Evaluation of Charges of Sexual Abuse in the Context of
Custody and Divorce
Gloria Burk, Ricardo Hofer, Katherine MacVicar, Morton Neril, & Robert Schreiber*
ABSTRACT: Sexual abuse allegations arising in the divorce and custody
context present extremely difficult problems for the evaluator The
allegation damages the family system and highlights dysfunctions within individual members and the family system itself.
The allegation, whether
true or not) is a symptom of significant family pathology. Therefore, the
evaluator should consider the developmental, dynamic, and family context
and obtain information from all possible relevant parties. The evaluator
should also attempt to minimize the trauma that results from a sexual
abuse investigation and evaluation. A case study is presented to
illustrate this approach.
In the last few years we have encountered an increasing number of
allegations of sexual abuse of children in the course of doing child
psychotherapy or when conducting formal evaluations, usually at the
request of a court. In the latter category; there has been a marked
increase in the number of cases referred to us where the allegations were
in the context of a bitter custody battle.
Even a casual perusal of the popular press and the research and
clinical literature indicates an exponential increase in the reports of
sexual abuse (Muram, Dorko, Brown, & Tolley, 1991), especially in
custody disputes. The proliferation of work in this area has led the
American Psychological Association to start publishing a separate set of
abstracts dealing with just this topic, and several professional journals
have devoted entire issues to it (e.g., the Fall, 1991 issue of the Journal
of Psychohistory devoted to historical and anthropological data on
child sexual abuse, and the 1991 issue of Child and Youth Services devoted to the problem of
false allegations of abuse).
Due to the emotional nature of the subject, as well as to the
inherent difficulties in ascertaining the facts when working with young
children, the great increase of these reports has led to a host of
worrisome questions for mental health professionals. How can we reliably
ascertain the incidence and prevalence of sexual abuse of young
children? Are we going through an historic period in which the incidence
and prevalence of such abuse is actually higher than in the past or are
we witnessing a lifting of long-repressed injunctions against the
recognition and reporting of very disturbing and destructive attitudes
and behaviors towards children? (DeMauss, 1991, Kahr, 1991). Is the
current epidemic of reports of child sexual abuse encouraging some
disturbed adults to believe they were abused as children or to search
for evidence of sexual abuse in others when it doesn't exist?
We believe that these factors contribute to the great increase of
sexual abuse reports in legal battles, and especially in custody
disputes. As sexual abuse allegations move into the legal arena, with
its formalized and specific set of rules, the opportunities for
distortion and manipulation, whether conscious or unconscious, grow
exponentially (Awad & McDonough, 1991; Pogge & Stone, 1990;
Saunders, 1988; White & Quinn, 1988).
In response to this, professionals from a wide variety of
disciplines, experience, and training, have become involved in the
investigation, evaluation and treatment of child sexual abuse (e.g.,
Coleman, 1990; Kendall-Tackett, 1992; Kendall-Tackett & Watson, 1991;
Korner, 1990; Muram, 1991; Paradise, 1989; Realmuto & Wescoe, 1992;
Strickland, 1989; Trute, Adkins & McDonald, 1992). These include
members of police departments, child protective services, prosecutorial staffs, pediatricians, and every kind of mental health
professional. Some mental health professionals have specialized in sexual
abuse evaluations and some centers have been created solely for that
purpose. As the result of this proliferation, a network of vested
interests, and even a bureaucracy, has developed that in its mixture of
crusading zeal and cottage industry often adds confusion to the assessment
of child sexual abuse. All of us have seen cases in which the
investigation of sexual abuse turned out to be as traumatic as the alleged
abuse itself (e.g., Hunter, Yuille & Harvey, 1990;'Goodman et al.,
1988; Kelley, 1990; Ordway, 1983; Schetkey & Benedek, 1989; Summit,
Mental health professionals must therefore consider all that has been
learned about the developmental, dynamic and family context of child
sexual abuse. In this paper we summarize our understanding of these
factors and how they impinge on the evaluation and treatment of child
The very fact that the allegation is sexual in nature instantaneously
confers a highly emotional charge to the situation and to all the
participants, including the professionals. No one is neutral about
sexuality, and most certainly not when it involves sexuality between
adults and children. In addition, an allegation of improper and
unacceptable sexual behavior occurring in the family, the main
socializer and regulator of sexual activities and the supposed provider
of a safe and protective environment for the young, adds intensity to
the entire situation. An allegation of sexual abuse within the family
severely damages the entire system of alliances within it, disrupting
established roles, unraveling bonds of trust, and highlighting
dysfunctions within individual members and the family system itself
It is important to emphasize that these effects are present whether
or not the abuse has occurred. They will take place as a result of a
report being made. The children become psychological pawns for the
adults involved: if the charge is true, pawns of the perpetrator; if
false, pawns of the accuser. In either case, harm ensues. The same is
true for the relationship between the adults following such a report.
The very existence of an allegation means there is serious family
pathology. This is likely to evoke strong feelings in the professionals entrusted with the family's investigation and treatment.
Mandatory reporting laws are in effect in most states. The practical
consequence of these laws is that the judicial system becomes involved
in sexual abuse cases early and intimately. While we think it is
appropriate to view this matter to be of such gravity to require the
involvement of the judiciary, it is important to bear in mind the
difference in goal and method used by the judiciary and mental health
professionals (Indest, 1989; Pogge & Stone, 1990; San Diego County
Grand Jury Report, 1992; Saunders, 1988; Watson, 1988; white &
The main goal of the judicial system is to determine if the charge is
true. The goal of finding out "what happened" unifies all the
stages of the judicial proceeding, from the questioning by the police,
through investigation, prosecution, defense, and final adjudication.
This goal informs the methods used at every stage.
While mental health professionals are interested in whether or not
the allegations are true (the reality principle), the core of the
professional's work and its main goal is the understanding of the meaning
that a given event, act, feeling or thought may have had for those
involved. This addresses a complex set of theoretical and clinical
tenets regarding personality theory and development. This emphasis on
the meaning of an act and its function in the person's life dictates the
methods that the mental health professional will use in trying to
discern those meanings: very detailed attention to the manner of delivery and content of speech
or other forms of communication (e.g., play, in children); great interest
in historical and developmental issues to aid in the understanding and
interpretation of current situations; the search for coherent themes in
the person's productions; a detailed exploration of the circumstances of
the family because of the role that intrafamilial relationships play in
the theory of personality functioning and development.
Different goals can result in serious problems when the judicial and
mental health systems collide. Seen from such different perspectives,
the same set of "facts" may be interpreted very differently.
professionals may see the workings of the judicial system as further
traumatizing the child and compromising an already seriously weakened
functioning of the family. Members of the judicial system sometimes see
the mental health professionals as fuzzy thinkers who do not respect the
rules of evidence and who hide behind impenetrable jargon. This is an unfortunate
state of affairs. It is obvious that this is one area where it is
imperative that there be clear communication between the two systems if
there is going to be any hope of bringing about
some resolution to the suffering families.
This situation has not been improved by the blurring of methodologies
found in the segment of the mental health community which we have called
the sexual abuse evaluation "industry." Under the guise of
psychological interviews, relentless and intrusive questioning of
children occurs without any regard for the most elementary principles of
interviewing. The "facts" are pursued without consideration of
their meaning to the child or for the effects of the process itself upon
In addition to the difficulties found in the intersection of the
judicial system and the mental health professional, it is important to
be mindful of the trying circumstances in which the latter is placed
when conducting a sexual abuse evaluation. While mental health
professionals are trained to systematically monitor countertransference
reactions, accusations of sexual abuse in children, particularly if
incestuous, tend to evoke very strong feelings associated with the
deepest layers of the evaluator's personality. The frequent
disintegration of the family attendant on sexual abuse allegations, the
high emotional pitch of all the participants, the heavy pressure that
the protagonists and society place on the mental health professional to
"solve" the situation (again the "did it happen or
not" question), all converge to put a heavy burden on the emotional
equanimity of the evaluator. The fact that so much is at stake for
parents increases the risk of being sued for malpractice or of being
reported to a licensing board. An evaluator's work is more exposed to
monitoring and review by mental health and other professionals than it
is for the traditional therapist. Mental health training programs
rarely, if ever, prepare trainees for hostile cross examination by an
attorney. It is little wonder that many professionals enter these cases
limit the number of such cases, and almost universally report emotional
exhaustion at the end.
Evaluation of a Case of Suspected Child Abuse
We have chosen an actual case that presents many of the theoretical,
technical, and practical aspects of this
complicated question, and lends itself to a comprehensive discussion of
child sexual abuse as it arises in the context of families in a disputed
custody evaluation. As we follow the evolution of the case and its
evaluation, we will comment about the larger issues involved and suggest
guidelines for improving the management of these cases, as well as point
to areas for further study. Names and some details have been altered to
Background of the Incident
William and Sheila were married after living together for a few months.
There were always problems, including heavy use of cocaine and alcohol, an
abortion, financial difficulties, and antagonism between the two sets of
grandparents. Sarah was born after the first year of the marriage.
parents separated before the child reached age one, and were divorced six
For the first two days after the separation Sarah remained with father,
but then lived with mother for two years, until she was 3. According to
father, at that time mother more or less insisted that he take the child
because mother was moving, was having difficulty with her boyfriend, and
had no money. It was supposed to be a temporary arrangement (3 months),
but father continued keeping Sarah because he felt she would be moved
around too much. "Sarah was visiting her mother regularly every other
weekend without problems, except that in retrospect father thought Sarah
was ecstatic to see him and "unhappy" after being with mother,
which suggested to him a vague sense of emotional neglect by mother.
had been no reason to suspect any physical or sexual abuse.
Sarah had been living primarily with father for approximately four
months. She was visiting her mother every other weekend. Mother picked up
her daughter for a routine weekend visit on a Friday evening. She returned her Sunday
evening about 9 P.M., as
usual, with no comment. According to father Sarah appeared "O.K.,"
except that she seemed "tired." When he put on Sarah's diaper before bed,
he noticed an "inflamed, puffed out" sore, shaped like a
"U" or a "W" between her vagina and anus. It looked
like "a cat took its sharpest nail and welted your arm." Father never
did call mother; as he said, "Sheila never asked about her ... and so what would make her have
any concern that I found a little
Two days later, after her return from day care, Sarah complained that
it hurt to go to the bathroom. The following Sunday or Monday father
asked, "How did this happen?" Sarah said, 'Mommy bit me and
licked me." Father said he did not pursue it, not wanting to make
something of it, but did tell his girlfriend, Ann, who stayed
occasionally during the week and over weekends. Ann said Sarah told her
that, "Mommy licked me and bit me and hit me with a spoon but it was an
accident." At some point (presumably two days later), Sarah came at
Ann, "and for no reason, started kissing and licking" her
legs. Ann tried to get her to stop, and said, "She was heading for
the genital area."
The way the report was made is not unusual, particularly with separated
or divorced parents. It illustrates the problem of troubled communication
within the family. Often, as is true here, divorced parents have not
talked directly to each other for long periods of time. This exacerbates
the children's feeling of being caught in the middle, leading them to
do or say things that are uncannily attuned to the parents'
Children typically cast what they say in a context and manner that
reflects their specific developmental stage and concern. This adds to the
dangers inherent in a situation in which a parent is drawing conclusions
exclusively on the basis of the child's statements or behaviors. We are
all aware of how easily information conveyed in this highly charged
situation can be distorted, inaccurate, or misleading, and what havoc this
distortion can create in the lives of all the participants. The only
remedy is to get the parents to talk to each other. The implication for
the evaluator is the absolute requirement to meet and talk with the
accused parent and the advisability of meeting with both parents jointly, even when they are angry and hostile
towards each other.
It will be recalled that Sarah first reported the alleged abuse to her
father and his girlfriend.
The person to whom the child made the original statement is important
in terms of assessing the veracity of the report as well as in
understanding the possible function of the abuse or of the report. Although the initial context and the content of the interaction in which
sexual abuse is first raised is not known, such initial reports most often
take place within the family. If this initial report is enmeshed in the
family context, the psychological meanings will get increasingly
obscured and confused as the child is subjected to more and more
interviews, first with other members of the family (themselves quite
polarized), and then with people further and further removed from the
family. While mental health professionals can rarely control the initial
stages of the investigation, it is necessary to give a great deal of
thought and consideration to the history of the case before beginning the
A friend of Sarah's father who lived next door happened to be a nurse
at a local children's hospital. She told them to call the advice nurse
there, which resulted in their bringing Sarah to the hospital the
following morning. Although the medical findings were equivocal,
"... could be caused by manual, oral [after the doctor was told the story],
or chemical," the social worker concluded that Sarah had been
sexually abused. At this point many people became involved, including
doctors, nurses, social workers, and policemen.
The authorities who are most likely to first hear a report of sexual
abuse the police, family doctors, ministers, or teachers
vary greatly in
levels of skill, experience, and character structure. This is also true of
those who follow the initial report, such as child protective services
workers, hospital emergency room personnel, and mental health
professionals of all disciplines. It is desirable to involve properly
trained people as early as possible and to videotape the initial
interviews, both to protect the child from intrusive duplication, and to
protect the "evidence" from further distortion or dilution.
Those who first deal with the abuse report often fail to achieve a
common perspective because of a lack of psychological training, the demands of an overburdened system, and
the different perspectives of the various professions that become
involved. Thus, police tend to be concerned with evidence for a
"crime," pediatricians to be looking for physical signs, child
protective service workers to be concerned with the immediate decision of
whether to leave the child at risk in the home, and mental health
professionals to be concerned with the emotional impact.
This absence of common perspective occurred in Sarah's case. There was
an early presumption that abuse had, in fact, happened. From that point
on, the effort was to find evidence that would confirm that presumption.
The focus was so narrow that two crucial factors in the proper evaluation of
sexual abuse were neglected the dynamics of the family functioning, and
Sarah's current developmental stage.
Family Dynamics Considerations in the Evaluation of Sexual Abuse
Viewing the allegation of sexual abuse as a family symptom is central
to understanding its meaning and function. The alleged victim, the accuser
(if different), and the accused have to be seen as part of the fabric of
the family structure. The evaluation should center on the family unit and
its functioning. Just as Winnicott states, "without maternal care
there could be no infant," without a troubled family there could be
In any family there will be continually shifting patterns of alliances
that interlock with one another. Healthier families will have flexible,
adaptive relationships that are able to cope with a variety of stresses
over time. The more differentiated and mature the adults in the
more likely they are to accept responsibility for their lives, and the
less invested they are in having others, particularly the children,
provide fulfillment of unmet emotional needs, as well as supplying an
ongoing sense of well being.
There are many kinds of mutual adaptation that two people make when
they form a couple. These patterns of mutual adaptation are the result of
the individual psychologies each person brings into the relationship, as
well as the sociohistorical conditions in which the couple lives. And just as there is much variation in the
degree of psychopathology in the individual and in the sociohistorical
conditions, there is much variation in the degree of adjustment,
stability, and pathology in the functioning of couples. This is
particularly true as it pertains to the mutual fulfillment of basic human
It is into this matrix that children, so peculiarly powerless and
helpless but nonetheless so powerfully significant,
are placed and grow. Because children so deeply touch their parents'
emotional lives, they unavoidably have a strong effect on the entire
network of relationships. Thus, a child's presence can lead to a
redistribution of conflict and tension in the family structure,
resulting in substantial realignments in it. The child may side with one
parent and enter into conflict with the other, leading to profound
changes in the couple's functioning. Or the child may become the
recipient, through projection, of the couple's chronic tension, taking
on the role of identified patient through the development of symptoms.
Often, actual symptoms are less crucial than the elucidation of the
maladaptive patterns of interaction which lead to the development of
The evaluator will be continually exposed to the network of forces in
the family unit pressuring him or her to be swept up in it. But because
of the strong emotions created by the allegation of sexual abuse, the
evaluator must maintain a firm separateness and independence without
losing the necessary empathy to carry out the evaluation. Remaining
independent of the family system is made more difficult by the various
other professionals who become involved through the course of the
evaluation, all pressing for an answer to the question, "Did it
happen, or didn't it happen?"
The mother was not contacted initially. The evaluation and subsequent
investigation were carried on without her. By the time she was brought
into the picture the conclusion had been reached that sexual abuse had
occurred and she was considered the prime suspect.
The exclusion of the accused parent from the initial steps of the
investigation is unfortunately more the norm than the exception in our
experience. At the onset the accuser has already defined the roles of the
family members and the field of investigation. There is a victim and a
perpetrator. What is required and expected is an investigation to determine whether or not the
"crime" has occurred.
Although the final goal is usually stated in terms of the protection
of the child, the accusing parent often has the goal of punishing the
other parent. The evaluator must redefine the field to include all
family members and carefully assess the family unit, its areas of
conflict and difficulty, and the network of alliances. The final goal
must be to improve the emotional functioning of the family members,
regardless of the ultimate configuration of the family.
The allegation of sexual abuse must be understood in the context of
the family's shared history. What is the specific meaning of the
accusation of incest to this family, and what particular function does
The estranged father's accusation may allow him to express his rage at
mother for having forced the role of major caregiver onto him after their
breakup. What was to be a temporary arrangement became permanent,
presumably because father worried about the mother moving around too much.
Previous history of this couple indicates that their relationship was
problematic from the onset, with heavy drug use, a previous abortion, and
financial problems. Thus, by "protecting" Sarah from her
"bad" mother, father may be trying to repair what is to him a painful
time in his life while at the same time projecting all the
"badness" of this period onto his former partner.
The evaluator's task consists of discovering the family's established
patterns of functioning that were in place prior to the new rules that
appeared in reaction to the accusation, and of determining the changes in
interlocking relationships that made it possible for the child or parent
to make the accusation of sexual abuse public. It is often useful to
understand why the particular family member is coming forward, in this
particular way at this particular time.
Father appeared to have established a new life following his divorce
from Sarah's mother. His new girlfriend was very much involved from the
beginning of the investigation of the alleged abuse. No information is
provided about the girlfriend's role in the "discovery" of the
abuse and the questioning of Sarah about it, or about the even more
important issue of the quality of Sarah's attachment to her. In addition,
it appears that a psychologically naive assumption was posited: that the
girlfriend was a neutral objective observer, as if her relationship with the father did not count, or as
if she would not have feelings about his firmer wife.
It is essential in this kind of evaluation to assess the marital couple
dyad both at the time of the alleged events and at the time of disclosure,
especially its level of maturity and how successful it has been at
maintaining a clear separation of generational roles. Has it been able to
provide a secure, safe setting for its children that encourages growth,
independence, and self-expression, as well as ensuring a stable sense of
belonging? How have sexual and aggressive impulses been controlled as well
as acknowledged and expressed? Is there any evidence of aggressive and/or
sexual symptoms within the nuclear family or the parents'
families of origin?
As mentioned previously mother and father had a stormy marriage, with
frequent and problematic involvement of both sets of grandparents. There
was evidence of poor control of impulses on the part of both parents, as
shown by heavy drug use. No information about their sexual life was
available, a glaring error of omission. The only information given about
the quality of parenting Sarah received from either parent is that at the
time they separated mother was having trouble coping with her own life and
gave Sarah to father to care for temporarily. Nothing was noted about the
consistency and appropriateness of the parenting Sarah had been receiving
before the separation, or even who the primary caregiver was. Without this
information it is impossible to fully understand the impact on Sarah of
her fathers' assumption of the role of primary caregiver or of the loss of
her mother. Data regarding the role of Sarah's grandparents in her
not provided either. Thus, the investigation proceeded with no effort made
to ascertain the quality of attachment and mothering that the child
received throughout her life, and from whom.
Frequently, there is a delay between the time an alleged event takes
place, the time the alleged victim reports it, and the time any action is
taken in response to the report. To understand this sequence of events and
its impact on all the participants, it is necessary to explore the
family's characteristic patterns of communication. How much do the family
members tell each other? What is told? What is denied or covered up?
is included and who is excluded? Who stands to gain or lose?
No information seems to have been elicited regarding the ongoing quality
of relationship and kind of communication between father and mother, Sarah
and each parent, and Sarah and her father's girlfriend, nor is there any information
about this in regard to Sarah and her grandparents. It is also not clear what patterns
of relating were altered either when the accusation
was made public or as the evaluation proceeded. In summary, a potentially
illuminating set of data was completely ignored.
In conducting an evaluation of sexual abuse it often
becomes necessary to enlarge the scope of the inquiry beyond the original
family in which the alleged event took place. These may include
step-parents, new girlfriends or boyfriends of the parents, grandparents,
nannies and teachers.
Sarah's maternal grandparents turned out to be central figures in this
family. The mother had continued to be dependent on them, both financially
and emotionally. They were constants for Sarah as well; while both parents
came and went in Sarah's life, the grandparents stayed. It is likely that
Sarah spent more time with the grandparents than with either parent, so
that the abrupt and cavalier separation from them was bound to have a
large impact. Their conspicuous absence from the evaluation process not
only resulted in the loss of important historians, but it also resulted in
Sarah's loss of important caregiving and attachment figures.
The level which a child has reached on all of the developmental lines
will determine in large part how she perceives, copes with and
communicates her experience of a traumatic event. Here we discuss only
those areas which are most central in the evaluation of suspected sexual
The child's cognitive level tells us about the basic building blocks
which she uses to understand trauma. The child in the preconceptual stage
(age 2-4) does not yet have basic fixed concepts to understand what has
happened; instead the processing of experiences occurs in terms of
developmental needs and desires. Syncretism and condensation of images are
common, as would be expected from the preeminence of primary process thinking
in this stage of development. Thus, a child at this age may tell the
examiner that a man bit her, but this seemingly simple and straightforward
report may be a condensation of her painful experience with the man and
past experiences of being bitten, as well as still-current wishes to bite.
The intuitive stage child (age 4-7) has conceptual structures, but
these are based on perceptions, rather than on more realistic and stable
ideas. The child often processes perceptions in terms of his or her own egocentric
ideas and fantasies. For instance, a boy may tell the examiner that he
has been secretly changed into a girl because his castration complex
determines how he interprets what happened. A girl may insist that she
is pregnant as a result of fondling even when she "knows"
intellectually that this is impossible. Thus, normative castration
fantasies are intensified and come to feel frighteningly real in cases
of sexual abuse.
The child at the stage of concrete operations (age 7-11) has taken a
tremendous step in realistic thinking and now has concepts to organize
and understand what happens to him or her. The potential is present for
making logical sense of the experience, as long as regression,
narcissistic vulnerability, or the intolerance of affect do not grossly
distort perceptions. At this stage, thinking is limited to the
experience at hand with limited ability to generalize from it. Suggestibility may also distort reporting of events, especially when
adults pressure the child to come forth with particular data.
Before the child has entered the stage of concrete operations one
cannot take what is said as the literal truth. What the child is
expressing is "her/his truth." This is very important from the
therapeutic perspective, but does not always translate directly into
secondary process data for the purpose of legal evidence.
The cognitive function of memory has a pivotal role in these cases,
since almost all allegations occur in the context of a report of a
remembered event. Young children frequently remember events through
perceptive or enactive memory, thus their expression in play and action.
Whether these memories can later be recovered in verbal memory depends
on whether or not, or to what extent, they have become unconscious.
(1988) suggests that many children, even those as young as 28 to 36 months, do retain verbal
memories of traumatic events. It is possible that as the child becomes
more verbal, the memory will emerge. Conversely, Ceci and Bruck (1993)
have demonstrated that children's memories can be created by adult
suggestion. Unconscious memories are outside the sphere of the coherent
ego and are therefore not recallable in words until some resonating
affective state leads to a cognitive and affective linkage. However
difficult it may be, it is necessary to make the distinction between the emergence of "true" memory from that generated by contagion or
Verbal Primacy vs. Earlier Modes of Communication
There is wide variation in the age at which children are able to
communicate primarily in words some can be extremely verbal by the age of
4, and others not until 8 years or older. In younger patients we expect
that the experience will be communicated
largely in play and that the verbal productions which accompany it will be
appropriate to the cognitive
level of the child. For instance, a young child who is being evaluated for
suspected sexual abuse plays out a game which she calls "water
tap," thus condensing the image of the tap which is familiar, and the
penis which is supposed to be unfamiliar.
Children in the preconceptual and intuitive phases who
we suspect may have been abused often engage in traumatic
play, which gives them an opportunity to repetitively experience in an
active mode what was most traumatic about the event. However, what detail
is expressed over and over in play may not be what is obviously traumatic
to an adult's mind. Instead, the expression in the abuser's eyes or the
child being held down may
make the biggest impression. What alerts us to the repetitive play's
traumatic origins may not necessarily be its content, but rather its
frantic and driven quality. The content of the play may be obviously sexual, but it can just as likely
be aggressive, depending on how the child has experienced and interpreted
the events. Children in the latency years are more able to talk directly
about their experience, or at least to struggle to put it in words.
Children have an intense need to maintain the tie to their parents,
however defective the latter may be. Young children sometimes talk in all
innocence about sexual events, only to find themselves abruptly separated
from parents, placed in foster homes, and encouraged to think of the
parents as bad people. The more dependent a child is on the parents the
harder it will be for him or her to sustain an accusation of
"badness" against them. Since self and object representations
cannot really be fully separate until adolescence, to think of a parent as
bad is to think of oneself that way also. To ward off the consequent
catastrophic loss of self-esteem, the experience must be denied both to
the external world and to the self. Thus, most children will often either
refuse to talk further to adults about the events or will recant. But the
need to blot out such an important aspect of reality can distort the
child's ego in far-reaching ways, such as learning and thinking
difficulties, or weakness of
the synthetic function of the ego.
Libidinal Phase Anxieties
Each libidinal phase has its typical impulses, wishes, anxieties, and
conflicts which color the effect traumatic events are likely to have.
general, the closer the external event to the prevailing fantasies and
conflicts at that time, the more traumatic it is likely to be. Because of
the intensity of developmentally determined fantasies the events may be
seen as the fantasy come true. For instance, the child at the height of
his oedipal wishes and his castration complex, who has a painful sexual
experience, may well believe that all his fantasies of punishment have
been realized. Or the sadomasochistically-tinged fantasies of a
latency-aged child will be intensified when the traumatic experience has a
large admixture of aggression. For children under the age of 4, fear of
loss of the mother or her love is the major anxiety, while children in the
oedipal period and in latency also experience internalized
It is not infrequent that the children we are asked to investigate have
been traumatized in many ways, including the child in our case report.
then becomes difficult to determine which responses relate to which traumas.
it is important to remember that states of helplessness and flooding of
the ego due to any developmental trauma may become sexualized, tinged with
aggression, or both.
An evaluator experiences first hand the child's defensive maneuvers to
avoid experiencing the unpleasant, and potentially disorganizing, affect
associated with a traumatic experience. Children easily experience
traumatic states of being flooded with painful, guilt-inducing affects,
and they try desperately to ward these off. The youngest children
sometimes refuse to talk or cover their ears as an avoidance or negation
of the experience, as though they believe that if they do not acknowledge
an event they can wish it away. Somewhat older children recant an
accusation in order to deny it to themselves, or they misremember details
which tend to fade in and out depending on how comfortable the child is.
Even latency children under-report
the frequency of sexual events, usually telling an evaluator that they
happened "only once." Children frequently turn passive into active in
play and action to master traumatic events. These driven reenactments
provide important clues about the reality and nature of the events. Compliance with the evaluator's wish that the child talk about the events
may lead the child to rush rapidly through a superficial account of what
happened in order to please the therapist but avoid the affects. Sometimes
children repress the memory of events in response to being told they must
keep them a secret; nonetheless the derivatives of the repressed memory
often find expression in some other, indirect ways.
Superego and Ego Ideal Development
Before the superego has become an internal structure,
children rely on the parents' superego for the regulation of their
impulses. Thus, in very young children, (less than 4 years of age), one
may initially see very little anxiety, guilt, or embarrassment about
sexual events, especially if the encounter was pleasurable. It is not
until later, when the parents convey their intense discomfort to the child, that negative feelings develop.
In older children, in whom the superego is forming, or has recently
formed, there develops intense and largely irrational guilt feelings
following sexual abuse.
Even when children have little actual intent to take part in a sexual
event, they may feel that they are responsible. A child's superego is
largely concerned with results rather than intentions, so to children
bad results mean bad motivations. In addition, the persisting
egocentricity of children make them feel that they can control events.
Since the gradual relinquishment of the early omnipotent wishes toward
the parents leads to the progressive establishment of the ego ideal,
early trauma frequently causes problems with this relinquishment, and
hence with the maturation of this function. This is especially true when
the perpetrator goes unpunished for his acts, and important adults are
seen as impotent or corruptible.
Omnipotence of Self and Object vs. Deidealized, Realistic Appraisal
The feeling that the parents, and by extension most adults, are
bestowed with considerable omnipotence is not given up until adolescence.
This makes the child feel that he is no match for the adult, and makes it
less likely that the child prior to adolescence will accuse an adult of
"badness" without there being some foundation to it. It also
renders the child quite suggestible during an evaluation. That is the
reason it is so important to be careful
not to provide hints to children about the "correct" answer, or
to lead them to answers by asking very specific questions (see Ceci &
Bruck, 1993). Because children believe that a court always discovers the
truth, they can be devastated when it is implied that they are lying or
when the defendant is acquitted in the case of actual abuse. With latency
a somewhat more deidealized
view of adults and authority comes into play, and the child is better able
to cope with an evaluation or a court appearance.
Truth, Lies, and Collusion with a Parent
The developmental lines for this particular function tend to be very
complex. The capacity to tell a lie, even a
"No, I didn't take the cookie" type of lie, can only develop
after there is some sense of feeling separate from the mother, usually
around 3 years of age. More complicated lies, in which another child is
blamed for one's own misdemeanors, become possible at a later age;
however, lies in which adults are falsely accused are rare before
The most confusing possibility for evaluators and therapists alike
occurs in the presence of collusion with a parent who is lying or
believes something that is untrue a collusion rooted in the wish to
maintain the bond with the parent. When oedipal and older children are
involved collusively with a parent, it is often possible to see the
child's play centering around "lies and secrets." The youngest
children find it very hard to keep a secret and it frequently emerges in
the play themes. A sensitive evaluation of the parent-child interaction
is very important when collusion is a possibility.
Fantasy and Reality
Sometimes it is said that children make accusations of sexual
impropriety against adults because of overactive imaginations. While it is
true that children distort reality because they cannot fully integrate it
when their egos are immature, they tend to distort it in the direction of
"regressive" perceptions. Thus, the child's theory of sexuality,
even in the latency years, tends to be one of oral and anal sexual
activities, which would be followed by "oral," "anal,"
or "umbilical" birth. Since the child's fantasies do not usually
emphasize genital activity, any recital about such activity is all the
On the other hand, the child's clinging to pregenital
sexual theories makes it hard to evaluate events which are reported as
centering around oral or anal interactions. Are these distortions of
genital sexual interactions, a part of the interaction in actual sexual
abuse, or nonsexual interactions blended together with normative oral and
anal fantasies? This is a complex issue, and only a careful look at all
the features of the alleged events will enlighten us.
We cannot properly discuss character until adolescence when the process
of relinquishing the ties to the parents makes possible a more constant and stable repertoire of
character traits. What we see in younger children are tendencies to deal
with instinctual wishes in ways which become more habitual, gratifying some
derivatives and warding off others. In highly overstimulated or molested
children the upsurge of sexual wishes often cannot be defended against, or
modified. This results in frequent periods of overexcitement, tantrums,
and self-destructive behavior. These may be merely
"breakthroughs" or may become modified so that they are then a
part of the defensive repertoire against other threatening impulses.
instance, we well know the impulse-ridden teenager who uses sexuality to
ward off preoedipal longings, or sadistic fantasies.
As we try to apply the foregoing considerations to Sarah,
the most salient fact is that this 3-year-old lost her mother as a
"mother," because of a recent major change in their
relationship. She went from constant, daily involvement with her, to every
other weekend visits. This loss was unavoidably coupled with a greatly
increased proximity to her father, who in turn was in a new relationship
with a woman. It is highly likely that this new set of facts led to an
early onset of an intensified oedipal stage, and if so, we would also
expect some early superego development. As these issues are explored, it
should not be forgotten that Sarah did not have a secure pre-oedipal
period. Each new
developmental stage for Sarah was greatly complicated by the external
world. Whether Sarah was sexually abused or not, she had gone through many
potentially traumatic events in her short life. Another important
contemporary loss for Sarah was that of her maternal grandparents, who had
played a central role in her raising since a very early age.
How did Sarah feel about her situation? How did she understand it, what
"theories" did she construct to account for it? What defenses
did she employ to prevent anxiety from fragmenting her ego? These were
questions the evaluator did not consider.
We also learn, as reported by the maternal grandparents (who were not
interviewed by the evaluator), that Sarah was a "biter." Does
this fact suggest that she had been "bitten" by her mother in the past, and was
therefore playing out an earlier trauma, or was she an orally aggressive
child because of her own, internal reasons? In the latter case, licking
and biting would be her "action and emotion language," and we
might understand Sarah's report about her mother as a projection of her
own aggressive impulses, an expression of the complicated feelings of
loss, rivalry, anger, and guilt that she felt toward her mother.
Course of the Evaluation
Mother was never notified that Sarah's statement was reported to the
Child Protective Services by the social worker at the local hospital.
addition, Sarah was to see her mother for a total of 40 minutes over the
next two months following the report. The therapist who worked with father
and his woman friend recommended an inexperienced therapist for Sarah.
Sarah's therapist apparently took a hard line from the outset and
interpreted Sarah's intensity as proof of abuse. The absence of
play or comment about what mother might have done was taken as proof that
the child was avoiding difficult material. The mother's hostility towards
the evaluator was taken as proof of mother's craziness. And the fact that
the mother had neither admitted abuse nor sought treatment for her "problem" was taken as farther proof
of abuse. The therapist's method of
treatment of the child is not known.
During this time, mother and her parents found a lawyer, who consulted
a child psychiatrist for his opinion regarding mother's potential for being
"abusive." His initial impression was that mother was basically
normal." The attorney then informed the psychiatrist that the testing
done by a court-appointed psychologist indicated that the mother was
"'borderline' or worse." The psychiatrist then referred the
mother to a highly respected psychologist for farther independent testing
to evaluate her mental status and potential for abuse. The psychiatrist did
not share his diagnostic impression with the psychologist at the time of
the referral. This testing confirmed the psychiatrist's impression, so he
sent the original report written by the court-appointed psychologist to
the second psychologist. That psychologist's analysis of this report
revealed that it was generated by a computer program, with some additional
material written by an assistant; in his opinion this report was totally inadequate, misleading, and wrong.
The mother also took a polygraph test at the suggestion of her
attorney. Its results supported her story completely. The
court-appointed evaluator succeeded in having these results ignored by
making the statement that false negatives in polygraph tests could be
the result of psychosis, serious drug abuse, or pathological lying.
statement was made in a very general way, in disregard of any evidence
that any of these conditions obtained in this case.
A review of the taped interviews that the evaluator conducted with
Sarah demonstrated many of the flaws possible when interviewing a child,
particularly one as young as this one. There were many utterances of
this 3-year-old that were "oracular," i.e., even after many
replays they remained open to widely different interpretations of their
context, their point of reference, or their relevance. In contrast to
the uncertainty about Sarah's statements, there could be no doubt about
the degree of conviction of the interviewer. At one point in the session
the interviewer is seen stripping a fedora and a three-piece gray suit
from a life-sized doll, revealing fleshy breasts and fishnet stockings.
"This is your mother!" she said, completely ignoring Sarah
who stubbornly kept muttering: "That is not my mother! That is not
Later in the session, when she was observed to be hitting this scary
creature with a stick, it was interpreted as "evidence" of her
hostility toward her mother. The evaluator did not hesitate to use
psychologically oppressive means to obtain responses which, because of
the manner and context in which they were obtained, have to be seen as
suspect, e.g. "just answer two more questions, and then you can go to
the bathroom!" The evaluator seemed unempathic, only concerned with
her own agenda. For instance, she never acknowledged or explored with
Sarah the effect of the earlier loss of her mother.
Significantly, mother's parents, intimately involved with the early
raising of Sarah, were never interviewed by the evaluator, and their
valuable developmental experiences and insights were never included in
the court report. Another important source of information was ignored
by the evaluator the mother by that time had a steady relationship with
a new man (whom she has since married, and with whom she has had a
subsequent child). He appeared to be an intelligent, reasonable, and
sensitive individual who was present with mother and daughter the entire time
of the weekend in question, and who confirmed mother's story that Sarah had
slipped on the top of a jungle gym while straddling the top bar. He
reported that Sarah "cried briefly but never complained afterwards."
Despite the testimony of the child psychiatrist who presented much of
the above information, and the mother's able legal representation, the
judge ruled that abuse occurred, and consequently ordered supervised
visitation. This arrangement eventually failed because the mother could
not afford to pay for supervision indefinitely, and the mother-daughter
relationship deteriorated because of the artificial nature of the
contact and the severe limitation of time.
The child psychiatrist made several attempts, both in person and in
writing, to present the additional information to the court-appointed
evaluator in the hope of persuading her to change her recommendations, to
no avail. He was eventually joined by the visit supervisor, who also
felt from observing mother and daughter that abuse had not occurred, also
to no avail. The mother and her family attempted to sue the
psychologist whose testing seemed to have sent the court-appointed
evaluator off in the wrong direction initially, but found out that such
testing is protected from such action. M other eventually gave up, had a
second child in her new relationship, and has not seen Sarah in three
years as of this writing.
Discerning the meaning of what a child says or does is a complex area
of investigation that severely tests the clinician's skills. Therapy
affords a long time to collect data and elucidate meanings, but in
evaluations a great deal is often made of only a few communications,
usually in the absence of a therapeutic alliance. A particularly
troublesome quandary, often
faced in an evaluation, is the determination of whether a child's report
is an accurate representation of a reality, or whether it is more a
reflection of the child's internal
state. All too frequently evaluators go by the principle that "the
child never lies about abuse" and simply assume that a real event did
occur whenever it is reported. Although this may be an easier position for
the clinician to take, it ignores the complexities inherent in the
In the case presented here we have a 3-year, 2-month-old girl who had
been separated from her mother and maternal grandparents (who were
probably her primary caregivers) for the previous four months, after
returning from a visit with mother. This case has two striking and unusual
features: first, the mother was accused of the sexual abuse, and second,
the child had gone through the traumas of her parents' stormy marriage,
difficult divorce, and loss of her mother.
Sarah had essentially been given over by her mother to her father at 2
years, 9 months, so that during the rapprochement phase she had suffered a
disruption in the relationship with her most important object. Since that
time she had seen her mother only every other week for weekend visits.
a child of under 3 this amount of contact is quite unlikely to be enough
to maintain an intrapsychic image of a good object, or, since object
constancy has probably not been achieved, a good self-object. One way she
responded was by remaining a hitter and a biter, a persistence of
oral-stage conflicts which she had exhibited earlier in life and with
which her maternal grandparents had tried to help her. She was still not
toilet trained, despite being past 3 years of age. The structuralization
of her ego was lagging, as doubtlessly the inconsistencies and losses of
parental care would lead us to expect.
In this case the possibility that mother did not molest her child was
not adequately considered. (This is
a common problem with allegations of sexual abuse.) It is unusual for a
mother to be accused of molesting a daughter. It is unusual to find women
who sexually abuse children of either sex, who are not social isolates,
have not had abusive childhoods themselves, or are not severely
emotionally disturbed (Wakefield & Underwager, 1991). The only
negative evidence concerning the mother's emotional stability was a
superficial computerized psychological report suggesting that she was
"borderline," a diagnosis contradicted by a subsequent, more
thorough, psychological evaluation.
One alternative interpretation of her statements is that Sarah combined
the pain of the perineal injury she sustained (and possibly the pain of
being hit with a spoon as a
punishment) with the pain of separation and her own "biting"
wishes. When making her report to her father, it is clear that Sarah knew that there are different
kinds of actions, those for which one is responsible and
"accidents" for which one is not responsible. This distinction
points to her having superego precursors that are beginning to determine
her actions, even if not yet fully effective. Sarah might have been
projecting her own "bad" wishes onto her mother or, since she is
not intrapsychically separate from mother, she could experience her own
"bad wishes" as mother's "bad wishes." She could have
been painfully uncertain about who is bad, her mother for leaving her or
she herself for wanting to bite mother in retaliation. Is it possible that
the outside pain (as from biting), is condensed with the inner pain of
longing and anger from the separation? If this were the case, what she
might "really" be saying to the adults is that she
feels her mother left her because of her hitting and biting wishes, and
that this is very painful to her.
There may well have been difficulties in the relationship between
mother and daughter before the weekend in question, but there was no
opportunity to explore this
because the two were never seen together during the evaluation. And by
the time the visitation supervisor provided her positive opinions about
the relationship, the
evaluator and the court were no longer interested.
Fortunately, we do not have to rely solely on what the child says in
this kind of situation. The child's symptoms are also available.
Although very young children often do not find sexual events
anxiety-producing since the superego is not yet internalized, any
painful stimuli usually renders it traumatic, and the sexual events
become organized in the child's mind around the pain. In this case, it
is hard to imagine that a child would not find an oral sexual
experience, complete with
biting, painful and traumatic. If the experience was painful and
traumatic, then we would expect to see various signs of both anxiety and
overstimulation. But Sarah did not display any apparent
post-traumatic symptoms, with the possible exception
of the biting and licking of her father's fiancée. The reason that this exception has a low level of plausibility is that
there were indications that these behaviors had never been given up (the
more that could be learned about this the better). The lack of any
subsequent symptoms or reports of post-traumatic play at home or in her therapy are telling evidence against
the alleged abuse having occurred.
In interviewing this child we would expect that themes of loss,
denial of loss, and attempts to restitute the good object would dominate
the picture. Attempts to pressure the child for disclosure of sexual
material, for further evidence of "badness" on her part or her
mother's, would not be in the best interest of this child, whose ego
already has been quite battered. If one pushes and prods the child there
is no way of telling if the material given by her constitutes a
submission to the powerful and aggressive evaluator or therapist, a way
to please the interviewer, or the truth. Chances are that a long period
of therapy working first on the loss of mother would be necessary before
any reliable material relating to the alleged sexual trauma could be
Charges of sexual abuse in the context of custody are
extremely serious, disruptive, and difficult to verify. What is learned
from this case, and from so many others, is that the process of
evaluation can itself contribute to a lasting morass of personal and
This paper has dealt with the conduct and effect of professional
intervention. However, an implicit and crucial question has been to
consider just what constitutes a successful outcome of this
intervention. It is not simply a matter of verifying or disproving an
accusation. whether or not abuse actually occurred, and whether or not
that can be determined, children must come out of the evaluative
experience feeling protected. Despite the obvious threats to themselves
and to the persons most responsible for their care, children must feel
that a protective umbrella has been formed to restore or build a safe
environment. The evaluator cannot do this directly, but should endeavor
to facilitate this by strengthening and supporting healthy elements
among the adults in the family. Guiding the child and others into
therapy may provide the
best opportunity for this to happen.
This is especially true in cases where the facts remain uncertain.
Long-term, patient, and non-judgmental therapy may allow for eventual
clarification. Even when this is not possible, it may allow children to understand and
work through their inevitable sense of responsibility and loss. Children,
at their own pace, should be allowed to play or talk about whatever they
wish. If they have been traumatized, this will surface in time.
quality rather than the content of the play may give a better sense of
whether or not a child has been abused. The therapist should honor the
child's defenses rather than roughly bypass them to obtain the
"truth." If the evaluation or the therapy is experienced as an
inquisition, it can lead to the formation of pathological defenses in the
child. Confusion, conflict, and the intensification of intra-and
interpersonal disturbance are all too frequently the result.
The potentially traumatic effect of the evaluation can not be
minimized. It can be harmful even if nothing has happened. The child may
already have been terrified by the initial interventions of family
members, police, or hospital staff, and may experience the evaluation as
a further assault.
It is our contention that an accusation of abuse usually
signals a significant disorder in the family. The evaluator
must widen the field of inquiry and perspective to allow an
understanding of what abuse means to everyone in the family, and to
comprehend the forces that generate a real or false charge.
How do we really understand the phenomenon that many accusers turn
out to have been abused themselves? Are they simply more sensitive to a common
problem that society has been denying? Are they
unconsciously choosing abusive mates, or unconsciously provoking abusive
behavior in their families, projecting and replaying their own
experience through unsuspecting family members?
We certainly have to think long and hard about better ways for
various agencies and systems to cooperate. Differences in orientation, philosophy, training,
purpose, and experience of the various agencies inevitably lead to
serious problems. These can include errors in judgment, repetitions,
false paths followed, inter-agency hostilities and competitions, which
all add to or create trauma for family members caught up in this
More attention must be paid to the emotional health of the evaluator.
At the very least this unfortunate person will soon come to feel exactly
what the child does in the eye of the investigative and psychological storm.
Though this can be helpful as a diagnostic tool, it is a painful one, and
adds considerably to the already high level of stress. If the evaluator is
not unbalanced already, these cases have the potential for disturbing the
sanest or calmest among us. In addition to unconscious projections, which
are inevitably focused on the evaluator, there are pressures to protect
the child, to please the court with a decision, to manage the evaluator's
own troubling internal reactions to abuse, and to defend against
contentious and passionate adults who may include members of the family,
attorneys, or other professionals who disagree. The result is either rapid
burn out or a tendency to adopt zealous positions regarding the topic of
sexual abuse, which offer protection from the pain of uncertainty. Consultation with colleagues seems even more necessary in this area than
We need to resolve the basic polarity between the pressure
to rush to judgment, often from the judicial system, and the importance
of patience, so that the child is able to deal with many powerful
forces, and so that the family dynamics may unfold. At times the
evaluator must act swiftly and decisively too, but usually the
therapeutic skills of waiting, neutral observation, and a thoughtful
search for a larger perspective are far more beneficial. Closer contact
and consultation among all disciplines, including regular meetings to
discuss cases, may be useful.
And there are other polarities besetting people in this field. Many
individuals, therapeutic camps, and agencies, divide into warring
factions of "believers" and "skeptics." While there
is no doubt about the increase in accusations of sexual abuse in the
context of custody disputes, it still remains to be determined what
percentage of these are false. Similarly, it is unclear whether there
are more cases now than before, or just a greater willingness to
recognize what has always been going on. We are learning that recovered
memories are not always true. There is a question whether we can
distinguish reliably between true and false memories. These are matters
that require persistent and careful thought and discussion. It is
easier, as in this paper, to point out what has and could go wrong, but
very difficult to find solid, positive ground.
Despite the many unknowns, we remain firm in our conviction that there
is no substitute for sophisticated clinical experience and judgment to
reach an integrated picture of the functioning of children to assess such
issues as memory, truth-telling, suggestibility, compliance, and
unconscious forces, in a developmental framework. This in turn must be
folded into the context of family dynamics, and the motivation and
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|* Gloria Burk, Katherine MacVicar, Morton Neril, and Robert Schreiber are
psychiatrists and Ricardo Hofer is a psychologist in Berkeley, California.
Correspondence should be directed to Robert Schreiber at 3036 Regent
Street, Berkeley, CA 94705. [Back]