved" (p.4).
He asserts that the relationship between abuse and effects "appears
quite straightforward: A sexually abusive environment usually hurts
children and, in the absence of appropriate treatment, hurt children
often grow to become hurt adults" (p.28-29). He then
describes the types of psychological effects believed to exist in the
sexual abuse "survivor," including a list of "core"
effects of sexual abuse.
The section on treatment, called
"survivor-oriented therapy," is based upon a psychodynamic
philosophy. The key issue in therapy is the original abuse.
The assumption is that childhood molestation may be relevant to many
adult and adolescent problems and that the therapist should always
consider the possibility that a client's presenting problem stems from
the abuse. He discounts the possibility of false accusations in
borderline and/or histrionic individuals and stresses that the therapist
believe the client's accounts of sexual abuse. The client should
be reassured that the abuse was not her responsibility and she should be
supported in the "healthy expression of rage."
Transference and countertransference are discussed
and Dr. Briere states that "Even disregarding the author's
impression that psychotherapists are considerably more likely than
others to have been maltreated as children, it is probable that child
abuse issues have personal relevance for many therapists"
(p.74). This may create problems in therapy: "Because the
repressing therapist spends considerable psychic energy keeping her
abuse out of consciousness and her anxiety down to manageable levels,
she may unconscientiously work to prevent the client from exploring her
own memories and feelings" (p.75). Dr. Briere gives several
concrete suggestions for minimizing the potential problems of
transference and countertransference.
He then describes several specific therapy techniques
such as "facilitating emotional discharge," role playing,
"good person, bad person," desensitization, working with the
"inner child," and self-control techniques such as relaxation
and self-talk. The section on family and group therapy is very
short, considering that group treatment is often recommended as a
preferred intervention. There is a brief discussion of the pros
and cons of confronting the abuser in a family session.
There is a chapter on client gender issues and the
power dynamics of male therapists with male or female clients and female
therapists with male or female clients. The book concludes with a
chapter on problems of isolation and burnout experienced by therapists
who work in this area. Dr. Briere believes that "A society
that discounts abuse and its effects will also discount those who work
with abuse victims" (p.168).
The appendices discuss Rorschach and MMPI patterns
found in adults who were molested in childhood and his own research on
the Trauma Symptom Checklist (TSC-33). The book ends with a
The main problem with this book is the uncritical
acceptance of the studies purporting to show severe difficulties
resulting from childhood sexual abuse. There is no discussion of
the problems in the studies he cites. Many of them have serious
design and measurement flaws which mean that any conclusions drawn from
them are highly tentative. For example, there are serious problems
with any studies which depend upon retrospective data, and it is
difficult to identify a direct cause and effect between sexual abuse and
later psychological problems in that sexually abusive families
frequently have other problems as well. There is no mention of
studies which show few or no effects in a nonclinical population.
He cites no evidence supporting his assumptions about
transference and countertransference in psychotherapy with adult sexual
abuse survivors. Although his hypotheses are interesting, they
should not be presented as fact. However, his suggestions for
dealing with possible problems are practical and useful.
We do not agree with Dr. Briere's philosophy that
everything a hysterical or borderline client says must be believed and
the client then treated for abuse that may never have occurred.
There is no discussion of possible iatrogenic effects of entering a
treatment program for abuse if there was no abuse. It is
conceivable that reinforcing a borderline individual (through attention
and talking about it in therapy) for abuse that never happened could
cause a deterioration in her ability to distinguish reality and trigger
a psychotic episode.
Although treatment techniques are described, there is
no mention of therapy outcome studies using these methods.
Behavioral techniques, which are supported by research, are described
alongside of other techniques which lack evidence to support their
use. Analogies are drawn between rape, incest, and extrafamilial
abuse as if the type of the offense makes no difference in
treatment. However, a critical reader may find some of the
specific techniques useful.
Reviewed by LeRoy Schultz, Professor, School of
Social Work, West Virginia University,
and Hollida Wakefield, Institute for Psychological Therapies, Northfield,