Title: |
Males at Risk |
Authors: |
Frank Bolton, Larry Morris, and Ann E. MacEachron |
Publisher: |
Sage Publications, Inc. © 1989 |
Sage
Publications, Inc.
2111 West Hillcrest Drive
Newbury Park, California 91320
(805) 499-0721
$35.00 (c) / $16.95 (p)
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:
Thus, for the male victim of the abuse of sexuality, the
impact could range from nominal to quite damaging, depending upon a number of
environmental and personal variables. The task for the clinician is twofold:
accurately asses the nature of the abuse and its relative importance to the
presenting problems and develop an effective treatment program accordingly (p.
93).
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:
You are a sexually abused child and you have been traumatized
by this abuse. You are not responsible for your abuse, but it is vitally
important that you learn to discuss the details of the abuse and then express
and accept your feelings about the sexual abuse and what has happened to you since
(p. 126).
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.