Transforming Trauma: A Guide to Understanding and
Treating Adult Survivors of Child Sexual Abuse
||Anna C. Salter
||Sage Publications, Inc., ©1995
2455 Teller Rd.
Thousand Oaks, CA 91320
The main message of this 353-page book is ". . . it's a dicey world out there" (p.309). That leads Salter to declare, "In many ways, this entire book is about safety" (p. 4). What makes the world dicey and makes safety central is the male sex
offender. The effects of sexual abuse by men are presented as universally destructive and enduring. Therapy is always necessary and must follow the model suggested by Salter in order to overcome the effects of the continued emotional and psychological presence of the male abuser in the mind and heart of the victim.
There are 27 pages of references, but the majority are from the chapters describing what is known about sex offenders, where a selection of research articles is cited as the basis for her views. However, disconfirming or contrary findings to Salter's views are not mentioned and she offers few qualifications or descriptions of the credibility of the cited research. She ignores the
meta-analysis and review of research on the effects of sexual abuse which demonstrates that no specific symptoms can be linked to abuse.
When Salter moves to her prescription for therapy, she cites no research data to support her sweeping pronouncements. Indeed, she defends her choice to offer no empirical basis for her treatment proposals:
"In moving from the research to the clinical, the book also moves from the measured tones of academic writing to more metaphoric rhythms. For some, no doubt the change will surprise. But I change it unapologetically. I believe the scientist and the clinician, the academic and the poet must be brought together if we are to enter the arena of healing" (p. 4).
With the current emphasis in the professional literature on the necessity for empirically validated treatments and the ethical requirement that vended treatments have scientific support for their efficacy and utility, this cavalier attitude is surprising. The treatment proposal Salter makes is derived from an hypothesized complex chain of intervening variables allegedly occurring inside the victim of sexual abuse. There is no support offered for this chain other than Salter's pronouncements that this is the way it is: "The helplessness and lack of a sense of efficacy that lies at the heart of controlling behavior comes not only from the onslaught of the outside world, but also from the survivor's experience of being overwhelmed by her own affect as well. Images, memories, dreams, intrusive thoughts, affective flashbacks, somatic flashbacks, full flashbacks-she is in as much danger internally as externally, and equally at sea" (p.211). "The difference between a 'pity party' and genuinely dysphoric affect is that plays for sympathy in the former are often a way
of passing negative affect along rather than feeling it" (p. 216). "In addition, the duet of predator and prey is marked by interlocking thinking errors . . . However, the resonance between perpetrator and victim goes beyond specific beliefs and extends to patterns of belief or 'process' thinking errors" (p.219).
The book may be of value for those who want a limited view of the understanding of sexual offenders and want to speculate about what kind of therapy may be of utility for those who have been abused. Those who desire a firm grounding in credible scientific research for what they do in therapy will not find it here.
Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.