Springer Publishing Company Description: 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
14-page bibliography. Comments: 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, Minnesota.
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