Creative Therapeutics, Inc. The social significance of this book is such that I will discuss the social context in which it was written before proceeding to review the book itself. Sex abuse and its offshoots confront psychiatrists, psychologists, and related mental health professionals with complex social issues which go far beyond the identification and treatment of legitimate sex abuse victims. Clinical and ethical dilemmas are raised at every turn as mental health professionals deal with mandated reporting, recovered memory therapy, satanic ritual abuse, multiple personality disorders, and the problem of false allegations which are woven throughout. Dr. Richard Gardner is foremost among those who suggest that these are symptoms of the sex abuse hysteria which permeate society and the mental health professions today. The 1980s were dominated by the belief within professional circles that children don't lie about sexual abuse. "Nonsense," says Gardner in his refreshing and sometimes provocative style. The National Council on Child Abuse and Neglect has identified false allegations of child abuse as a serious social problem. The number of children and families harmed by false allegations has reached epidemic proportions. Increasingly, professional organizations are being called upon to take positions on the controversial issues involved. In l988, the American Academy of Child and Adolescent Psychiatry came out with a position paper stating that when sex abuse is alleged, false allegations should always be considered, especially in the context of divorce or when the accuser is an adolescent. More recently, the American Medical Association and the Australian Psychological Association have come forth on the side of science and debunked repressed memory therapy. The American Psychological Association has tried to straddle the fence, while some associations remain immobilized, declining to take a position at all. In the meantime, serious questions have been raised about the efficacy of psychiatric services and the validity of the theories on which they are based. Media coverage and high profile court cases are exposing the weaknesses of the profession as never before. The public is observing the battles between and amongst the mental health professions over controversies relating to the efficacy of recovered memory therapy, multiple personality disorders, satanic ritualistic abuse, and more. Responsible practitioners have been asserting the need for a more comprehensive and scientific framework for evaluation and treatment of sex abuse cases. To this end, Richard Gardner's 436-page book makes an enormous contribution to the mental health professionals, child protective service workers, judges, lawyers, police investigators, and most importantly, the children and families who stand to have their lives destroyed by incompetent evaluations. The criteria he presents for differentiating true from false allegations were developed over 12 years of experience assessing audio- and videotapes, investigation and evaluation reports, literature reviews, and his own experience applying the protocols. The book opens with a discussion of the terms "molestation" and "abuse" that is useful and descriptive, free of the emotionally charged language that has contaminated much of the sex abuse literature in the last 20 years. Gardner provides differentiating criteria for all the parties involved, including children, accusers, and accused. The protocols examine every possible context in which sex-abuse allegations occur. Studies on pedophiles are reviewed. Criteria for evaluating the reports of previous examiners are provided. Gardner describes the use of his prescribed projective measures. He outlines 62 differentiating criteria, including the construction of criterion-referenced time lines as a method for organizing relevant data. He focuses on the collection of data most relevant to sex-abuse allegations and identifies pitfalls to be avoided, such as leading questions. Furthermore, he discusses how to conduct this type of inquiry using non-leading questions, so as to avoid contaminating the assessment. He provides the reader with many examples throughout the differentiating criteria of exactly how to ask relevant, non-leading questions and how to negotiate the interview with further inquiry based upon the nature of the responses. Although the differentiating criteria may appear overwhelming at first, the reader will quickly grasp the relevance and necessity to be thorough — the consequences for incompetent assessments are horrendous for the people involved. Evaluators who follow his method should find it easier to maintain a position of neutrality throughout the assessment process. For those who need to see quantifications, there is a scoring system. There is no cut off score per-se. However, there is utility and probative value in looking at the numbers, as they help to delineate the true from false allegations. It has been Gardner's experience, as well as mine, that scores for true allegations are relatively high, and scores for false allegations relatively high in the false direction. Just as medical researchers use a medical model for comparing healthy versus diseased organs, Gardner provides information about "known to be different" groups such as sexual abusers and falsely accused, legitimate sex-abuse victims and victims fabricating sexual abuse. Using the "known to be different" groups is a well-established psychological method for measuring discriminative validity. Throughout the book, Gardner discusses his ideas about strengths and weaknesses with respect to the protocols. His book is exceptionally user friendly as he communicates the ground work for the reader to use the differentiating criteria. Gardner, a prolific writer and major contributor to the advancement of child and family psychiatry, has now written 38 books. He writes in a candid, down-to-earth style that is easily understood by professionals and lay persons alike. Using common sense interspersed with humor, he holds no punches and tells it like it is. Although this offends some people, others find his outspokenness refreshing. As Gardner states, "When we can't know what is true, we should follow what is most probable . . . the most probable things are the most likely . . . if is sounds incredible, it probably isn't true." Protocols for the Sex-Abuse Evaluation is more than a "how to do it" book. It is a consciousness-raising text, exposing the complex web of people and systems that make up the sex-abuse industry. Gardner calls it only a beginning in terms of the application of such protocols. Nevertheless, these protocols provide a foundation that demands the highest level of accountability and competence from those involved in the assessment, litigation, and treatment aspects of the sex-abuse allegation process. Use of these protocols should reduce the serious problem of false positive errors that plagues the field of sexual abuse. Reviewed by Randy Rand, 650 E. Blithedale Ave., 2nd Floor, Suite M, Mill Valley, CA 94941
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