Sage Publications Description: This 292 page edited book consists of 16 chapters written by a wide variety of authors. The book focuses on the incest offender and information necessary for responsible treatment. It is divided into three parts — defining the problem, profiles and identification, and treatment. Chapters cover topics such as the problems in defining incest, reporting requirements and confidentiality in therapy, sexual abuse by stepfathers, biological fathers, and noncustodial fathers, isolation as an etiological dynamic, the grooming process, sibling incest, sexual abuse by women, sexual addiction, community resources, offender identification, and treatment issues for clinicians. As in many edited books the chapters are of uneven quality with some being quite good and others of dubious value. The editors of this volume have included a majority of chapters that do not demonstrate an awareness of nor an adherence to some basic scientific values and criteria. Several of the chapters are based on The Incest Perpetrator Project, which collected information about incest perpetrators from volunteers from different types of treatment programs. These included Parents United, the Sex Offenders Unit at Utah State Prison, forensic mental health facilities, and private agencies. The respondents filled out a 304 item questionnaire which was the basis of the information gathered. The book closes with a weak list of resource organizations
and a good index. Discussion: Much of this anthology is a repetition of old ideas and programs, but some chapters present new ideas. For example, Chapter 8 on women perpetrators of child sexual abuse discusses barriers to recognizing female child sexual abuse. The author, Craig Allen, believes that major barriers are Freudian beliefs about the incest taboo, feminist explanations of child sexual abuse as male dominance and exploitation of women and children, and overgeneralization of the empirical observation that female sexual abuse of children is rare. The author points out that serious attempts to gather information about female abusers are just beginning and recommends withholding judgment about such cases until more is known. The discussions in Chapters 2 (Susan and Frank Bolton) and 16 (Robert Kelly) on confidentiality issues and the duty to report aptly illustrate the difficulties for the clinician who is caught between the legal requirements and desire to provide effective treatment. There is much confusion about what is actually required legally, and Chapter 16 offers several recommendations. These are sensitive and insightful presentations of unavoidable tensions for the clinician. Chapter 5 by Jane Gilgun and Teresa Connor on isolation as a factor in sexual abuse presents an interesting concept. Although the data comes from in-depth interviews with perpetrators and consultations with clinicians rather than from an empirical study, the chapter is thoughtfully written and is consistent with observations frequently made by clinicians. It presents a good starting point for testing a hypothesis which could prove helpful in treatment. Jon Conte's introduction presents a good overview of the problem and the current state of knowledge. He states that many of the currently accepted concepts about incestuous offenders should be viewed cautiously as untested theories. Unfortunately, some of the chapters which follow fail to heed this advice. The major difficulty in this book is the repetition of unsupported beliefs and myths about incest and sexual abuse in some of the chapters. In Chapter 11 on professional and treatment issues for clinicians, Lynn Roundy and Anne Horton state that "Recidivism is a fact of life with this population" (p.180). In reality, studies about recidivism agree that incest perpetrators, in contrast to other sexual offenders, have low recidivism rates. These authors also make a number of unsupported assertions about religion. They claim that it is not uncommon for the clergy to deny that the member of the congregation has abused a child and call the victim to repentance for fabricating the allegations. They assert that perpetrators have very rigid religious values (a claim also made in Chapter 12). Although the authors acknowledge that these observations are not documented in the literature, they are nevertheless presented as true. They state that "professionals who treat incest are subjected to negative feedback from a segment of the clinical community" (p.171). There is no support offered for this claim, which we have never heard before. They use Russell's figures on the prevalence of sexual abuse, which are higher than anyone else's, to assert that "sexual abuse is common in families" (p. 168). Nodie Davis, Vicki Granowitz, and Deena Levi in Chapter 12 make the astonishing recommendation that "it is imperative that an evaluation for the potential of incest be undertaken with virtually every client" (p. 190). This means that even if clients have an entirely unrelated presenting complaint they should be evaluated for their potential to be incest offenders. This possibility "should remain in the therapist's thoughts ... throughout the course of treatment." Were this suggestion to be seriously considered and followed, it would most assuredly produce such a high rate of false positives that unavoidable mischief would be done. Several "guidelines" for determining that a family or client is at high risk for incest are presented. These include personality disorders, coming from a dysfunctional family, chemical dependency issues, co-dependency, authoritarian discipline in the family of origin, dressing younger than the chronological age, delayed or accelerated development of secondary sex characteristics in adolescence, rigid religious back-grounds, loss of job or a death in the family, being easily threatened or defensive. Guidelines for assessing risk in children include insecurity, perceptions of powerlessness, previous molestation outside the family, absence of friendships and activities outside of the family, and physical or mental handicaps. It is suggested that an important question in assessing the child is "Is the child able to say 'no,' and is that 'no' respected" (p. 195). Additional guidelines are presented for assessing relationships, and include such things as communication characteristics, power imbalances, former abusive relationships, and parenting behavior. The authors state that an affirmative finding on any single factor is not in and of itself indicative of the probability of incest. But the clinician should use these guidelines for determining when a family is at high risk. However, their criteria (only some are listed here) are so inclusive that it is unlikely to find any client or family who failed to met several. Also little or no empirical evidence is given to support the efficacy or utility of these suggested guidelines. Such recommendations can only be based on the assumption that incest is epidemic in our society. The danger of these recommendations is that such a stance is likely to result in ready suspicion and the inadvertent development of a false accusation. Sexual addiction appears several places in the book. Patrick Carnes devotes Chapter 9 to it and the concept is mentioned in several other chapters. But nowhere is it acknowledged that this is a controversial concept which does not enjoy general acceptance from experts in the field. The problems with an addiction model applied to human behavior are not explored. Kathleen Faller (Chapter 4) reports on her clinical experience with 196 stepfathers, biological fathers, and noncustodial fathers who sexually abused their children. Although half of the biological fathers and stepfathers admitted to the abuse, only 20% of the noncustodial fathers did. Since these cases were all "validated," the author assumes the abuse was real and those who did not admit were denying. She therefore goes on to discuss the characteristics of the abusing noncustodial fathers and the hypothesized factors that resulted in their abusive behavior. However, since there is no discussion of what is meant by "validated" (i.e., substantiation by a social worker, the statement by a child, suspicions of a caretaker or custodial parent, a finding by the justice system, Faller's opinion, etc.) there is no way to evaluate her chapter. There is likely to be an indeterminate number of false accusations included in her subjects, but with the information she supplies, this cannot be assessed. There is no attention given to false accusations in this book. The impression is that this is not perceived as a serious problem. For example, Charlotte Shuler in Chapter 15 recommends that a child be referred to therapy as soon as the incest is "discovered" and that the therapist participate with the police in the early interviews. Such a stance assumes that all allegations once made must be true. The potential of this policy for iatrogenic harm to the child is ignored. The book would have been better and have more value to the clinician had all of the chapters adhered more rigorously to the empirical data. As it stands now it has little to offer to the clinician who desires to grow professionally and responsibly in the treatment of incest families, perpetrators, and victims. Reviewed by Hollida Wakefield and LeRoy Schultz.
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