IPT Book Reviews

Title: Child Survivors and Perpetrators of Sexual Abuse
Editor: Mic Hunter
Publisher: Sage Publications, Inc., 1995

Sage Publications, Inc.
2455 Teller Road
Thousand Oaks, CA 91320
$38.95 (c); $17.95 (p)

This 184-page book demonstrates an extremely serious but often overlooked failure of mental health professionals. The separation of clinical practice and science is scandalous and has brought the mental health professions to the brink of irrelevance as far as the general public is concerned. This schism led to the formation of the American Psychological Society as a protest and statement that the American Psychological Association has abandoned science in the interest of preserving practice.

This book, representing some of the more highly regarded treating professionals, presents chapter after chapter of speculative theorizing and guessing with little or no quantified empirical support for most of the propositions advanced. An example is the first chapter by Friedrich. It is simply assumed that an experience of sexual abuse is always and inevitably severely traumatic and damaging. This is in the face of the replicated and established scientific data reporting that only a small proportion of children actually abused show serious long-term negative effects. Although there is a grudging acknowledgment that the behaviors supposedly showing the problem of "dysregulation" (Friedrich's term for disordered behavior) can be causally linked to a large number of experiences, the chapter forges ahead as if it were clearly established that sexual abuse alone causes the dysregulation. There is no mention of the fact that in several studies, when family dysfunction is controlled the effect of sexual abuse drops out. The suggestions for treatment repeat the strategies and techniques of dynamic, feeling-expressive, insight-oriented therapy with a nod to group and family therapy. No data are presented to suggest the proposed therapy has known and demonstrated effectiveness and utility.

The chapter on survivors of ritual, satanic abuse by Gayle Stroh is based on the author's conviction that at least some of the claims of adults that they were horribly abused in bizarre and improbable fashion are true. While, again, it is acknowledged that there are false claims and there is an insightful description of possible reasons for adults to produce erroneous accounts, cautions are muted in the emotionally charged presentation. Again these convictions are maintained in the face of a lack of corroborative evidence and recent research reports showing the likely iatrogenic effect of therapist's beliefs and expectations.

The other chapters give descriptions of therapy approaches and practices with no information about outcomes. Clinicians may find some interesting and potentially useful suggestions but any attempt to use them in therapy must be done with the clear statement that there is no information about their validity. They are at best experimental procedures. As such, the ethical responsibility is to warn potential consumers about the lack of support and the provisional quality of the therapy. Failure to do so leads to the major weakness of the sexual abuse treatment movement and literature, vending services with no evidence for their effectiveness.

Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.

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