Sage
Publications, Inc.
Description: This 264 page book is about males and sexual abuse experiences. It begins by discussing male sexual development and how male sexual socialization is different from that of females. The authors believe our current definitions of childhood sexual abuse with the focus on overt sexual contact are too narrow and propose an "Abuse of Sexuality" model. Children can be raised in environments ranging from nurturing and healthy to those which abuse sexuality through over-stimulation and overpermissiveness, evasiveness, misinformation and negative attitudes, or seductiveness from adults. This model, therefore, allows consideration of experiences that disrupt the development of healthy sexuality but do not meet the usual definitions of "sexual abuse." The authors then critically and thoughtfully review the literature concerning male. victims. They point out that there is not agreement concerning incidence, effects, perpetrator characteristics, the development and events surrounding male sexual abuse, etc., and they note the "tenuous nature of the knowledge base" (p.73). However, they summarize what is known. They have a good discussion of female offenders and of the pedophile, and they carefully review the literature on the consequences of sexual abuse. They note that although there are individual differences, male victims do experience emotional and behavioral problems as a result of sexual abuse. The situation may be complicated for males through the stigma of homosexuality and the expectation that a male should be self-reliant and able to take care of himself. The authors critically evaluate the claims that childhood sexual assault leads to homosexuality or to becoming a perpetrator. The last half of the book deals with assessment of effects and with treatment for adult survivors and children. The authors state:
The authors note that less than 5% of the sexual abuse treatment programs are specifically designed for the male victim of any age. They emphasize the need to carefully assess the individual and then use a mix of theoretical concepts and approaches. They point out that except for the source of the problems and personal victimization issues, male victims of the abuse of sexuality have emotional and behavioral problems common to other males who enter psychotherapy. Therefore, techniques which have been found useful for such problems are appropriate to use here. The authors stress that although insight-oriented therapy may enable the male to learn the connections between his victimization and his problems, insight alone doesn't solve these problems.. In addition to describing the emotional and behavioral problems that must be addressed in therapy, the authors discuss therapeutic goals and provide descriptions of many different techniques. They have developed a "Systematic Multi-Remedial Evaluation and Treatment" model and they provide research evidence for the treatment techniques described. In general, their approach uses a variety of behavioral techniques, cognitive restructuring, and sex education. The authors include a thoughtful discussion of relevant topics such as confronting the abuser, developing healthy relationships, confusion about sexual orientation, assessment and treatment for sexual dysfunctions, and treatment of deviant sexual responses. The section on treatment for sexually abused male children is excellent. The authors point out that most treatment approaches for children give the child the primary message:
However, they assert that the focus must not remain on emotional responses and expression of feelings. Effective treatment for child victims must also include "techniques for altering the maladaptive conditioned and socially acquired affective, cognitive, and behavioral response to the sexual abuse experience" (p.127). For example, the child should be given an opportunity to learn and demonstrate competency and the therapist should focus on the child's knowledge and skills, and not on his role as a victim. The therapy should include teaching relationships and coping skills, anxiety reduction, anger management, and appropriate sexual behavior and beliefs. The last chapter is on formulating their Systematic
Multi-Remedial Evaluation and Treatment approach. The multidimensional
assessment technique is presented and various psychological tests and assessment
questionnaires and techniques are discussed. A six-step treatment process is
then described. The book contains an excellent bibliography of approximately 500
references. Discussion: The authors have carefully reported the research and thoughtfully conceptualized their Abuse of Sexuality model. For the most part they have avoided the repetition of unsupported beliefs and claims about sexual abuse which has characterized much of the literature on sexual abuse victims. Their section on effective therapy for child victims is particularly useful and provides a welcome contrast to the feeling-expressive insight-oriented type of therapy which is used over and over again, despite the lack of any empirical evidence for its efficacy. One criticism of the book is that the authors are sometimes not sufficiently critical of some beliefs and techniques. For example, Summit's child sexual abuse accommodation syndrome is described and uncritically accepted although there is no empirical evidence supporting this hypothesized accommodation process and the syndrome has been challenged and refuted in recent years. They uncritically describe the use of anatomical dolls, play, and drawings for assessing both school-aged children and adolescents, even though there is no empirical base supporting the use of these techniques. Despite these criticisms, this is an excellent book. It provides a thoughtful discussion of what is known about sexual abuse of males and gives detailed information about assessment techniques and treatment strategies. I recommend it to anyone who works with male incest victims. Reviewed by Hollida Wakefield, Institute for Psychological Therapies, Northfield, Minnesota.
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