Treating Women Molested in Childhood

Article excerpt

Treating Women Molested in Childhood. Catherine Classen (Ed.). San Francisco: Jossey-Bass, 1995. Hardcover: $29.95; 242 pages.

This edited book is part of a series which addresses current treatment techniques for a variety of clinical problems. In this volume, experienced clinicians address the state-of-the-art in the treatment of adult sexual abuse survivors. Chapters cover the main treatment modalities and many important issues of concern to the practicing clinician working with this often challenging clinical population. As pointed out by the editor, because of the prevalence of sexual abuse survivors in treatment, this book is likely to be relevant to most therapists at some point in their career.

Chapter 1. Assessment and Diagnosis: Christine Courtois

This chapter focuses on the difficulties facing practicing clinicians who are working with clients who present with a variety of symptoms and who vary in the extent of their memories of previous sexual abuse experiences. The subtitle, Walking a fine line: Asking without suggesting or assuming, accurately reflects the tone of the chapter: one of "openness and neutrality." Courtois alerts the clinician to the dangers of either over- or underidentifying a history of sexual abuse while undertaking the initial assessment. A strength of the chapter is the description of four types of client presentations, followed by concrete suggestions for handling each of them that neither lead the client nor deny the possibility of abuse. Also included are suggestions for assisting clients who are attempting to find corroborating evidence of their abuse, a brief discussion of tools for assessing sexual abuse and abuse- related symptoms, and a discussion of diagnostic concerns.

Chapter 2. Crisis Intervention: Joan A. Turkus

Turkus discusses a common yet disturbing presentation of the adult victim of childhood sexual abuse: the acute crisis state. Most informative are the six clinical vignettes which illustrate the various forms of crisis that may occur and that provide a focus for a discussion of methods of intervention and treatment during a crisis. The author writes from the psychiatrist's perspective and, hence, imparts useful knowledge regarding the efficacy of psychotropic medications in the treatment of PTSD, depression, and dissociative disorders. Essential reading is a discussion of the need for careful pacing in treatment in order to prevent the reactivation of PTSD symptoms in the survivor.

Chapter 3. Individual Psychotherapy: Mary R. Harvey & Patricia A. Harney

This chapter discusses treatment of the survivor from an ecological perspective of psychological trauma. The authors stress the importance of considering the context of each survivor's experience: i.e., factors related to the person, the traumatic event, and the larger environment in which the abuse occurred and in which the woman is currently living. Four case vignettes are used throughout the chapter to illustrate the psychological impact of child sexual abuse, the ecological view of trauma, and the application of this approach to the treatment of adult survivors. While the case examples are useful to bring these issues to light, at times their frequent use appears disruptive to the flow of the material (particularly in the beginning of the chapter). A drawback to the selection of these cases is that only one appears to be of a person in treatment for any length of time and some of the others appear to have had only an initial contact with the therapist. This contributes to speculation as to how the individual's issues will actually be played out in therapy. A more effective approach might have been to present cases that represented women at various points in the recovery process. The greatest strength of this chapter is in the clearly outlined approach to establishing treatment goals during the different stages of treatment and the delineation of the elements related to the assessment of recovery. …