Child Sexual Abuse: Assessment

Child Sexual Abuse: Assessment L. Dennison Reed, Psy.D. 1

THE HISTORY AND POLITICS OF CHILD MALTREATMENT 2

FORMATIVE EVENTS IN THE 19TH CENTURY THE CASE OF “MARY ELLEN.” FREUD’S “ETIOLOGY OF HYSTERIA” THE OEDIPAL COMPLEX 3

USA: LATE 19TH CENTURY THE CASE OF MARY ELLEN Severe physical abuse. No laws against child abuse. Protection based on laws governing cruelty to “animals.” 4

FREUD’S RESEARCH CONCERNING “ HYSTERIA” In the formative years of his career, Freud was determined to discover the cause of “hysteria,” the archetypal female neurosis of his time. 5

“HYSTERIA” NOW AND THEN In Freud’s time, the term “hysteria” was quite inclusive. Freud’s notion of “hysteria” encompassed symptoms of several modern day disorders including PTSD and other anxiety disorders, Depression and Borderline Personality disorder. 6

FREUD’S SAMPLE Freud’s patients were primarily Viennese women from conventional, “respectable” homes. 7

DISCLOSURES OF CSA As Freud gained their trust, time after time his patients unburdened painful memories of childhood sexual encounters, most often perpetrated by their fathers. Other adult males, including relatives and friends of the family, were also named as perpetrators. 8

Freud’s Realization of the Impact of Child Sexual Abuse Freud was so impressed with the fact that the independent accounts of his female patients were so detailed and compelling that he became convinced that their claims were true and that the “hysteria” seen in these women was the product of a history of child sexual abuse. 9

In 1896, Freud published“The Etiology of Hysteria” In The Etiology of Hysteria Freud stated: “At the origin of every case of hysteria is a childhood sexual trauma.” 10

Freud Privately Acknowledges the Pervasiveness of Father-daughter Incest In his personal correspondence with his confidant, Wilhelm Fliess, Freud cited “seduction by the father”(sexual abuse) as the essential point in the development of hysteria. 11

“Freud’s Fraud” In the name of “discretion,” Freud refused to publicly identify fathers from “respectable Viennese families” as sexual aggressors. Instead, he identified women (governesses, nurses, maids) and children as the perpetrators. 12

THE REJECTION OFFREUD’S THEORY Freud’s “Etiology of Hysteria” was not well received by the Viennese patriarchy and became the subject of ridicule. 13

FREUD’S GROWING DISCOMFORT In addition to the rejection of The Etiology of Hysteria, Freud’s letters to Fliess reflect Freud’s growing awareness of and discomfort with his own incestuous feelings towards his daughter. 14

Freud Retracts “The Etiology of Hysteria”(1897) Within one year of publishing The Etiology of Hysteria, Freud completely dismissed the the notion that hysteria stemmed from a history of CSA. 15

The “Oedipal Complex” to the Rescue Freud claimed that his patients’ accounts of child sexual abuse were actually the product of wishful incestuous “fantasies” that are universally experienced by all children, and that these fantasies become confused with reality. The Oedipal Complex served to fuel the prevailing skepticism about allegations of CSA. 16

The Empirical Basis for The Oedipal Complex Interestingly, Freud’s rejection of his earlier theory and his adoption of the Oedipal Complex was not based on any new empirical findings. In fact, 100 years later there is still no empirical support for the Oedipal Complex. Yet it continues to influence some mental health professionals’ (and others’) beliefs about the credibility of allegations of CSA. 17

The USA in the 1930s The legal profession joins the psychiatric profession in promoting skepticism about allegations of CSA by women and children. Wigmore, in his authoritative Treatise on Evidence(1934), cautioned that women and girls were predisposed to bring false claims of sexual abuse against “men of good character” and should be examined by a psychiatrist to determine their credibility when they make such claims. 18

Wigmore’s Oversight? In his Treatise on Evidence, Wigmore provided an example of two young sisters who had made “false” sexual abuse allegations against a male relative. For some reason, Wigmore failed to mention that both girls had sexually transmitted diseases. 19

The USA in the 1960s Progress in identifying child physical abuse. The “Battered Child Syndrome” (C. Henry Kempe). Society’s denial and ignorance of CSA persists. A few states mandate reporting of child maltreatment. 20

The USA in the 1970s Federal laws instituting mandated reporting of child maltreatment on a national level. Finkelhor: National CSA prevalence study. Growing awareness of the existence of CSA, but denial of CSA being perpetrated by “respectable” people persists. The most authoritative psychiatric text in 1975 states that the prevalence of incestual abuse is less than one in one million. 21

The USA in the 1980s:Information and Misinformation Researchers find that even very young children can provide accurate testimony relating to abuse (e.g., Goodman, Saywitz) Media blitz raises awareness of the existence of CSA (i,e., day-care cases, repressed memories of CSA, etc.) but misinformation abounds. “Indicators” and “checklists” for CSA are widespread, but empirical support is lacking. 22

The USA in the 1980s: Increased Suspicion andIncreased Skepticism Society’s “Index of Suspicion” for CSA increases markedly. “Children never lie about CSA” becomes an increasingly common refrain But, the “Backlash” begins . . . again. The reliability of children’s sexual abuse allegations is once again aggressively challenged. 23

The USA in the 1990s:Professional Advocacy Groups Form American Professional Society on the Abuse of Children (APSAC) Association for the Treatment of Sexual Abusers (ATSA) International Society for the Prevention of Child Abuse and Neglect (ISPCAN) 24

The USA in the 1990’s:The Criminal Justice System Between 1986 and 1997, the number of child molesters incarcerated in state correctional facilities tripled; and there was a substantial decrease in the number of children who were sexually abused Special protective measures were introduced to make the court process less traumatic for children, e.g., permitting children to testify via closed circuit TV But, those responsible for screening and investigating CSA cases (i.e., law enforcement, MHPs and CPS) often lacked adequate training and resources 25

The USA in the 1990s:The “Backlash” Gains Momentum Richard Gardner, MD authors several influential books and articles asserting that: 1. The vast majority of CSA allegations relating to custody cases are fabricated and are fostered by malicious and psychiatrically disturbed mothers. 2. Allegations of abuse in day care facilities are rarely true and are the product of ‘hysteria’ by parents and investigators. 26

The USA in the 1990s: Research Developments There is a “New Wave” of suggestibility research. In 1995 APA publishes Ceci & Bruck’s Jeopardy in the Courtroom which focuses on the weaknesses of children’s testimony. This book becomes widely accepted as the definitive text on children’s suggestibility. “Contamination” and “The Attack on the Interviewer” become the most popular defenses in CSA cases. Tom Lyon publishes a stinging critique of the “New Wave” in suggestibility research. 27

The USA in the 1990s:Mental Health Issues The existence of “Repressed” memories of CSA is hotly debated Some therapists are successfully sued for allegedly ‘implanting false memories of CSA’ Promising therapeutic interventions for CSA victims are developed, i.e., CBT, EMDR 28

The USA in the NEW MILLENNIUM:Child Molesters Exploit New Technology Distribution of child pornography via the Internet becomes quite widespread There is a dramatic rise in internet ‘seduction’ of children and adolescents. 29

The USA in the New Millennium:Public Perception of CSA Increased awareness of widespread CSA tempered by increased skepticism re. children’s suggestibility More people are aware that virtually “anyone” could be a child molester (e.g., discovery of widespread abuse by priests/clergy, Jerry Sandusky). Public ‘outrage’ about the cover-up in the Sandusky case; increased penalties for failure to report abuse Children continue to be portrayed in the media and by some researchers/expert witnesses as being inordinately suggestible and unreliable; which contributes to increased skepticism when they allege sexual abuse 30

The New Millennium:“Polarization” Child sexual abuse continues to be a “polarizing” phenomenon; with people holding strong opinions about whether children should be believed when they allege sexual abuse 31

The New Millennium:Mental Health Professionals Are Still Under Attack Those who interview children in cases of suspected sexual abuse continue to be routinely attacked and discredited in court for allegedly using improper interview techniques Therapists and others continue to be successfully sued for allegedly implanting ‘false memories’ of child sexual abuse; and for ‘failing’ to report sexual abuse to the authorities 32

The New Millennium:Major Strides in Research Impact of CSA Samples more representative (i.e., large general population studies) Prospective studies (vs. Retrospective studies) Studies of “Twins” Children’s Suggestibility Child Forensic Interview techniques Treatment Efficacy The Neurophysiology of trauma 33

The New Millennium:Professional Advocacy Groups Provide Valuable Educational Resources American Professional Society on the Abuse of Children (APSAC); Association of the Treatment of Sexual Abusers (ATSA); the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Empirically-supported Practice Guidelines Excellent journals and other publications High-quality seminars/conferences Access to experts in the field Affordable student membership 34

The New Millennium:Problems with the Criminal Justice System Continue In most jurisdictions, in incest cases, law enforcement STILL: Does not respond to the crime scene on a timely basis—or at all Does not conduct a crime scene analysis Rarely obtains a confession (often because of the failure to act on a timely basis) Criminal proceedings are still not very ‘child-friendly’; and these are often hard cases to prove Special protective measures for children in court are rarely used; and many judges lack training in CSA 35

The New Millennium Most Mental Health Professionals Still Lack Training in CSA The vast majority of practicing mental health professionals still know very little about proper methods of screening for CSA and for conducting child forensic interviews (especially of preschoolers) Even now, most graduates of APA-approved doctoral psychology programs lack sufficient training and competence in screening for CSA and for conducting forensic interviews 36

The New Millennium:Are Children A Priority in the USA? Child protective services nationally are grossly under-funded and overwhelmed Although the United States is the wealthiest country on earth, more than 20% of our children live in poverty. 37

Child Poverty in 35 Economically Advanced Countries-UNICEF 2012 Report

Why Aren’t Children More of a Priority? Children don’t have: Political clout; lobbyists; money; influence Children typically don’t complain to people in power Many ‘good-hearted’ people are apathetic when it comes to actually doing somethingto help children Many people think they can’t really make a difference 39

You can make a difference! Knowledge is power! Learn how to detect, treat and prevent child maltreatment. Join professional organizations that are devoted to improving the lives of maltreated children, e.g., APSAC, ATSA. There is power in numbers! Volunteer your services, e.g., therapeutic services, become a Guardian ad Litem, join volunteer organizations that serve kids 40

Child Sexual Abuse: Assessment