• TABLE OF CONTENTS
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 Title Page
 Dedication
 Acknowledgement
 Table of Contents
 Abstract
 Introduction
 Review of related literature
 Methodology
 Results and discussion
 Conclusions, implications, summary,...
 Appendices
 References
 Biographical sketch














Title: Factors that impact on female incest clients in counseling
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 Material Information
Title: Factors that impact on female incest clients in counseling
Physical Description: xi, 185 leaves : ill. ; 28 cm.
Language: English
Creator: Josephson, Gilda S., 1946-
Copyright Date: 1985
 Subjects
Subject: Incest -- Psychological aspects   ( lcsh )
Counselor Education thesis Ph. D
Dissertations, Academic -- Counselor Education -- UF
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Thesis: Thesis (Ph. D.)--University of Florida, 1985.
Bibliography: Bibliography: leaves 178-183.
General Note: Typescript.
General Note: Vita.
Statement of Responsibility: by Gilda S. Josephson.
 Record Information
Bibliographic ID: UF00099479
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000875744
notis - AEH3308
oclc - 014696919

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Table of Contents
    Title Page
        Page i
        Page ii
    Dedication
        Page iii
    Acknowledgement
        Page iv
        Page v
    Table of Contents
        Page vi
        Page vii
        Page viii
    Abstract
        Page ix
        Page x
        Page xi
    Introduction
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
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        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
    Review of related literature
        Page 15
        Page 16
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    Methodology
        Page 55
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    Results and discussion
        Page 74
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    Conclusions, implications, summary, and recommendations
        Page 122
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    Appendices
        Page 130
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    References
        Page 178
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    Biographical sketch
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Full Text







FACTORS THAT IMPACT ON FEMALE INCEST CLIENTS IN COUNSELING


BY

GILDA S. JOSEPHSON























A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY





UNIVERSITY OF FLORIDA

1985












Copyright 1985

by

Gilda S. Josephson













Dedicated

to

Jeff Weingarten

and to

the loving memory of my parents

Pearl and Herbert Port















ACKNOWLEDGEMENTS


I would like to thank my chairman, Dr. Roderick McDavis, and

the members of my committee, Drs. Margaret Fong, Harry Grater, and

Phyllis Meek, for their guidance and encouragement during the many

stages of this project. I am especially grateful to Dr. McDavis

for his patience as well as his high standards regarding

organization, structure, and editing. Special appreciation goes

to Dr. Fong for encouraging the direction of this research, for

stimulating my thinking on it, and for her intense work on the

final revisions. Very special thanks are extended to Dr. Meek for

inspiring my interest in women's issues and for her unwavering

confidence in my power as a woman.

This project would not have succeeded without the love and

support I received from my family and friends. To Jeff, who was

with me every step of the way, whose belief and pride in me helped

me believe in myself, and whose caring and support were

invaluable, I express my deepest love and appreciation. To my

children, Douglas and Francine, I give a special hug and thanks

for their incredible understanding and patience. I am especially

grateful for Jeff and Doug's computer expertise. I wish to thank

Marcia Hoggard, who helped me find my way to Gainesville and who

knows why she deserves a special appreciation.












To my friend, Mindy Hersh, who was always available to

advise, counsel, interpret, and love me, I extend my deepest

gratitude. To my friend and colleague, Judith McBride, whose

steadiness has kept me calm and whose expert counsel on incest I

sought regularly, I express warm appreciation. I would also like

to thank Janet Moore, Cathy Owen, and Sharon Knight whose care and

interest helped reenergize me on our Fridays. A special

acknowledgement goes to Bonnie Baker who supported, commiserated

with, and laughed with me step-by-step.

I am thankful to Linda Hague, who was calmly able to put all

the numbers together. I am appreciative of Dr. Jaquie Resnick for

her helpful advice with the development of the instruments in this

study. I would also like to thank Dr. Janet Larsen and Dr. Franz

Epting for their assistance.

I wish to acknowledge my gratitude to several incest

researchers who impacted on my work. Judith Herman, Christine

Courtois, Diana Russell, and Sandra Butler were professionally

inspiring and personally supportive to me.

Finally, I wish to express my appreciation to the women who

participated in this study. Their courage and willingness to

speak out about their incest experiences was immeasurable. They

are, without a doubt, "survivors."















TABLE OF CONTENTS


ACKNOWLEDGEMENTS....................................... iv

ABSTRACT............................. ........... ix

CHAPTERS

ONE INTRODUCTION...... ............................ 1

Statement of the Problem....................... 1
Purpose of the Study........................... 6
Need for the Study....... ...................... 6
Significance of the Study...................... 11
Definition of Terms............................ 12
Organization of the Study...................... 14

TWO REVIEW OF RELATED LITERATURE................... 15

A Conceptual Framework for Child Sexual Abuse.. 15
Definition.................................. 15
Incidence of Incest......................... 17
Incest Participants......................... 18
Perpetrators............................. 18
Victims................................... 19
Mothers of incest victims.................. 20
Siblings of incest victims................. 20
Family Dynamics............................. 21
Effects on Victims.......................... 22
Clinical research results.................. 22
Empirical research results................ 24
Theoretical Framework for Studying Incest...... 27
Systems Approach............................ 27
Social and Cultural Approach................ 29
Professional Perspective of Incest........... 33
Treatment of Adult Incest Victims............... 37
Presentation for Treatment.................. 37
Self-disclosure and Counseling............... 39
Disclosure of Incest........................ 40
Reactions to Disclosure of Incest............ 41
Clients' Resistances to Therapy............. 45
Counselors' Role in Treatment of Adult
Incest Victims............................ 47
Summary..... ................................. 53

vi















THREE METHODOLOGY...... ............................. 55

Research Design................................ 55
Research Questions............................. 57
Population and Sample.......................... 57
Instruments.................................... 59
Structured Interview........................ 59
Barrett-Lennard Relationship Inventory...... 64
Procedures..................................... 65
Recruitment of Subjects..................... 65
Screening of Volunteers..................... 67
Administration of Instruments............... 67
Analysis of Data............................... 68
Limitations of the Study....................... 72

FOUR RESULTS AND DISCUSSION......................... 74

Results....................................... 75
Description of the Sample................... 75
Description of the Variables of Interest.... 82
Client background variables................ 82
Variables related to disclosure of
incest during childhood................. 82
Counselor variables....................... 84
Other variables related to disclosure
of incest ............................... 89
Research Question One....................... 92
Research Question Two....................... 93
Research Question Three..................... 95
Research Question Four ...................... 98
Research Question Five...................... 99
Ancillary Results........................... 102
Summary of Results.......................... 104
Discussion of Results.......................... 108

FIVE CONCLUSIONS, IMPLICATIONS, SUMMARY, AND
RECOMMENDATIONS.... ......................... 122

Conclusions .................................. 122
Implications................................. 123
Summary....................................... 125
Recommendations for Future Research........... 127














APPENDICES..................................... ........ 131

A STRUCTURED INTERVIEW........................... 131

B BLRI CONTENT VALIDATION CERTIFICATION.......... 159

C NEWSPAPER ADVERTISEMENT AND LOCAL NEWSPAPERS... 162

D LETTER TO DIRECTORS OF MENTAL HEALTH AGENCIES
CRISIS CENTERS, HOTLINES..................... 164

E LETTER TO PRIVATE THERAPISTS................... 167

F LETTER TO POTENTIAL SUBJECTS................... 170

G INFORMED CONSENT .................... ........ 174

H LOCAL COUNSELING REFERRAL SOURCES.............. 177


REFERENCES............... .................... .......... 178

BIOGRAPHICAL SKETCH... ................................. 184


viii















Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy



FACTORS THAT IMPACT ON FEMALE INCEST CLIENTS IN COUNSELING

By
GILDA S. JOSEPHSON

December, 1985



Chairman: Dr. Roderick McDavis
Major Department: Counselor Education


Incest victims often seek counseling as adults for relief

from a variety of difficulties. Once in counseling, some victims

avoid disclosing incest to their counselors, while others disclose

and resolve conflicts associated with incest. The purpose of this

study was to identify and explore factors that assist female adult

incest clients in disclosure and exploration of incest during

counseling. Clients' background factors, counselors'

characteristics, attitudes, and behaviors, and other factors were

investigated.

Thirty-seven women who were sexually abused during childhood

by family members and who had visited counselors in the past three

years participated in this study. Each subject completed a

structured interview and a Barrett-Lennard Relationship Inventory

(BLRI).











Demographic and incest data were described. Variables of

interest such as client background factors, factors related to

childhood disclosure, counselors' characteristics, counselors'

reactions to incest disclosure, impact of disclosure and

counselors' reactions on subjects, and other variables that might

be related to disclosure were obtained from the interview. The

BLRI was used as a measure of clients' perceptions of counselor

characteristics.

No relationship was found between disclosure of incest during

counseling as adults and three client background factors: age of

onset of incest, close relationships during childhood, and

satisfaction with childhood counseling. Reactions that subjects

received when they disclosed during childhood were not found to be

related to disclosure of incest during counseling as adults.

No relationship was found between disclosure of incest to

counselors and perceptions of counselor characteristics prior to

disclosure. Counselor characteristics that were helpful to

subjects in disclosing and discussing incest were described. No

relationship was established between counselors' reactions to

subjects' disclosure and the amount of time spent discussing

incest for the duration of counseling. Subjects' belief that

incest was the main issue to discuss in counseling was not found

to be related to disclosure of incest to counselors.











Subjects disclosed most frequently when they thought they

would feel better by disclosing, someone encouraged them to

disclose to counselors, and/or when counselors asked them

directly. Implications for training, practice, and research were

discussed.















CHAPTER ONE
INTRODUCTION



Statement of the Problem



When children are hurt physically or emotionally, their

parents usually provide the nurturing and soothing. However, when

children are sexually molested by family friends or relatives,

their parents very often do not find out about it. Children do

not tell their parents because they may be afraid of their

parents' anger or may worry about being blamed. Embarrassment

also prevents children from talking about being sexually molested.

When sexual abuse is perpetrated by one of the parents, it is less

likely for the children to come forth openly and trust anyone with

this personal information, commonly referred to as the "incest

secret" (Burgess & Holmstrom, 1974; Herman, 1981; Rush, 1980).

Once incest has occurred, the probability of legal and social

authorities finding out about it is low. The adults in the family

fear legal sanctions and social shame. The children involved are

fearful of causing family dissolution or retaliation and will not

risk disclosure to outside authorities (Meiselman, 1978). The

children are at greater psychological risk when they are unable to











seek help and resolve the conflicts associated with their

victimization. Consequently the abuse often continues, escalates,/

and results in children feeling more confused, guilty, fearful,

and isolated (Courtois & Watts, 1982; Herman, 1981; Sgroi, 1982).

Children may disclose their incest experiences as a result of

various precipitants. Changes in the relationship with the -

perpetrators such as attempts at intercourse, increasing seclusion -

and restrictions, and/or the onset of puberty often prompt the

victims to disclose. Victims may fear that their younger siblings

will begin to be subjected to abuse and often disclose to protect

them. For many victims, however, the decision to keep silent

often continues into adulthood. Most incest victims reach their

adult years bearing their secrets intact (Herman, 1981). In one

survey of college students, it was reported that of the 19.2% of

the female population and 8.2% of the male population who

indicated being sexually abused by an adult, 63% of the girls and

73% of the boys never told anyone (Finkelhor, 1979).

There are some writers who have stated that the effects of

incestuous relationships were not negative and may even have been

beneficial to the victims (Bender & Blau, 1937; Constantine cited

in Herman, 1981; Kinsey, Pomeroy, & Martin, 1953; Ramey, 1979).

The majority of the literature, however, describes the traumatic

effects that exist for victims of incest (Courtois & Watts, 1982;

Finkelhor, 1979; Herman, 1981; Meiselman, 1978; Tsai & Wagner,

1978). Some of the complaints common to incest victims include

inability to trust males and females, low self-esteem,












self-hatred, passivity, sexual identity conflicts, impairment in

sexual functioning, feelings of isolation, guilt and shame, and

somatic complaints.

The presence of these symptoms has led to the suggestion of

the existence of a syndrome common to all incest victims, termed a

"Post-Sexual-Abuse Syndrome" (Briere, 1984, p. 12). This syndrome

consists of a pattern of relatively chronic symptoms which include

dissociation, anxiety, isolation, sleep disturbances, anger,

sexual dysfunction, substance addiction, and self-destructiveness.

Briere indicated that these symptomatic behaviors were originally

coping mechanisms to childhoods characterized by victimization.

As a result of sexual abuse occurring early in children's

psychosexual development, such symptomology became integral

components of victims' personality structures as they developed

into adulthood.

Because these psychological effects persist into adulthood,

many victims seek counseling for relief from a variety of

difficulties and a range of symptoms. Once in counseling, some

victims either consciously or unconsciously avoid revealing their

incestuous histories (Courtois & Watts, 1982; Finkelhor, 1979;

Herman, 1981; Meiselman, 1978). Those clients who use an avoidant

pattern may continue in therapy for years without disclosure

(Courtois & Watts, 1982; Herman, 1981). Other clients who

disclose their incestuous experiences do not return for counseling

after their disclosure (Meiselman, 1978); they return but avoid

bringing up the issue again (Forward & Buck, 1978); or they bring











up the incest again in counseling but minimize and/or deny the

detrimental effects on them (Courtois & Watts, 1982; Herman,

1981). There are other clients, however, who do reveal their

incest histories and eventually resolve conflicts associated with

their victimization (Courtois & Watts, 1982; Giaretto, 1982;

Herman, 1981; Meiselman, 1978).

It is not known why some clients are willing to disclose and

explore their incest experiences, while others go to great

lengths to avoid the issue. It has been suggested that the

disclosure or lack thereof may parallel how victims handled their

experiences throughout their lives. Those who did not disclose

during childhood for fear of the reaction of others may

project this fear onto their counselors, while those who were

not that traumatized by the experiences disclose rather easily

(Courtois & Watts, 1982). Others disclose because they are in

pain at the time they sought counseling or because the counselor

guesses it or coaxes them to talk about it. It was reported that

incest victims have difficulty trusting both males and females as a

result of their betrayal as children; thus the building of rapport

with them is a more difficult task than usual (Herman, 1981;

Meiselman, 1978). There was speculation that victims of incest

have magical expectations of their counselors, which leads to

disappointments, resentments, and greater levels of mistrust on the

part of incest victims (Sgroi, 1982).











Counselors may contribute to their clients' nondisclosure and

avoidance of the issue of incest due to their own discomfort with

the subject (Meiselman, 1978; Olson & Sykes, 1982; Sgroi, 1982).

Counselors may convey their values and attitudes regarding incest

through their behaviors. Counselors' reactions such as shock,

horror, distress, blame, and disbelief could result in

strengthening clients' resistances to disclosure and may lead to

their avoidance of bringing up the issue again (Courtois & Watts,

1982; Herman, 1981; Meiselman, 1978; Sgroi, 1982).

Factors in the counseling process that may be helpful or

detrimental to clients with respect to disclosure and resolution

of conflicts associated with their incestuous histories include

counselors' gender, attitudes, and assumptions about sexual abuse,

reactions to the clients, type of therapy, and timing of

interventions (Courtois & Watts, 1982; Herman, 1981). Clients'

resistance in the form of various defenses such as repression,

intellectualization, dissociation, denial, and unrealistic

expectations are factors that could impact on clients' willingness

to reveal their incestuous backgrounds (Sgroi, 1982).

Additionally, client-counselor relationships and the level of

trust developed in them by clients has been suggested as a factor

in clients' willingness to disclose incest experiences (Meiselman,

1978). There has been, however, no in-depth analysis conducted to

investigate if and how these factors affect the clients'

willingness to disclose and explore their conflicts.












Purpose of the Study

The purpose of this study was to identify and explore the

factors that assist female adult incest clients in disclosing and

discussing their incest experiences during counseling. Three

areas were investigated: a) factors in clients' backgrounds that

may have influenced their decisions to disclose their incest

experiences to their counselors; b) clients' perceptions of

counselor characteristics, attitudes, and behaviors that were

helpful or detrimental to them in the decision to disclose their

incest experiences to their counselors; and c) clients'

perceptions of factors that were conducive or not conducive

to them for further exploration of their incest experiences with

their counselors once disclosure occurred.



Need for the Study

Although adult incest victims often seek counseling in

various mental health centers or in the private sector, they

frequently do not get the help they need (Butler, 1978; Sgroi,

1982). Incest victims enter into counseling with specific needs

that must be met in order for therapy to progress. These needs

remain unmet because incest clients may have resistances to

receiving support (Herman, 1981, Meiselman, 1978). It also has

been suggested that some counselors are uncomfortable with incest

clients and may react in ways that are not helpful to these

clients (Courtois & Watts, 1982; DeYoung, 1981).












When adults molested as children disclose their histories to

their therapists they may be seeking some sense of cathartic

relief. In addition to this, they may be seeking reassurances

about some aspect of the incestuous experience. Meiselman (1978)

stated that some victims are fearful that their personalities have

become permanently warped by the incest and that they are doomed

to becoming psychotic. Incest victims want reassurance that there

is hope for them to successfully resolve their conflicts. They

also may be seeking reassurance that they are not responsible for

the incest situation.

Many victims feel guilty for participating in the activities

and for not terminating the affair earlier (Giaretto, 1982;

Herman, 1981; Meiselman, 1978). Herman (1981) indicated that once

young daughters reveal their incest secret they need a lot of

reassurance that they are believed and are not to blame. Adult

clients also need this unwavering belief in their stories, since

skepticism disrupts rapport (Meiselman, 1978). They also need

praise for their courage in coming forward.

Incest clients have resistances to receiving the reassurances

that they need (Herman, 1981). Often, the clients' shame over

their participation in incestuous relations is so great that they

have strong impulses to flee from their therapists once they

disclose. Having left therapy once, they find it very hard to

return. Herman (1981) indicated that the relief and gratefulness

incest victims feel after disclosing their secret arouses

threatening feelings in them. They long to trust and further












confide in their therapists, yet their childhood legacy is one of

betrayal by both parents. In any intimate relationship, they may

fear further exploitation, neglect, and/or abandonment. Their

resistance to receiving support, appropriate as the support might

be, is high.

Another behavior seen in incest clients has been described as

a "flight into health" (Forward & Buck, 1978, p. 166). Clients in

group therapy who receive acceptance from the group despite their

revelation of incest often feel a great sense of relief and

euphoria. They may leave therapy prematurely because they feel

"cured" (Forward & Buck, 1978, p. 166). One further resistance

seen in young incest victims is an emotional withdrawal masked by

a bland external appearance and an apparent lack of concern about

the incest (Peters, 1976). This defense is a result of the need

to protect themselves while they were involved in the incestuous

experiences and may continue into adulthood even after the

cessation of the incest. Incest victims may use familiar defenses

such as repression, intellectualization, dissociation,

minimization, and denial to avoid disclosure and to avoid talking

about the incest again (Courtois & Watts, 1982; Forward & Buck,

1978).

Courtois and Leehan (1982) indicated that adults abused as

children often exhibit great sensitivity to understanding another

person's moods. They believed that this skill is a defense

mechanism developed by abused children to avoid triggering violent

outbursts. Incest victims, therefore, may be very sensitive to












the feelings, attitudes, and mood changes of their counselors

(Courtois & Watts, 1982; Meiselman, 1978; Sgroi, 1982). Incest

victims are aware of the feelings of horror that their stories

elicit, and are therefore extremely sensitive to any reaction of

withdrawal and discomfort on the part of their counselors, no

matter how subtle the cues (Herman, 1981).

Some counselors feel uncomfortable when clients reveal their

incestuous histories (Herman, 1981; Meiselman, 1978; Sgroi, 1982).

Butler\ (1978) described the reactions of religious leaders,

medical professionals, and counselors when questioned about the

incidence of incest among their parishioners, patients, and

clients. Butler indicated that they denied any incidence of

incest and became anxious when questioned. The few who said they

were familiar with a number of incest cases said they felt

untrained and unskilled to deal with them and seldom attempted any

intervention or counseling with the victims or their families. As

a result of the feelings of uncomfortableness displayed by

counselors when their clients revealed their incest histories,

many clients felt "cutoff" and did not bring their incest up

again (Meiselman, 1978, p. 346).

Some counselors refused to believe that the incest actually

took place. Since psychoanalytic theory relies strongly on the

belief in sexual fantasizing by children, therapists have been

trained to deny and not believe reports of incestuous experiences

(Herman, 1981; Rosenfeld, 1979). When this attitude of disbelief

is conveyed to clients, clients are denied the opportunity to share











their experiences and receive the therapeutic assistance and

intervention which may be required (DeYoung, 1981).

Meiselman (1978) indicated that clients feel more confused and

hostile when not believed by their counselors. Consequently,

clients may terminate therapy prematurely.

Another reaction of counselors that may impede the progress

of therapy is intense anger toward the offender. A common error

made particularly by female therapists is overidentification with

victims which results in reactions of horror and rage. When

therapists express intense anger towards the offenders, clients

may become defensive of the offenders. Incest clients who have

some positive feelings toward their offenders may not feel safe

openly sharing these feelings with their counselors (Courtois &

Watts, 1982, Herman, 1981).

Some therapists, particularly males, may identify with the

aggressor. They may try to excuse or rationalize the behavior of

the offenders, either to themselves or to their clients. These

therapists focus on the victims' activities that may imply

complicity or enjoyment. Clients' positive feelings towards the

offenders are encouraged while their anger is discouraged or

denied. These counselors tend to focus excessive interest in the

sexual relationships with the offenders and ignore other aspects

of the relationships. Counselors who behave in this manner with

their clients may induce feelings of guilt, blame, and

helplessness in their clients (Courtois & Watts, 1982; Herman,












1981). They also run the risk of sexual involvement with their

clients in reality or in fantasy (DeYoung, 1981; Herman, 1981).

Incest victims may be regarded by some of their therapists as

"damaged goods" (Sgroi, 1982, p. 113). Many victims are perceived as

so altered and damaged that the usual constraints about sexual

behavior do not apply to them, and are thus more vulnerable to

sexual victimization by their therapists (DeYoung, 1981; Sgroi, 1982;

Summit & Kryso, 1978). Clients have reported sensing a change in

their therapists' attitudes toward them once their incest

histories were revealed (DeYoung, 1981; Sgroi, 1982).



Significance of the Study

The results of this study have implications for practice,

training, and research. If counselors have more knowledge

about the needs and beliefs that incest clients bring to

counseling, they may be better able to help the clients set clear

goals and become aware of unexpressed and thus unmet needs.

Knowledge of those factors that are helpful to disclosure may help

counselors better facilitate client disclosure early in therapy.

Information about counselor reactions that may be helpful to

clients once disclosure is made can help counselors become more

effective in helping clients explore their incestuous experiences

and resolve their conflicts successfully.

The results of this study could have benefits for training

future counselors. Information obtained about client needs and

helpful and nonhelpful factors in counseling interactions can












help develop a data base for courses in training programs that

focus on counseling victims of sexual abuse. Knowledge of the

reactions perceived by clients during the counseling process could

be used to help counselor-trainees explore their own attitudes and

reactions towards incest victims.

The results of this study could stimulate further research in

the area of sexual victimization from the perspective of the

victims. The importance of studying how early sexual experiences

are perceived by the victims themselves has been stated by

Finkelhor (1979). Further research regarding counselor attitudes

toward incest, client-counselor interactions, incest client

resistances to therapy, and treatment issues could be conducted as

a follow-up to this study.



Definition of Terms

For the purpose of this study, the terms below will be

defined as follows:

Adult incest victims. Persons 18 years or older who were

victims of familial sexual abuse during their childhoods. The

victims may sometimes be referred to as incest survivors.

Background factors. Circumstances in the childhood of the

subjects such as age at onset of incest, close relationships, and

satisfaction with counseling experiences.












Child sexual abuse. A sexual act imposed on a child who

lacks emotional, maturational, and cognitive development. The

ability to lure a child into a sexual relationship is based upon

the all powerful and dominant position of the adult or older

adolescent perpetrator, which is in sharp contrast to the child's

age, dependency, and subordinate position. Authority and power

enable the perpetrator, implicitly or directly, to coerce the

child into sexual compliance. The abuse may consist of all types

of sexual contact such as inappropriate sexual talk,

exhibitionism, kissing, fondling, masturbation, fellatio,

cunnilingus, dry intercourse, and digital or penile penetration of

the anus or vagina (Sgroi, 1982).

Congruence. Having consistency between what an individual

says and what she or he implies by expression, gestures, or tone

of voice (Barrett-Lennard, 1962).

Counselor characteristics. Counselor gender and personality

qualities.

Empathy. The ability to sense another person's affect and

intensity of experience as well as recognizing its particular

context (Barrett-Lennard, 1962).

Incest. A form of child sexual abuse that takes place

within the immediate or extended family. This includes parental

incest (with parent, stepparent, or surrogate parent) and familial

incest (with grandparents, aunts, uncles, cousins, or siblings).

The presence or absence of a blood relationship between incest










participants is of far less significance than the kinship role

they occupy (Sgroi, 1982).

Incest offender. The adult or older adolescent who is in a

more powerful and dominant position than the child and has

implicitly or directly lured the child into sexual compliance.

The offender also may be referred to as the perpetrator, aggressor,

or abuser.

Level of regard. The affective aspect of one person's

response to another including various qualities of "positive" and

"negative" feeling. Examples of positive feelings include

respect, liking, appreciation, and affection. Examples of

negative feelings include dislike, impatience, and contempt

(Barrett-Lennard, 1962, p. 4).

Unconditional regard. The degree to which constancy of

regard is felt by one person for another who is communicating

self experiences to the first (Barrett-Lennard, 1962).



Organization of the Study

The remainder of this study is organized into four chapters.

Literature related to the conceptual framework of incest, the

theoretical and historical perspective of incest, and the special

issues to be considered when counseling adult incest victims is

reviewed in Chapter Two. The methodology used to conduct this

study is described in Chapter Three. The results of the study and

a discussion of these results are presented in Chapter Four. The

conclusions, implications, summary, and recommendations for future

research are presented in Chapter Five.














CHAPTER TWO
REVIEW OF RELATED LITERATURE

The review of literature in Chapter Two is divided into

three sections: a conceptual framework for child sexual abuse,

theoretical approaches to studying incest, and the treatment

issues in counseling adult incest victims. The section regarding

the conceptual framework includes the definition of and

description of behaviors involved in incest, incidence of incest,

participants and family dynamics in incestuous abuse, and the

reported long-term effects on victims. The section about

theoretical approaches reviews the systems theory and the

social and cultural theory as they apply to the study of incest,

the portrayal of incest in literature and media, and the view of

incest in the psychiatric and professional literature. The

section on treatment issues describes approaches and special

considerations that must be addressed when working with incest

clients. These issues include factors impacting on clients'

decisions to enter psychotherapy and to disclose the incest,

reactions to disclosure of incest, clients' resistances, and the

counselors' role in the treatment of adult incest victims.

A Conceptual Framework For Child Sexual Abuse

Definition

Child sexual abuse consists of sexual acts imposed on

children who lack emotional, maturational, and cognitive

15











development. The ability to lure children into sexual

relationships is based upon the all-powerful and dominant

positions of adults or older adolescent perpetrators, which is in

sharp contrast to children's ages, dependencies, and subordinate

positions. Authority and power enable the perpetrators,

implicitly or directly, to coerce children into sexual compliance

(Sgroi, 1982).

When child sexual abuse takes place between children and

nonfamily perpetrators, the abuse is labeled extrafamilial sexual

abuse. The adults involved in extrafamilial sexual abuse include

babysitters, neighbors, friends of parents, daycare or school

personnel, scout leaders, and other adults who have access to

children.

Intrafamilial sexual abuse, or incest, consists of sexual

contacts between children and older family members. Nonparent

perpetrators may involve older siblings, cousins, aunts, uncles,

or members of the extended family who do not occupy parental roles

with the victims. Parent or parent-figure perpetrators include

biological parents, stepparents, grandparents, and boyfriends or

girlfriends of parents (Sgroi, 1982).

Although laws differ state to state, many legal definitions

of incest refer to marriage or sexual intercourse with blood

relatives (Russell, 1982). It is now widely recognized that sexual

intercourse is not the_only sexual activity which constitutes

incest. Sexual behaviors such as inappropriate sexual talk,

exhibitionism, intimate kissing, fondling, mutual masturbation,











fellatio, cunnilingus, dry intercourse, and digital or penile

intercourse are included in recent expanded definitions of

incest (Finkelhor, 1979; Herman, 1981; Russell, 1982; Sgroi, 1982).

Incidence of Incest

A study conducted by Finkelhor (1979) surveyed 530 female

college students and 266 male college students and then held a

follow-up personal interview with those volunteering to

participate. Finkelhor's findings show that of the 19.2% females

who were sexually abused by an adult during childhood, 8.4% were

abused by a family member and 1.3% by a father or stepfather. The

medianage of the victims at onset was 10.2 years and 94% of the

perpetrators were male. Of the males, 8.6% were sexually abused

during childhood and 1.5% of these assaults were by family members

(17%). The median age of the boys at onset was 11.2 years and 84%

of the perpetrators were male.

Russell (1982) surveyed a random sample of 930 women in the

San Francisco area. Detailed interviews were designed to

encourage good rapport in order to facilitate disclosure of early

sexual experiences. Russell reported that 16% of the sample

experienced intrafamilial sexual abuse before age 18 and 12% of

the women experienced incest before age 14. The rate of

father-daughter incest was 4.5%, which was almost five times

greater than previous estimates. The perpetrators were

predominantly male (96%). One further finding of Russell's study

was that only 2% of intrafamilial sexual abuse incidents were












reported to the police. These extremely low figures provide

evidence that reported cases are only a small fraction of the

actual incidence of incest.

Incest Participants

Perpetrators

Characteristics of the perpetrators of incestuous abuse have

been described by (roth (1979) In examining a sample of 148

offenders who sexually assaulted underage persons and who were

referred to the sex offender program at Somers Correctional

Institute in Connecticut, Groth discovered certain biopsychosocial

traits the offenders displayed. Offenders ranged in age from 14

to 73, with 71% under age 35. At the time of their first offense,

most men were under age 30. In 14% of the cases, the offenders

were members of the child's immediate family. Groth stated that

this number does not reflect the true proportion of incest

offenders to extrafamilial sexual offenders since there is

reluctance to prosecute family members and incest offenders are

thus less likely to be in this sample.

The impression that emerged from Groth's study of sexual

offenders is that child molesters are relatively young, are

heterosexual men who are not insane, retarded, or sexually

frustrated, and who have multiple life difficulties. The sexual

encounters with children are distorted expressions of needs for

intimacy, power, affiliation, control, hostility, and aggression











as opposed to sexual needs. They seek to control their child

victims rather than injure them and thus pose more psychological

than physical harm to their victims.

Victims

DeFrancis (1969) investigated 263 child sexual abuse cases in

the files of the American Humane Association Protection Agency.

DeFrancis determined that over 90% of child sexual abuse victims

were girls. Most incest activities begin with prepubescent girls

and boys with a range of two months to 17 years. The median age

at onset for girls is 10 years and for boys 11 years. Female

incest victims tend to be the oldest daughters in father-daughter

incest families. They are characterized as being pseudomature,

seductive, passive, and responsible for caretaking others in their

families (Herman, 1981).

Boys involved in incestuous relationships most often are

abused by men and are more often subject to physical abuse along

with thesexual abuse. inkelhor (1984), reviewed data from the

1978 National Reporting Study of Child Abuse and Neglect and

determined that families of boy victims are poorer and more likely

to be broken, which would be consistent with the higher frequency

of physical abuse occurring with the sexual abuse. Generally,

boys who have been incestuously victimized are more often

characterized as hostile and aggressive compared to the passive

state of female victims.












Mothers of incest victims

Mothers in incestuous families have been characterized as

"silent partners" (Forward & Buck, 1978, p. 45). Often they are

absent from their homes, physically or emotionally. They are

passive, nonnurturing, depressed, and disenchanted with their

lives. Mothers' behaviors range from ignoring signs that incest

is taking place to subtly promoting it. Many of these women have

poor social skills, few friends or outside interests, and often

lack everyday living skills such as ability to drive and handle

money. They tend to fear change or separation from the offender

once the incest is revealed and often feel inadequate to take

responsibility to stop the incest from reoccurring (Sgroi, 1982).

Siblings of incest victims

Siblings of incest victims may be unaware that incest is

taking place and may be resentful of the incest victims' special

positions in the family. Incest victims may get special

privileges such as new clothes, extra money, or freedom from

physical abuse. They may be perceived as having special

relationships with the offenders, and thus, there may be much

sibling rivalry present. In other instances, siblings are aware

of the incest that is taking place since they may have been

victims themselves. Sometimes these multiple victims will discuss

their abuse with each other and give each other mutual support.

Siblings are often very sensitive to the incest family's problem

despite parental attempts to shield them from information about

the incest accusation (Goodwin, 1982).












Family Dynamics

The incest family is frequently isolated. Particularly in

parental incest families, personal relationships outside of the

home are discouraged and often are severely limited. Family

members have few friends and are encouraged to meet all their

social needs within their households. Perpetrators usually

dominate family decision making although these perpetrators may

appear to outsiders to be quiet, unassertive, and emotionally

colorless people. Incest families tend to move often, thus

decreasing the possibility of intimacy with other people (Sgroi,

1982).

Gelinas (1983) describes the "parentification" of the

children in incest families (p. 319). Incest children gradually

come to function as parents by doing the cooking, laundry, child

care, and caretaking for their parents. These children actually

assume responsibility for these tasks as opposed to being helpers.

Mothers tend to be subordinate and powerless and withdraw

physicallyand/_oremotionally. (Incest children take over

responsibility for their fathers' emotional needs to the exclusion

of their own.' The incest perceived consciously or unconsciously

as necessary by all family members to keep_the family unit intact.

The outside world is perceived as hostile and family members

often sabotage any members' attempts to interact with outsiders.

Children in incest families see power being used capriciously,

inconsistently, and irresponsibly. They learn howto use power

and frequently manipulate each other. Denial is the most












frequently used coping skill in incestuous families. Real

feelings are often denied, and projection of these feelings on

others is very common. Role boundaries are often blurred and

limits are rarely set (Giaretto, 1982; Herman, 1981; Meiselman,

1978; Sgroi, 1982).

Effects on Victims

The full effects of overt incest may not be observable until

such time that victims attempt to make adult sexual adjustments

(Meiselman, 1978). Most of the clinical research includes data on

a few males in samples with a majority of females without

specifically mentioning which effects apply to males. The

empirical studies clearly distinguish the effects of child sexual

abuse on female vs. male victims. It is difficult to draw

conclusions about male victims at this early stage in research

since few clinical and even fewer empirical studies have been

conducted exclusively with boy victims.

Clinical research results

Gelinas (1983) described the emotional reactions and

self-perceptions that are found to be salient in clinical research

with incest victims. These include feelings of shame and guilt,

manifestions of chronic anxiety, feelings of vulnerability, and

phobias. Depression is commonly cited and is described as

chronic, resulting in an inability to find satisfaction or

pleasure in life, and leading to suicide ideation or suicide

attempts. A sense of stigma in adults as a result of the memory

of the childhood sexual abuse often leads to victims reporting












self-perceptions of worthlessness, helplessness, impairment in

self-esteem, sense of inferiority, and inability to control their

own destiny-

Interpersonal relationships are often affected by the incest.

Victims have difficulty in trusting men and this distrust is

manifested by social isolation, difficulty in establishing_close

relationships, and fear of being exploitedor abandoned. Adult

incest victims often seek out redeeming relationships compulsively

and desperately, thus leading to their involvement with

inappropriate partners. Victims may choose spouses who are

physically and emotionally abusive to them and to their

children (Gelinas, 1983; Herman, 1981; Justice & Justice, 1979; Tsai

& Wagner, 1978).

Adult sexual functioning has been a major emphasis in the

literature on long-term effects. Affective problems include

generalized negative associations with sexual activity, difficulty

in associating pleasure with arousaland intimacy, and flashbacks

to the incest experience during sexual activity. These negative

associations may lead to retreats from all sexual contacts, or to

attempts to avoid close relationships. Some victims perceive

sexual threats from any affectionate gestures from their partners.

Specific sexual dysfunctions such as vaginismus, inability to

tolerate arousal or sexual stimulation) inability to orgasm, and

orgasm without a sense of pleasure are mentioned (Burgess &

Holmstrom, 1978; Rosenfeld, Nadelson, Krieger, & Backman, 1979;

Tsai & Wagner, 1978).











Empirical research results

The empirical studies reinforce the findings in the clinical

literature and give more specific proportion to the effects.

Depression is most commonly reported in the clinical literature on

long-term effects of incest. However, in the empirical studies,

there is little discrimination between incest victims and control

groups.) Herman (1981) noted major depressive symptoms in 60% of

the incest victims in a study, and in a (comparison group of women

who had had seductive but nonincestuous fathers, 55% also reported

depression.)Meiselman (1978) in a study of 58 adult incest

victims in therapy found depressive symptoms in 35% of the incest

victims compared to 23% of the control group (100 randomly

selected therapy clients), which was not a significant difference.

In regard to suicidal behavior the findings were more clear

cut. Herman found that 38% of the incest victims versus 5% of the

nonvictims had made at least one suicide attempt. Briere (1984)

conducted a random study of 153 female walk-in clients to a local

community health center. Briere reported that 51% of the sexual

abuse victims versus 34% of nonabuse victims had a history of

suicide attempts.

Emotional reactions such as fear and anxiety were reported by

Briere (1984). Briere found that 54% of the sexual abuse victims

experienced anxiety attacks compared to 28% of the nonvictims.

Nightmares were more common in victims than nonvictims (55% vs.

23%) and sleeping difficulties were more prevalent in victims

(72%) than nonvictims (55%).












Negative self-concepts was another long-term effect confirmed

by empirical research. Courtois (1979) interviewed 30 adult

incest victims and reported that 87% of the victims believed that

their sense of self had been moderately to severely affected by

the experience of incest. (They sensed being different, branded,

and permanently damaged.

Women sexually abused during childhood reported problems with

relating to both men and women. Meiselman (1978) found that 60%

of the sample in a study disliked their mothers and 40% felt

negativelytoward their fathers. Fear of husbands or sex partners

was seen in 64% of the sample compared to 40% of the control

group. Thirty-nine percent of the sample never married.

Difficulty in parenting is a long-term effect now being

looked at empirically. Goodwin, McCarty, and DiVasto (1982)

investigated 100 mothers of abused children and compared them to

500 women from the same community. Of the mothers of abused

children, 24% reported incest during their childhood compared to

only 3% of the control group. They suggested that when closeness

and affection were confused with sexual overtones as in incest,

incest victims had difficulty being emotionally and_physically

close with their own children, and thus, set the stage for child

abuse.

Revictimization of incest victims later in life was reported

in Russell's (1982) random survey of 930 women in San Francisco.

Russell found that 33-68% of the sexual abuse victims were raped

later on in life compared to 17% who were not childhood victims.












Between 38% and 48% of the sexual abuse victims had physically

abusive husbands compared to 17% who were not childhood victims.

Between 40% and 62% of the incest victims were sexually assaulted

by their husbands compared to 21% of nonvictims.

Adult sexual adjustment of incest has been a major area of

empirical investigation. Meiselman (1978) noted that sexual

maladjustment was the most outstanding finding of the incest cases

studied. Of the incest victims, 87% reported serious problems

with sexual adjustment since the incest compared to 20% of the

control group who reported sexual problems. Orgasmic dysfunction

was reported by 74% of the women and flashbacks to the incest

interrupted sexual experiences with chosen partners during

adulthood.

Promiscuity is another long-term effect reported empirically.

Meiselman (1978) reported 19% of the sample characterized their

behavior as promiscuous. Fromuth (1984) conducted a

survey of college women. Fromuth observed that the (subjects

who experienced child sexual abuse more often described

themselves as promiscuous rather than stating that they

were sexual with numerous partners. /Promuth did not find

differences between sexual abuse victims and nonvictims on the

measure of number of partners.) Fromuth concluded that the self-

description of promiscuity may have more to do with negative

self-concept which would lead to a sexual self-labeling rather

than a true reflection of their behavior.












James and Meyerding (1977) interviewed 136 prostitutes and

found that 55% of them were sexually abused as children prior to

their first intercourse. Of the adolescents in their sample, 65%

had been forced into sexual activity before age 16. Silbert and

Pines (1981) supported this link between juvenile sexual abuse and

prostitution in their investigation of prostitutes. They found

that 60% of the prostitutes they interviewed had been sexually

abused before the age of 16 by an average of two people for an

average of 20 months.

Substance abuse by incest victims also has received empirical

support. Herman (1981) reported that 35% of the incest victims in

a study abused alcohol and drugs compared to 5% of nonincest

women. Briere (1984) found that 27% of childhood sexual abuse

victims had a historxyof alcoholism compared to 11% of nonvictims.

Sexual abuse victims had a 21% rate of drug addiction compared to

2% of nonvictims.

Theoretical Framework for Studying Incest

Systems Approach

Rather than viewing intrafamilial sexual abuse as originating

exclusively from individual factors such as adjustment problems of

the perpetrators, family disorganization, or victim

characteristics, some researchers see incest as the product of a

cumulative influence of a number of factors. Tierney and Corwin

(1983) described a "systems" approach for explaining the

occurrence of incest (p. 106). Variables in their model fall into

four broad categories: socioecological or family climate factors;











aspects of family structure; predisposing factors in the

perpetrator, victim and spouse; and precipitating or situational

factors.

Socioecological factors such as household density, geographic

isolation, and social isolation may promote a climate for seeking

social and sexual satisfaction within the family. tSocial

isolation has been associated with higher risk for sexual abuse by

Finkelhor (1979). Family composition is an aspect of family

structure that may lower the constraints against illicit sexual
I
contact. Stepfamilies appear to be more prone to sexual

exploitation (Finkelhor, 1979; Russell, 1984). Role disturbances

such as the role reversal between mothers and children and the

lack of a strong, affectionate relationship between mothers and

children are family structural features that have been associated

with incestuous families (Browning & Boatman, 1977; Herman, 1981;

Summit & Kryso, 1978). Power imbalances have been observed in

incest families. These imbalances are seen in domineering,

authoritarian, patriarchal family systems (Finkelhor, 1979;

Herman, 1981; Meiselman, 1978).

The systems model synthesized the individual maladaptive

personality characteristics of incest participants as described in

the literature. Male parent or parent figures)were psychosexually

immature, had low impulse control, few social ties, childhood

deviant sexual contact within family, and low marital and sexual_

satisfaction. The female spouses were seen as having poor

self-concepts, low marital and sexual satisfaction, emotional











distance from the victims, and histories of childhood abuse. The

victims had few social ties and had high needs for affection and

attention.

The above factors may be present in families and yet may not

lead to child sexual abuse unless certain changes take place that

add more strain on family members. Life stresses, in the absence

of positive coping skills, are factors that may precipitate sexual

abuse. Parental absence is another precipitating condition.

(Gelinas (1983) noted that sexual contact often began when mothers

were in hospitals giving birth to new siblings) Fathers who have

been away and return to a changed home situation may be at higher

risk to sexually abuse their children. Incapacitation of mother

as a result of illness, travel, or desertion has been mentioned as

a contributing factor in incest families (Herman, 1981).

Social and Cultural Approach

Sexual victimization of children is not universal. There are

cultures and societies in which the incest taboo is strictly

observed (Mead, 1968). One of the major theories that accounts

for the frequency of the violation of the incest taboo in our

society from a social and cultural point of view has been called

the Male Supremacy Theory (Finkelhor, 1979). This theory has been

associated with incest clients' reluctance to disclose their

incest experiences to others and with certain societal attitudes

and behaviors towards incest victims (Brownmiller, 1975; Courtois,

1979; Finkelhor, 1979; Herman, 1981; Rush, 1980).












This theory stated that our society has a high degree of male

supremacy. Men are considered as the dominant status group and to

maintain control, need a vehicle by which to socialize women to a

subordinate status. The vehicle of sexual victimization and the

threat of it are helpful to the controlling group to keep women

intimidated (Brownmiller, 1975). This process starts in childhood

with the victimization of girl children. Finkelhor (1979)

indicated that whether or not it functions to maintain male

dominance as Brownmiller suggested, the sexual exploitation of

women and children is certainly easier in a male-dominated

society.

Florence Rush (1980) related evidence of the tradition of

encouraging sex between men and little girls that dates back to

ancient civilization, over 5,000 years ago, when sex and marriage

between men and very young children took place with great

frequency. Women and children were viewed as property of their

fathers or husbands and had no rights of their own. All

heterosexual relationships were defined as financial transactions.

Marriage was the purchase of a daughter from her father, a female

could be sold and resold by her master as a prostitute, and a rape

was the theft of a girl's virginity which could be compensated for

by payment to her father or by marriage to her.

This view of women as property of men was carried through the

centuries. Women who who were raped were forced to marry the

rapists or were punished along with the rapists (Brownmiller,

1975). Jewish women who were raped during the European pogroms












could be easily divorced by their husbands. Male children were

also subject to sexual abuse although they could not legally be

raped. However, if they were homosexually assaulted, they could

be put to death or exiled.

The tradition of a male dominated society continued through

the twentieth century. Herman (1981) explained how this type of

society with its resultant differences in male and female

socialization impacted on sexually exploitive behaviors of males

and females. Herman cited Mitchell (1974), Lewis (1976), and

Chodorow (1978) who focused on the psychological consequences of

the sexual division of labor in child care. Children raised by

subordinate females insured that boys and girls differed in every

aspect of personality development such as the formation of gender

identity, the acquisition of conscience, the capacity to nurture,

and the internalization of the incest taboo. As a result, boys

developed a male psychology of domination and girls, a psychology

of victimization. A male's socialization within a patriarchal

family leads to his difficulty with empathizing with his victim.

Without empathy, he has diminished his major internal barrier to

abusive behavior. With a restricted ability to form mutually

affectionate relationships, men tend to enter into sexual

relations with subordinate females such as women who are younger

and/or perceived as weaker, as well as girl children.

In twentieth century Western society, the rights of ownership

and exchange of women within the family were vested primarily with

the father. Daughters belonged to fathers alone and though the












incest taboo forbade them to make sexual use of their daughters,

no other man's rights are offended should the fathers choose to

disregard this rule. Thus, of all possible forms of incest, that

between father, stepfather, or father figure and daughter is the

most easily overlooked (Herman, 1981).

The prevalence of incest is reflected in literature and

media. Not only is incest portrayed as a common occurrence, but

the children are considered responsible for the incestuous

experiences. The "Seductive Daughter" (Herman, 1981, p. 36) dates

back to the biblical story of Lot. Lot's wife was turned into a

pillar of stone (cold and withdrawn) and therefore, to preserve

the seed of their father, Lot's daughters decided to seduce him.

They made him drink wine and each had sex with him. Lot is seen

as entirely innocent in this situation and the initiative of the

sexual encounters was the full responsibility of his daughters.

Rush (1980) cited many examples of the portrayal of seductive

young girls in literature and the movies. One example of the

modern American version of the seductive daughter is in the book

Lolita. Humbert Humbert, a middle-aged man gave an account of

his seduction by 12 year old Lolita. She was the temptress, the

initiator. She was the example of the sexually wise, turned on

and seductive young girl who wanted and initiated sexual activity

with an older man. The movie Taxi Driver starred Jodi Foster as

a 12 year old prostitute who was happy to sexually satisfy any

male's sexual desire.











Professional Perspective of Incest

The contemporary psychological thought concerning incest and

its effects developed during the 20th century as a result of the

work of Freud (Courtois, 1979). Freud's initial belief, stated as

early as 1892, was that childhood sexual trauma was the underlying

etiology for female clients' hysteria. Peters (1976) indicated

that Freud may have had difficulty accepting the high incidence

rate of his clients' reports of incestuous activities. This was

evidenced by Freud's admission to suppressing the fact of a father

as molester in two cases reported in 1895. By 1924, Freud shifted

the emphasis from the actual occurrence of childhood sexual trauma

to childhood fantasizing of sexual desires for their parents.

Some writers believe that Freud, as well as other

psychoanalysts of that time, welcomed the idea that reports of

sexual victimizations could be regarded as fantasies. The thought

that respectable family men were having sex with their daughters

was too monstrous a thought for the professionals (Finkelhor,

1979; Herman, 1981; Meiselman, 1978). The widespread acceptance

of Freud's theory of childhood sexual fantasies led to the common

practice of psychotherapists allowing their patients to repress

emotionally significant and pathogenic facts (Peters, 1976).

There was little examination of early sexual trauma and its

impact on psychological functioning for the next 30 years. The

few studies that investigated incest concluded that childhood

incest did not appear to be psychologically damaging. Children in












a sample of psychiatric cases reported by Bender and Blau (1937)

were viewed as charming, seductive, willing, and sexually

initiating.

During the 1960's there was an increase in the number of

studies devoted to incest. Some of these studies investigated the

individual and family dynamics of incest. Other studies

investigated and supported the view that incest was symptomatic of

family dysfunction rather than of individual dysfunction and that

incest was harmful to the child participants (Cormier, Kennedy &

Sangowicz, 1962; Gagnon, 1965; Lustig, Dresser, Spellman & Murray,

1966). Rather than blaming incest victims for their

seductiveness, writers began looking at other members of incest

families. Tormes (1968) conducted a study on incest for the

American Humane Society. Tormes studied the family setting and

circumstances surrounding father-daughter incest and concluded

that mothers in incestuous families fail to protect their children

from sexual abuse.

During the 1970's, the women's movement helped to bring

incest out in the open as it did with other sensitive issues such

as rape, spouse abuse, and child abuse. Concern for the welfare

of victims also contributed to a shift in the focus and number of

studies on sexual abuse (Finkelhor, 1979). Studies in the 1970's

tended to focus on how sexual abuse is ignored and how victims are

not believed. Peters (1976), a psychiatrist who worked with

sexual assault victims in private psychoanalytic practice and in

the Philadelphia rape victim clinics, wrote a landmark article












documenting case histories of incest victims. Peters challenged

the existing psychoanalytic belief that reports of childhood

incest were mostly fantasies of young minds. Peters criticized

the practice of psychotherapists who allowed and continued to

allow patients to repress facts concerning their incest

experiences. Peters related the repression of these facts to

serious psychological problems for the victims as adults.

Butler (1978) interviewed incest victims and their families

throughout the United States to gather information on the

participants in incest. Butler reported on the difficulty she

encountered when she talked with members of professional

communities about their contacts with incest victims. The

professional communities consisted of religious leaders,

pediatricians and other physicians, nurses, law enforcement, human

services workers, and counselors when she asked about their

experiences with incest victims. Despite the reports of the

widespread prevalence of incest that were being published, the

response she received from professionals was one of denial that

incest was taking place. Butler indicated that the professionals

she interviewed were uncomfortable talking about incest. They

said that they were untrained and unskilled in ways to deal with

incestuous assault and rarely attempted counseling or intervention

with the members of such troubled families.

Descriptive data on variables in childhood sexual

victimization such as incidence, participants, family dynamics,

sexual behaviors involved, short and long-term effects, and risk












factors were collected by researchers in the 1970's. Finkelhor

(1979) surveyed 796 male and female college students in the New

England area. Notable in Finkelhor's findings was the frequency

of incest among girls (14%) and boys (9%), with father-daughter

incest reported as the most traumatic. Some of the factors

Finkelhor identified as possible high risk for incest were

stepfather in home, absent mothers, unsatisfactory marital

relationship of parents, and social isolation. Force and age of

partner were found to be two factors that produce the most trauma.

A salient finding in this study was that 63% of the girls and 73%

of the boys who were sexually abused by adults never told anyone.

Researchers in the 1970's studied the long-term effects of

incest. Meiselman (1978) investigated 58 women clients who

experienced incest during childhood using a control group of 100

randomly drawn patients. Meiselman determined that psychotherapy

patients with incest experiences did not differ from psychotherapy

patients without incest with respect to type of psychopathology.

However, the incest group was more disturbed, and more likely to

have physical complaints and interpersonal and sexual

difficulties.

Courtois (1979) conducted structured interviews with 30 women

in the Baltimore, Maryland and Washington D.C. area who

experienced incest during childhood. The women were recruited by

advertisements in newspapers, magazines, and radio and by referral

from therapists. Courtois investigated details of their family

background and incest experience, including its aftereffects. A












major value of this study was the suggestion to use new methods

and new areas of inquiry for future, less biased investigations of

incest and its effects.

As more rigorous research methods are being used, more

accurate data are being collected about incest. As a result, more

relevant and therapeutic treatment methods are being developed and

studied in the 1980's. The next section will detail literature

related to the area of treatment of adult incest victims.

Treatment of Adult Incest Victims

Presentation for Treatment

Adults who have experienced incest during childhood usually

present for treatment in a characteristic "disguised presentation"

(Gelinas, 1983, p. 326). Gelinas organized the symptoms of this

presentation into an Incest Recognition Profile (IRP). Clients

often have presenting problems of chronic depression and may have

atypical elements such as dissociative and/or impulsive elements.

Incest clients may describe histories of premature housekeeping

and heavy childcare responsibilities during childhood or

adolescence. Gelinas stated that if the symptoms of the disguised

presentation become the focus of treatment and the history of

incest remains hidden, treatment will become increasingly

frustrating and unsatisfying for clients. These clients will be

at risk for becoming repetitive treatment seekers while the

negative effects of incest become more elaborated.

Factors related to entering psychotherapy in a clinical

sample of adult incest victims was investigated by Kerr and Crisci












(1984). The researchers developed a 75 item questionnaire

covering areas such as demographics, sexual abuse experiences,

attempts to disclose the experiences to others and responses to

disclosures, use of peer and significant adult relationships, and

therapy histories. Psychotherapists were contacted about the

study and were asked to select incest clients who could then

volunteer to participate in the study. Nineteen women volunteered

and completed the self-administered questionnaire.

Information was elicited about subjects' current and previous

therapies. Of the 19 subjects, all had been in therapy at least

twice. The range of separate therapy contacts initiated was from

2 to 17 separate therapies. The most frequent number of separate

therapy contacts was five. Although the subjects may have entered

therapy for the first time in the range from age 12 to 31, age 18

was the most frequent age of entering and 19.36 was the mean age.

Ten questions were asked about each of the therapy contacts

and cumulative reports of the first and fifth contact were

reported by the researchers. Subjects reported coming to their

current therapies for a range of problems in living, with 68.5%

wanting to specifically talk about their sexual abuse experiences.

In 49.3% of the treatment contacts, child sexual abuse was not

discussed at all. The researchers concluded that the repeated

therapy contacts and difficulty in discussing sexual abuse

experiences, particularly at the beginning of therapy, suggests

that undisclosed child sexual abuse may have remained problematic

for these clients. Failing to address the past sexual abuse in











some direct form seems to leave conflicts unresolved for incest

clients. These findings support the contention of Gelinas (1983)

that negative effects of incest will persist if the incest is not

dealt with directly during therapy.

Self Disclosure and Counselina

Jourard (1963) discussed the importance of self-disclosure by

clients and counselors during counseling. Jourard defined

self-disclosure as talking about oneself to another person. He

believed that self-disclosure was a factor in the process of

effective counseling and suggested that people become clients

because they have not disclosed themselves in some optimum degree

to the people in their lives.

The relationship between talking about oneself and positive

mental health dates back to Freud in the nineteenth century.

Freud believed that when people struggled to avoid knowing their

own thoughts and feelings, they got sick. They could only become

well and stay relatively well when they knew their inner thoughts

and feelings. The method by which they could know themselves was

through self-disclosure to another person. The real self, or

subjective side of people, includes what people think, feel,

believe, want, or worry about. People reveal their subjective

sides through the process of self-disclosure.

Jourard stated that in order to elicit and reinforce

self-disclosure in clients, counselors should manifest their real

selves in the counseling process. Counselors can do this by











spontaneously and honestly conveying their thoughts and reactions

to their clients. This self-disclosure on the part of counselors

can facilitate self-disclosure on the part of clients.

Disclosure of Incest

Although disclosure of incest to counselors may be helpful to

clients, not all clients spontaneously disclose. Children

involved in incest are often warned by the offender not to tell

anyone. The offenders warn the children that whatever happens as

a result of disclosure will be the children's fault. Breaking up

of families, someone going to jail, mothers having nervous

breakdowns, and children being removed from their homes are all

examples of the threats received and reported by child incest

victims in order to keep them quiet (Berliner & Stevens, 1982).

Sgroi (1982) discussed two types of disclosure of child sexual

abuse, accidental and purposeful. External circumstances may lead

to the accidental revelation of the secret of incest. Purposeful

disclosure takes place for various reasons. Young children may

tell secrets because the activities were so stimulating that they

want to share them with someone.

Older children often disclose in order to escape or modify

some family pressure situation. The adolescents who previously

may have enjoyed the special loving relationships with their

fathers may now be more interested in peer relationships outside

of their homes. Their fathers, however, want to keep them

isolated and become very restricting with them. Other situational

changes that may prompt older children to reveal the sexual abuse











include fear of becoming pregnant, protection of younger siblings

from abuse, and/or separation or divorce of mother from the

offender (Berliner & Stevens, 1982).

When incest victims become adults, life changes take place

that foster disclosure of incest. Moving away from home seems to

precipitate disclosure since victims may feel safer and out of the

family grasp. Since incest victims may be more vulnerable to

repeated sexual victimizations, they may realize their inability

to protect themselves and seek treatment. Relationships,

marriages, and parenting are additional developmental stresses in

the lives of adult incest victims. They may fear that they or

their spouses will harm their children, fear that their children

will be sexually abused by the same family members who abused

them, and fear that the extended family may never be normal

because of all the intact secrets (Goodwin & Owen, 1982).

Despite the numerous reasons incest victims give for

disclosing their incest, there are many incest victims who never

reveal their secrets. Courtois and Watts (1982) indicated that

disclosure as adults may be associated with the reactions they

received when they disclosed during childhood.

Reactions to Disclosure of Incest

Sgroi (1982) discussed some of the family reactions to

disclosure of incest activities by child victims. The

perpetrators often react with alarm. They know that exposure

could result in loss of social status, job, and family. They

usually react defensively with self protection as their main goal.












They may react with hostility to the children who disclose and

towards anyone who is supporting or advocating for these victims.

Perpetrators use their power within their families to the fullest

in order to control their children and other family members and to

undermine the credibility of the allegations.

Mothers of incest victims may initially react to disclosure

by expressing concern for their children. Some mothers may have

previously been told about the incest or may have suspected it and

did not intervene. Even with no direct responsibility, mothers of

victims must face the consequences of siding with their children.

They usually end up choosing between protecting the children or

protecting the perpetrators. If perpetrators are providing

mothers with economic support, social status, and/or emotional

support, the choice is very difficult and painful. If

perpetrators have previously been violent or abusive towards their

families, mothers may fear further abuse. If perpetrators exert

pressure on mothers to side with them, it is not unusual for

mothers to collapse under this pressure. Mothers may express

disbelief of their children's stories, side with the perpetrators'

stories of seduction and compliance by their children, and/or

minimize the negative effects of the activities.

Siblings may react protectively and with concern for the

victims; however, they too may also act defensively. They fear

disruption of their family life, the unknown, and separation even

if their home lives have been problematic for them. Siblings, as

their mothers, may have to choose between the victims and the











perpetrators. Perpetrators have much of the power in the families

and are more effective in getting the support they need from

siblings. Sgroi stated that only those family members who have

great ego strength and security can be expected to maintain

protection and concern towards the victims.

Roland Summit (1983) discussed the critical role of the

mental health profession in the crisis of disclosure. Summit

explained the difficulties facing emotionally distraught children

who are accusing respectable, reasonable adults of perverse,

assaultive behavior. Disbelief and rejection by adult caretakers

increase the helplessness, hopelessness, isolation, and self-blame

that children are already experiencing as a result of the sexual

abuse. Victims looking back are usually more embittered towards

those who rejected their pleas for help than to the perpetrators

who initiated the sexual activities. When no adults intervene to

acknowledge the reality of the abusive experience to the children

and to fix responsibility on the adults involved, children tend to

deal with the sexual abuse as an intrapsychic event. They

incorporate high levels of guilt, self-blame, pain, and rage.

Caretakers of incest victims may turn to mental health

professionals for expert advice once disclosure of incest takes

place. Summit expressed concern that clinical specialists tended

to reinforce the more acceptable belief that children were rarely

legitimate victims of intrafamilial sexual abuse and that their

complaints could be dismissed as fantasies, confusions, or wishes

for power within the families.











Reactions of rejection, disbelief, blame, anger, and lack of

support can impact on how incest victims perceive the helping

professionals (Courtois & Watts, 1982). Courtois and Watts

reported that adult incest victims often do not disclose the

secret of their childhood experiences for fear of a negative

reaction by the people they may confide in. If they have further

experienced negative reactions from therapists during childhood

disclosure, their fear of being hurt again may be compounded.

Many adult incest victims disclose because they are in such pain

at the time of therapy or because the counselors guess or coax the

information out of them.

There is some evidence that disclosure may take place more

readily when victims experienced a close relationship with a

nonparental adult during childhood (Kerr & Crisci, 1984). Over

50% of the 19 adult incest clients they surveyed believed that had

been influenced at least slightly toward entering therapy by these

adults, despite the fact that disclosure of sexual abuse occurred

in less than 13% of these relationships.

There is no empirical evidence of the factors that are

helpful to adult incest victims for disclosure of their incest

experiences during counseling. Knowing the particular issues that

adult incest victims are coping with has led some authors to

suggest why confiding in therapists is difficult for this client

population. These resistances to therapy experienced by incest

victims are detailed below.











Clients' Resistances to Therapy

Meiselman (1978) gathered information on 58 cases of incest

who had presented for treatment in a psychiatric clinic from

1973-1976. This information was compared to a control group of

100 nonincest clients seen at the same facility during the same

period of time. Clients who revealed their incest seemed very

fearful that the incest had caused some permanent damage. Their

perceptions of themselves as bad, damaged people led some of them

to fear that their personalities were warped. Their concerns

about the effects of the incest may have been denied or minimized

by the perpetrators, other family members and nonfamily members

and they often do not trust their own perceptions. The people

whom they are to have trusted the most in this world have betrayed

their trust. They may have been rejected, not supported,

certainly not protected. Therefore, trusting anyone, even those

in whom trust is justified, is a difficult task for incest

clients.

Meiselman also noted the intense need that clients have for

seeking reassurance about their responsibility for the incest.

Incest victims have been told that they are sexy, seductive, and

that they are to blame for the occurrence of incest. Incest

victims who never told anyone believe that there must have been

something they could have done to prevent its occurrence or to

terminate the affair earlier than the incest ended. This high

level of guilt has been cited as one of the reasons clients may

not disclose to their counselors (Herman, 1981).











Herman believed that incest clients' strong feelings of shame

and hopelessness and their fear of betrayal in intimate

relationships were the first major obstacles to forming working

alliances with therapists. If they did disclose, their feelings

of shame were so intense that they had strong impulses to flee

from therapy. Herman stated that this inclination to run from

therapy could be moderated by calm, accepting attitudes on the

part of the therapists. It was also important for clients to hear

that they are not necessarily permanently damaged.

Herman stated that once the first obstacle of shame was

overcome, clients often felt relieved and grateful. However,

though they may long to trust and confide further in their

therapists, their suspicion was aroused. They have had so little

experience with consistent trusting people that they have no frame

of reference for trusting others. They may fear that their

therapists will dominate and exploit them or neglect and abandon

them. This fear must be clarified and discussed before the V'

clients act on it and disrupt therapy.

Incest clients may tend to test their therapists for long 4~-

periods of time. MacVicar (1979) reported on counseling six

incest victims, ages 13-19. MacVicar indicated that a

considerable amount of seductive behavior took place with male

therapists. Since incest victims have been subjected to sex as a

replacement or substitution for affection, they often have

difficulty distinguishing between sex and affection. They

sexualized their relationships with men, and particularly with











male therapists. Although there was no empirical evidence

comparing this behavior to other psychologically disturbed

clients, this behavior has been reported from clinical samples

(Courtois & Watts, 1982; Herman, 1981; McBride, 1983/1984;

Meiselman, 1978).

Testing behavior may also be directed at female therapists.

Incest clients are often full of rage towards their mothers for

not protecting them, and in many cases, not supporting or

believing them. They have learned not to trust females.N MacVicar

(1979) reported that in a study, the girls tested the female

therapists over and over again by getting involved in

self-destructive behavior. They were concerned with whether the

therapists could intervene and provide some sense of protection.

One of the long-term effects of being involved in an

incestuous relationship was that adult incest victims exhibit

nonassertive behavior.' They had an inability to express anger

directly and if they felt angry towards their therapist, they

tended to terminate therapy prematurely. If clients sensed any

invalidation of their feelings by their therapists, they relived

the incestuous experience which caused them to feel powerless and

hopeless. Leaving therapy prematurely resulted in the clients

feeling even more hopeless than before therapy started (Herman,

1981).

Counselors' Role in Treatment of Adult Incest Victims

Courtois and Watts (1982) described some of the counseling

pitfalls that may occur when counseling adult incest victims.












They believed that the attitudes and assumptions held by

counselors about incest and incest victims are of foremost

importance. They stated that it is important to view incest as a

sexual assault where the children are always considered victims. L-

However, counselors should not assume the aftereffects are always

devastating.

Courtois and Watts indicated that as a result of the

stereotyping and myths surrounding all forms of sexual assault,

incest often evokes responses of horror, disbelief, judgment, and

denial. If these attitudes and reactions are perceived by the

clients, there can be harm done to the therapeutic relationship.

Sensitive counselors may tend to treat incest clients as extremely

special or so complicated that they do not have adequate skills to

treat them properly. This attitude may lead counselors to quickly

refer incest clients away or to subtly steer them away from

focusing on the incest experiences.

Counselors may tend to focus only on the incest to the

exclusion of other concerns and issues. The limits of the

therapeutic relationship may be extended by having more frequent

sessions or giving them extra attention outside of the scheduled

sessions. Although incest victims at times do warrant extra

support and attention, categorizing them as always needing this

Extra work may reinforce their sense of differentness and isolate

them even further.

Counselors may show attitudes of skepticism and ask questions

about complicity of clients in the incest when their clients











reveal their experiences. Courtois and Watts believed that this

attitude may reflect the theoretical tradition of the discipline

of psychotherapy which started from Freud. These attitudes

invalidate clients' feelings and may lead to further confusion and

resentment on the part of clients.

Herman (1981) believed that most counselors lack the ability

to work with incest because they have never been trained to do so.

Psychoanalytic tradition has focused on denial and disbelief of

the high prevalence and effects of incest. Until recently there

was little professional literature for counselors to refer to when

confronted with incest clients. Supervisors were trained to

question the truthfulness of disclosure of incest by clients.

There was no institutional support for counselors to examine their

own assumptions and feelings about incest. Thus, training

institutions reinforced counselors' tendencies to deny and avoid

facing their feelings about incest. This avoidance was

rationalized as concern for the "fragile" patient (Herman, 1981,

p. 181).

In addition to avoidance and denial, counselors may use other

defensive techniques when working with incest victims. Female

therapists tend to identify with victims and may react strongly

with feelings of helplessness and despair when first hearing of

the incest. They may feel so overwhelmed that they are unable to

react calmly. Herman believes that this overreaction may be a

result of the revival of female therapists' own seductive elements

in their relationships with their fathers, or the recognition for











the first time the overt or covert incest in their own histories.

They may relive their own childhood reactions of the excitement of

feeling special, the fear of being overpowered, and the longing

for protection.

If therapists have not mastered their own feelings about

incestuous elements in their own childhood, they will tend to shy

away from the details in their clients' stories. These reactions

can aggravate clients' feelings of isolation and reinforce their

sense of being contaminated people who frighten others away.

Clients' fear that the incest is such a terrible secret is

validated and they may leave therapy in disappointment.

Another error that some therapists make is to express intense

anger towards the perpetrator, possibly more than their clients

are actually feeling. They may try to get their clients to

express their anger and stand up to their fathers, and may be

unwilling to hear any positive things clients may express about

their fathers (or the perpetrators). They may try to deflect their

clients' anger away from their mothers and onto their fathers,

pointing out that mothers were victims too.

Herman (1981) indicated that when therapists show intense

anger towards the offender, clients may feel robbed of the special

relationship they may have had with their offender fathers. Often

they feel angrier towards their mothers for not protecting them,

and their fathers may have been the only source of caring and

affection in their lives. They may assume that the therapists are

motivated by spite and jealousy and experience therapists as











rivals. As a result, clients perceive the counseling relationship

with hostility and competitiveness rather than with cooperation.

Clients may also feel blamed and judged for having tender feelings

towards the offenders, when therapists model and unconsciously

convey that angry feelings are the only acceptable feelings to

have towards incest offenders.

Male therapists tend to identify with the offenders.

Herman (1981) described the difficulty some males have permitting

incest clients to express anger towards the offenders. They may

excuse or rationalize the offenders' behavior and may tend to

focus on the victims' behaviors that imply complicity or

enjoyment. Male therapists may focus more on the sexual aspects

of the relationships and ignore other important issues. The

effects of these mistakes not only increase clients' guilt and

hurt. They begin to relive the incestuous relationship with

powerful males in caretaker roles. Once again, they are not

being protected, their feelings are invalidated and they feel

powerless and hopeless.

Male therapists run the risk of becoming sexually involved

with their clients, either in fantasy or in reality. This is seen

as further victimization of clients who have experienced

childhoods of sexual exploitation. Mary DeYoung (1981) reported

on three women from a 10 member support group who were sexually

involved with their male therapists.












There were three commonalities in the case reports by

DeYoung. First, all three clients were reluctant to discuss

victimization with their therapists until they had been in therapy

for some time, despite the fact that the women believed that their

personal problems were directly related to their incest

experiences. Second, all three women in this study flashed back

to their incest experiences during their sexual encounters with

their therapists, evoking negative feelings in them. Third, in

each of the cases, the sexual contact initiated by the therapist

came immediately after the disclosure of the incest. Somehow, the

clients were perceived in more sexual terms once disclosure of

incest took place.

The clinicians' perceptions of the impact of incest on their

clients was studied by Sheehy and Meiselman (1981). The

researchers assessed if the presence of incest in the case

histories of female clients caused therapists to judge their

clients to have less favorable prognoses than nonincest clients.

It was hypothesized that clinicians would judge incest clients to

be more disturbed and have less chance for recovery than nonincest

clients.

The results of the study showed that there were significant

differences between the therapists' willingness to work with

clients. Therapists indicated that they would be less willing to

work with incest clients. The researchers suggested that the












presence of incest caused the clients to be perceived as difficult

in some way that was not reflected in their prognoses or that the

therapists did not feel comfortable working with incest victims.

Summary

Literature related to a conceptual framework for child sexual

abuse, theoretical approaches to studying incest, and the

treatment issues in counseling adult incest victims was reviewed

in this chapter. Intrafamilial sexual abuse or incest is

currently recognized as a widespread phenomena in which both girls

and boys are victimized. Perpetrators are generally young, not

insane, of normal intelligence, and have multiple life

difficulties. Mothers and siblings of incest victims are

portrayed as contributing to the maintenance of the incest secret

within the family as well as being victims themselves. Victims

are seen as usually suffering from a multitude of symptoms in many

spheres of their adult functioning.

Incest is viewed as originating from a cumulative influence

of a number of factors. These factors include socioecological or

family climate factors, aspects of family structure, predisposing

factors of the perpetrators, and precipitating or situational

factors. The prevalence of incest was attributed to a cultural

climate where there is a power differential between males and

females. Males are considered the dominant sex and women and

children are seen as the property of men. Incest has been denied











and/or minimized by the helping professionals until recently.

Since being brought to light in the 1970's, incest is now being

studied more rigorously.

The treatment of adult incest victims may be affected by a

number of factors. Due to the effects of the incest experiences,

adult incest victims have particular resistances to entering and

completing treatment. Incest clients usually do not initiate

counseling specifically for recovery from incest. Once in

counseling, incest clients often are reluctant to disclose incest

to their counselors. Counselors may contribute to the resistances

of incest clients as a result of feelings aroused in them when

incest histories are revealed. There have been no empirical

studies conducted to determine factors that impact on adult incest

victims disclosure and exploration of their incest experiences

during counseling.















CHAPTER THREE
METHODOLOGY


The purpose of this study was to identify and explore the

factors that assist female adult incest victims in disclosing and

discussing their incest experiences during counseling. Three

areas were investigated: a)factors in clients' backgrounds that

may have influenced their decisions to disclose their incest

experiences to their counselors; b)clients' perceptions of

counselor characteristics, attitudes, and behaviors that were

helpful or detrimental to them in the decision to disclose their

incest experiences to their counselors; and c)clients' perceptions

of factors that were conducive or not conducive to them for

further exploration of their incest experiences with their

counselors once disclosure occurred. This chapter includes a

discussion of the research design, the research questions, the

population and sample, instruments, research procedures, analysis

of data, and limitations of the study.

Research Design

Due to the exploratory nature of this research and in order

to collect the maximum amount of data, a modified case study

format was chosen as the method of study. Early research in the

area of sexual abuse incidence and effects consisted of case

studies that were instrumental in providing information for the















formulation of later controlled, experimental studies. As a

method of research, the case study has several advantages.

First, it is intensive and brings to light important variables,

processes, and interactions that deserve more extensive attention.

It pioneers new ground and very often is the source of new

hypotheses for further study. Second, case study data provide

useful anecdotes to illustrate more generalized statistical

findings (Isaac & Michael, 1981). Its exploratory nature is its

most outstanding feature, as well as being its greatest deficit.

Its lack of controls permits things to vary as they will and thus

increases its potential for new and important findings. It is

therefore a logical choice for research in a previously unexplored

area (Neale & Liebert, 1973).

The case study has played an important role in psychology,

and can be a potential source of scientifically validated

inferences if modifications are made to reduce threats to internal

validity (Wisner, 1982/1983). Some of the modifications suggested

by Kazdin (1981) were applied in this study. Some of Kazdin's

suggestions were not relevant since this was a descriptive rather

than an experimental study. The two modifications applied were

the inclusion of objective data (in the form of one

empirically-based inventory) and the reporting of many cases

instead of just one.












Research Ouestions

1. What is the relationship between background factors of

adult incest clients and their decisions to disclose their incest

experiences to their counselors?

2. What is the relationship between reactions of family

members and others to clients' disclosure of incest during

childhood and clients' disclosure of incest to counselors as

adults?

3. What counselor characteristics helped or hindered clients

in disclosing their incest histories to counselors as adults?

4. What is the relationship between counselor reactions to

clients' disclosure of incest and the amount of time spent

discussing incest for the duration of counseling?

5. What other factors encouraged or discouraged clients from

disclosing and or/discussing incest during counseling as adults?

Population and Sample

The population from which this sample was drawn consisted of

adult women living in Alachua County, Florida, and surrounding

areas who were victims of parental and/or familial sexual abuse

prior to age 18. Alachua County, Florida, consists of rural areas

and the city of Gainesville. The population of the county is

approximately 151,000 people (1980 census), with over 35,000 of

these being students at the University of Florida in Gainesville.

The exact size of the incest population in Alachua County is

unknown. The number of adult incest victims who visited mental

health facilities in Alachua County and the University of Florida











during the year 1983-1984 was approximately 150. This number is

probably much lower than the actual number of incest victims in

Alachua County for two reasons. First, agencies do not keep

records of how many clients are incest victims. Second, this

number does not include clients who visited private practitioners

and clients who are not currently in treatment.

An estimate of the size of the incest population can be

determined by looking at studies conducted in other cities.

Russell (1982) investigated a random sample of 930 women in San

Francisco. Sixteen percent of the sample reported at least one

experience of intrafamilial sexual abuse before the age of 18

years. Finkelhor (1979) surveyed 530 female and 266 male college

students in the Boston area and reported that 28% of the women and

,23% of the men reported that they experienced incestuous sex.

(The difference between the two studies is partially due to

Finkelhor not applying an age limit in cases of incest.) It is

believed that intrafamilial sexual abuse takes place in all ethnic

groups, at all socioeconomic levels, and in both cities and rural

areas. There are no data on the percentages of incest victims who

are or who have been in counseling.

Subjects were selected on the basis of the following

criteria: they were adult women (over 18) who experienced parental

or familial incest prior to age 18; they had at least one visit

with a counselor or psychologist during adulthood; their visit

with a counselor or psychologist was within the last three years;

the focus of their counseling sessions) was not necessarily their












incest; they could but did not have to be in therapy at the time

of this study.

Potential subjects were not selected to participate in this

study if they were below age 18, were victims of extrafamilial

sexual abuse rather than intrafamilial sexual abuse, were not

female, or did not experience counseling within the last three

years or as adults. Women who were institutionalized or

incarcerated at the time of the study, who were hospitalized

during the six weeks prior to the interview, or in other ways were

unable to participate were not included in this study. Data were

obtained from 37 subjects.

Instruments

In order to collect data about the client/counselor

relationship, a structured interview was conducted with all

subjects by the researcher. In addition, the Barrett-Lennard

Relationship Inventory (Barrett-Lennard, 1964) was used.

Structured Interview

The structured interview has been used only recently to

gather information about victims of sexual and physical abuse

(Courtois, 1979; Russell, 1975, 1982; Wisner, 1982/1983). The

structured interview is particularly useful to explore a problem

area for which insufficient information exists. It is

personalized, flexible, and adaptable, and permits in-depth, free

responses. Since the richness of the data might vary according to

the interviewer, it was decided that the interviews would all be

conducted by the same researcher. Two of the disadvantages of











using a structured interview were that the data collected may be

subject to subtle biases of the interviewer and/or overt

manipulation by the interviewer. The risk of the influence of

these disadvantages was reduced by keeping in mind these

possibilities as well as carefully preparing the exact questions to

be asked during the interview.

Other limitations of this type of instrument were the time

consumption and difficulty with summarizing results. The

structured interview also was vulnerable to personality conflicts

and required a skilled and trained interviewer. The researcher

has had five years of counseling experience. Three years of this

experience has been with counseling adult victims of incest and

rape.

The structured interview was developed by the researcher and

consists of four parts. A copy of the structured interview

appears in Appendix A. A panel of experienced researchers

reviewed the content and format of each item in the structured

interview. Part One of the structured interview consisted of

demographic questions about the subjects, including their dates of

birth, ages, ethnic identifications, marital status, parental

status, living situations, educational levels, and income levels.

Part Two of the structured interview contained questions

pertaining to the incest and its perceived effects on the

subjects. Part Two was designed to probe in some depth the

specifics of the incest. Subjects were asked to discuss the

following variables of the situation: age at onset of incest,











frequency and duration of the sexual activities, relationship of

the perpetrator to the subjects, and type of activities involved

in the incest.

The subjects were asked to discuss their beliefs as to why

the incest ended and if any other members of their immediate

family were abused as well. Questions about disclosure to family

members or others were included to ascertain to whom the subjects

chose to disclose and what reactions they experienced from these

people. The impact of the incest and its long-term effects also

were explored in this section. Questions about subjects' close

relationships with others during childhood were included since

there has been some recent evidence that adult incest victims may

be more likely to enter psychotherapy if they had close

relationships with adults during their childhood (Kerr & Crisci,

1984).

Part Three of the structured interview consisted of questions

about counseling experiences during childhood. The subjects were

asked about their ages at onset of counseling, type of counselors

they visited, sex of counselors, duration of counseling, and

whether or not other family members were included in the

counseling. It has been suggested that the reactions of

significant people to the child incest victims' disclosure of

incest may effect the victims' decisions to disclose as adults

(Courtois & Watts, 1982). Questions about whether or not subjects

disclosed to their counselors during childhood and reactions of

their counselors to them were included. Factors that may have











prevented them from discussing the incest during counseling were

ascertained. Reasons for termination of counseling and

satisfaction with their counseling also were discussed.

Part Four of the structured interview consisted of questions

pertaining to counseling experiences since age 18. If clients

visited more than one counselor during the past three years, they

were asked to answer items in Part Four for the first and last

counselors seen within the last three years. Subjects were asked

about the difficulties they were experiencing at the time they

decided to seek counseling. The difficulties listed in Part Four

were taken from the description of possible long-term effects

which are explicated in the literature referenced in Chapter Two.

Since clients may enter counseling without disclosing the incest

and with a "disguised presentation" (Gelinas, 1983, p. 326), they

were asked whether they were planning to disclose the incest and

whether they believed that the incest was the main issue that

needed to be resolved.

Questions in this section also included clients' perceptions

of counselor characteristics. The list of counselor

characteristics was taken from the research that describes the

characteristics of counselors which may be influential in

therapeutic change (Barrett-Lennard, 1962; Mann & Murphy, 1975;

Strong, 1968). A counseling history was taken that included

questions about the duration and type of counseling subjects

experienced. Subjects' disclosure of incest to their counselors

and factors they perceived as helpful or not helpful to them in











deciding to disclose their incest to their counselors were

explored.

The reactions of counselors to disclosure of incest have

often been cited as a factor in determining how the clients

responded to further treatment (Courtois & Watts, 1982; DeYoung,

1981; Herman, 1981; Sgroi, 1982). Therefore, questions about the

reactions of subjects' counselors to their disclosure and about

how subjects felt and behaved once they experienced these

reactions were included in the structured interview.

The last two questions of the structured interview gathered

information about subjects' reasons for volunteering for the study

and their reactions to their participation in this study.

Although questioning incest victims about their past experiences

has the potential to be distressing to them, it has been reported

that volunteer incest victim subjects have been very willing to

talk to concerned and interested interviewers. Kerr and Crisci

(1984) indicated that adult incest victims in their study reported

feeling empowered by having the researchers listen to them relate

their incest experiences. The information from these two

questions was solicited for its potential value in future research

methodology using the structured interview format.












Barrett-Lennard Relationship Inventory

The Barrett-Lennard Relationship Inventory was developed

under the basic postulate that there are five aspects of the

therapist's attitude that are influential in the process of

therapeutic change. These include the therapists' level of regard

for their clients, the extent to which this regard is

unconditional, the degree of the therapists' empathic

understanding, the therapists' congruence, and the therapists'

willingness to be known by their clients. In addition to this, it

was believed that it was the clients' experience of these aspects

of the therapists' attitude and behaviors that most crucially

affected the outcome of therapy (Barrett-Lennard, 1962).

The BLRI based on Mann and Murphy's (1975) adaptation of the

BLRI (Barrett-Lennard, 1964) measured clients' perception of the

counseling relationship. It contains 36 items in five scales:

four eight-item scales entitled Empathic Understanding,

Genuineness, Unconditional Regard, and Level of Regard, and one

four-item scale entitled Resistance. The first four scales

measure clients' perceptions of counselors' characteristics and

the resistance scale refers to clients' resistance to the

counselor. Each item has a response on a seven point scale

indicating extent of agreement or disagreement with the item.

Internal consistency reliabilities of the five scales ranged from

.53 to .82 (Strong, Wambach, Lopez & Cooper, 1979).

The scales used in this study were the four scales that

measure subjects' perceptions of counselor characteristics. It











was decided not to use the resistance scale in this study for two

reasons. First, the scale was poorly defined and the number of

items were too few. Second, this study investigated subjects'

perceptions of counselor characteristics and this scale does not

measure that variable.

Although the validity of the original BLRI is well

documented, there was no available validity information on the

shorter version developed in 1975. Therefore, as part of this

study, the content validity of the shorter version of the BLRI was

investigated. Copies of the long and short versions of the BLRI

and the scoring keys for each version were distributed to four

experienced researchers. They were asked to state their opinions

as to whether or not the items in the short form represent the

corresponding items in the longer form for the four variables,

level of regard, empathy, unconditionality of regard, and

congruence. The researchers evaluated the two versions of the

BLRI and agreed that the items in the short form were

representative of the items in the long form for the four stated

variables. A signed copy of this statement is included in

Appendix B.

Procedures

Recruitment of Subjects

Participants were recruited by using two main methods.

First, ads were placed in local newspapers, magazines, and

newsletters. The ads and announcements stated that women who were

sexually abused by a family member or members during their













childhood and had visited a counselor at least one time during the

past three years were needed for a research project. The wording

of the ads and the list of where they were placed are found in

Appendix C.

The second method involved mailing requests for assistance to

mental health agencies, hotlines, crisis centers, and other

community counseling services. A copy of the letters to the

directors of these agencies can be found in Appendix D. The

letters explained the research study and the need for assistance

in locating volunteers. The letters were sent to the directors of

these agencies who were asked to pass the information on to their

staff members. A second set of letters was sent to

psychotherapists in private practice. These letters were similar

to the agency letters in content, but differed in requesting that

the therapists themselves inform suitable clients of the study.

The therapist letter is in Appendix E.

A letter to potential subjects was included in the mailings

to directors of agencies and to private psychotherapists. The

letter to potential subjects can be found in Appendix F. All

letters outlined the purpose of the research, the need for

volunteers, and the confidentiality of the interview and its

contents. The letters also stated that participation would be on

a strictly volunteer basis and volunteers could remain anonymous.

There would be no remuneration provided. All interested potential

subjects were asked to contact the researcher for further

information.












Screening of Volunteers

An initial telephone screening was conducted to eliminate

subjects who did not meet the criteria for the study. An

explanation of the research was given and any questions the

volunteers had were answered. If they agreed to participate,

appointments were made for the subjects to meet with the

researcher.

Administration of Instruments

At the appointed time, a consent form stating the purpose and

benefits of the research was given to the participants and

explained. The consent form is in Appendix G. Subjects were

informed that the interview portion of the research would be audio

taped to insure accuracy of reporting. Subjects also were

informed of their right to withdraw from the study at any time and

to omit answering any items to which they objected. The

researcher's sensitivity to their possible discomfort in talking

about their experiences was acknowledged at the beginning of the

interview. Confidentiality of all information was stressed. All

participants were informed that the results of the study would be

made available to them upon request. Opportunities for subjects

to ask questions were made before and after completing the

interview and the instrument.

Data were usually collected in one day. There were a few

subjects who could not complete the interview in the time allotted

and, therefore, returned a second day to complete the study. One

subject was not able to complete the interview due to the fact












that she had never disclosed and the incest was still occurring.

The interviews and instruments were administered in the following

order: Structured Interview Parts One, Two, Three, Four, and the

BLRI. The interviews and instruments took between one and

one-half to four hours to complete.

Due to the potentially distressing nature of the histories

the subjects were recalling and discussing, a referral list of

local counseling services was made available to all subjects. The

referral list is located in Appendix H. In addition, access to

the researcher by telephone was mentioned to the subjects in case

any concerns arose following their interviews.



Analysis of Data

This section describes the method of statistical analyses

used for the demographic data, the incest data, the variables of

interest, the research questions, and the ancillary data.

Demographic characteristics of the sample were compiled by using

frequency distributions and relative frequency distributions for

the following categories: age, race, marital status, parental

status, education, occupation, and income.

The incest data were described by frequency distributions and

relative frequency distributions in two categories. The first

category is the description of the incest situation and includes

information about duration of incest, age at ending of incest,

perpetrator, types of sexual activities, and frequency of incest.

The second category of the incest data is the description of the












family situations and includes information about family position,

other family members sexually abused, occurrence of abuse in

addition to sexual abuse, religion, and religious strength of

family during childhood.

The variables of interest were described by frequency

distributions and relative frequency distributions. The variables

are categorized according to client background variables,

variables related to disclosure of incest during childhood,

counselor variables, and other variables that may be related to

disclosure of incest. Client background variables that are

described include age at onset of incest, close relationship with

someone during childhood, and satisfaction with counseling

experiences during childhood. Variables related to disclosure of

incest during childhood include whether disclosure occurred during

childhood, to whom disclosure was made, and reactions of persons

to whom disclosure was made.

Counselor variables that were investigated in this study

include counselor characteristics and counselor reactions to

incest disclosure. Counselor characteristics of empathy,

congruence, level of regard, and unconditionality of regard are

described by means, standard deviations, and ranges of the

subscale scores of the Barrett-Lennard Relationship Inventory.

Additional counselor characteristics mentioned by subjects also

are described by frequency distributions and relative frequency

distributions.











The counselor variable, reactions to disclosure of incest, is

described by frequency distributions in two categories, reactions

of counselors to disclosure of incest and feelings and behaviors

of subjects once disclosure occurred. In exploring other

variables that might be related to disclosure of incest during

counseling, information was described by frequency distributions

and relative frequency distributions about the impact of incest on

adult functioning, subjects' belief that incest was the main issue

to discuss in counseling, and type of counseling experienced by

subjects.

Research question one asked what the relationship was between

background factors of adult incest clients and their decisions to

disclose their incest experiences during counseling. The

relationship between background factors of adult incest victims

and subsequent disclosure of incest to counselors was determined

by using point-biserial correlation technique and by determining a

phi coefficient. The three background factors that were

correlated with disclosure of incest to counselors were age at

onset of first incest (point-biserial); close relationships during

childhood (phi coefficient); and satisfaction with counseling

during childhood (point-biserial).

Research question two asked what the relationship was between

reactions of family members and others to clients' disclosure of

incest to counselors as adults. The reactions that subjects

received when they disclosed their incest during childhood were

correlated with their decision to disclose incest to their











counselors as adults by determining a phi coefficient by using a

contingency table. The variables were positive or negative

disclosure experiences during childhood and disclosure of incest

to counselors as adults.

Research question three asked what counselor characteristics

helped or hindered clients in disclosing their incest histories to

counselors as adults. This question was described using two

methods. The relationship between subjects' perceptions of their

counselors' empathy, coungruence, level of regard, and

unconditionality of regard, and subjects' disclosure of incest as

adults was investigated by determining point-biserial correlation

coefficients for these variables. The counselor characteristics

that helped or hindered subjects from disclosing incest were

described by frequency distributions and relative frequency

distributions.

Research question four asked what the relationship was

between counselor reactions to clients' disclosure of incest

during counseling and clients' further discussion of incest in

counseling. A point-biserial correlation technique was used to

compute a point-biserial correlation coefficient for the variables

positive or negative counselor reaction and amount of time spent

discussing incest for the duration of counseling once disclosure

occurred.

Research question five asked what other factors may have

encouraged or discouraged clients from disclosing and/or

discussing incest during counseling as adults. Factors that












subjects perceived as impacting on their disclosures and

discussion of incest during counseling are described by frequency

distributions. The relationship between the variables, subjects'

belief that incest was the main issue needing to be discussed in

counseling and subjects' disclosure of incest during counseling

was analyzed by computing a phi coefficient for these variables.

Finally, ancillary results were described by frequency

distributions and relative frequency distributions. The ancillary

results include factors that subjects believed were helpful for

disclosure and discussion of incest in counseling, reasons for

volunteering for the study, and how subjects experienced the

interview process.

Limitations of the Study

There were several limitations to this study. One threat to

internal validity was due to the use of a structured interview as

the major instrument for this study. The interview was less

subject to control than other methods of inquiry. The

interviewer's skill could have varied as she became more

experienced or more fatigued.

Another threat to internal validity was that the study

required the subjects to discuss their experiences in retrospect.

The retrospective data from the interview and the BLRI may have

been influenced by conscious or unconscious distortion and/or by

memory deficiencies. However, what is important is that it was

clients' perceptions of their counseling experiences, whether

distorted or flawed, that could have been an important determinant








73



of the events that took place during the counseling process as

well as the counseling outcome.

There were also some threats to external validity. The

generalizability of this study is questionable due to the method

of the selection of the subjects. The subjects may not be

representative of all incest victims. The use of 37 subjects and

the prescreening of subjects helped to overcome this limitation.

This study was explorative in nature and was meant to generate

ideas for future research using more rigorous experimental design.















CHAPTER FOUR
RESULTS AND DISCUSSION



The first section of Chapter Four presents the results of the

data collected for this study. First, a description of the sample

is presented with demographic and incest data summarized. Second,

descriptive statistics of the variables of interest are presented.

Third, the correlation coefficients and t-scores or Z-scores are

summarized for the correlation of variables to answer each

research question. Finally, ancillary results are described. The

ancillary results include subjects' opinions about factors that

would be helpful to incest clients during counseling as well as

reasons for volunteering for the study. The second section of

this chapter presents a discussion of these results.

A total of 39 women who responded to newspapers ads or were

referred by their therapists and who completed a telephone

screening with the researcher were interviewed. One 21 year old

woman did not complete the interview because she became very

distressed talking about her incest. She had never disclosed her

experiences to anyone and the incest was still occurring. Another

woman who completed the interview had not visited a counselor

within the last three years, although she did discuss her sessions












with a counselor she visited 10 years ago. The data collected

from these two subjects were disallowed, leaving a total of 37

completed interviews.

In one part of the interview, subjects were asked to discuss

information about their counselors. While 27 of the subjects had

visited only one counselor, 10 had visited two counselors. Thus,

some items have more than one response per subject. The number of

responses is indicated in each of the tables where frequency

distributions and/or relative frequency distributions are

summarized.

Results

Description of the Sample

The sample in this study is described by presenting the

demographic data and incest data for the subjects. The

demographic data are summarized in Table 1. All of the subjects

in this sample were female. The majority of subjects (n=34, 92%)

were White, two (5%) were Black and one (3%) was Hispanic. Their

ages ranged from 18-50 years old, with 14 (38%) in the range of

22-30 and 17 (46%) in the range of 31-40.

In respect to marital status, 15 subjects (41%) were single,

10 (27%) were divorced, five (13%) were separated, and six were

married. Thus, a large majority were not married (n=30, 81%) at

the time of the interview. In regard to parental status, over

half of sample had no children (n=21, 57%) and 16 (43%) had 1-5

children.











The educational levels of the sample ranged from high school

graduate equivalency diplomas through various graduate degrees.

There were no subjects who fell below the high school degree level

and a high number, 15 (41%) had bachelor degrees or higher.

Consistent with this result, the occupations of the subjects

showed a majority (n=26, 70%) in white collar or professional

occupations, with an additional 10 (22%) being students who were

unemployed or part-time workers. Three (8%) were full-time

houseworkers. In looking at annual income levels apart from

spouses, the largest number, 11 (37%) earned $10-15,000. Eight

(27%) earned between $15-30,000, two (6%) earned above $30,000,

and nine (30%) earned below $10,000.

The sample also was described by presenting data collected

about subjects' incest histories. The incest data are summarized

in Table 2. Of the 56 separate incidences of incest reported by

subjects, the duration of incest ranged from a single incident to

more than nine years. Incest usually ended just prior to or

during adolescence with the highest numbers ending at age 12

(n=12, 18%) and at age 16 (n=9, 16%).

The perpetrators were most frequently fathers (n=13, 24%) and

uncles (n=13, 24%). Nine (16%) of the subjects were abused by

stepfathers and one subject was abused by her adoptive father,

making a total of 23 (42%) of the subjects victims of male

parental incest. Brothers were perpetrators in six (12%) of the

cases. One subject (2%) was molested by a female cousin, the only

reported female perpetrator.












Table 1
flmnnrin Ch f afr,-ir-i cI-nc


nf 5nh-icPr'i-


Characteristic


n %


Age(years):


18-21
22-30
31-40
41-50


Marital status:


Characteristic

Race:


Black
Caucasian
Hispanic


Parental status:


Single
Divorced
Married
Separated
Widowed

Education:


GED (h.s. equiv)
Vo-tech
College:
1 year
2 years
3 years
A.A. degree
B.A. degree
Graduate school
1 year
2 years
3 years
4 years
M.A. degree
Ed.S. degree
R.N.


13.5
3

19
5
13.5
5
16

5
3
3
3
5
3
3


No children
One child
2-3 children
4+ children


Occupation:

Houseworker
White collar
Professional
Student
Part-time



Income:

$ 0-5,000
5-10,000
10-15,000
15-20,000
20-30,000
30,000+


1 %


" & ad __ __ w- W. s xl-c












Table 2
Description of the Incest Situation

Duration of incest:

Time: %

Single incident 11 20
6-12 months 4 7
1-2 years 6 11
3-5 years 11 20
6-8 years 11 20
9 years or more 10 18
Unknown 1 1

Age at ending of incest (yrs):

Age: n %

0-4 0 0
5-9 10 19
10-12 14 25
13-15 15 27
16-19 16 29


Perpetrator: n %

Father 13 24
Adoptive father 1 2
Stepfather 9 16
Brother 3 6
Adoptive brother 1 2
Stepbrother 2 4
Half brother 2 4
Grandfather 4 7
Uncle 13 24
Male cousin 4 7
Female cousin 1 3
Mother's boyfriend
(live-in) 1 3
Uncle-figure 1 3












Table 2 continued

Types of sexual activities during incest:

n %

Voyeurism 28 50
Forced, prolonged, kissing 28 50
Sexually suggestive language 27 48
Forced hugging 33 59
Breast fondling 34 61
Vaginal fondling 38 68
Manual stimulation of
offenders' genitals 21 38
Oral stimulation of
offenders' genitals 15 27
Oral stimulation of
subjects' genitals 14 25
Vaginal intercourse 23 41
Anal intercourse 2 4
Posing for pornography 7 13
Digital penetration 21 38
Masturbation 12 21
Dry intercourse 3 5

Frequency: n %

Once 10 18
Occasionally 12 22
Regularly, 1/wk. 5 9
Reg. more than
1/wk. 17 31
Reg. less than
1/wk. 11 20












Subjects were read a list of sexual behaviors and asked to

respond "Yes" or "No" if they experienced these during their

incest. The most frequently occurring type of sexual activities

included vaginal fondling (n=38, 68%), breast fondling (n=34,

61%), and forced hugging (n=33, 59%). Vaginal intercourse

occurred in 23 (41%) of the cases and voyeurism (being watched or

forced to watch offender) was reported in 28 (50%) of the cases.

Subjects were questioned about the frequency of the incest.

Of those subjects who experienced incest regularly over a-period

of time, five (9%) reported that the incest took place once a

week, 17 (31%) reported more than once a week, and 11 (20%)

reported that the incest took place less than once a week. Thus,

60% responded that the incest occurred regularly and at various

intervals.

In addition to the incest data, subjects' childhood family

circumstances were investigated and are described in Table 3. In

regard to subjects' positions in their families, 17 (46%) of the

subjects were the oldest children in their family and four more

(11%) were only children. Ten subjects (27%) were middle children

and six (16%) were the youngest child in their family.

Subjects were asked if they knew of other immediate family

members who were sexually abused. Eleven sisters of the subjects

and four of their brothers were also sexually abused. Other

family members reported being sexually abused include cousins,

mothers, father's stepdaughters, son, and father.












Table 3
Description of Family Situations


Family position:



Oldest child
Middle child
Only child
Youngest child


n %

17 46
10 27
4 11
6 16


Other family members sexually abused:

Family member:


Sister
Brother
Cousin
Father's stepdaughters
Mother
Father
Son


Occurrence of abuse in
Response:

Yes
No


Religious upbringing:


11 44
4 16
3 12
2 8
3 12
1 4
1 4


addition to sexual abuse:


30 81
7 19


Protestant
Catholic
Jewish
Atheist/None


Family was strongly religious:

Response:

Yes 15 41
No 22 59











When asked if they were physically abused in addition to the

incest, 30 (81%) subjects reported being physically or emotionally

abused by someone in their families, although not necessarily by

the incest perpetrators. In respect to religious background, 20

(54%) of the subjects were raised in various denominations of

Protestantism, 12 (32%) were raised Catholic, and three (8%) were

Jewish. Twenty-two subjects (59%) indicated that they were not

raised in a strongly religious atmosphere.

Description of the Variables of Interest

Client background variables

This study investigated three variables in the backgrounds of

the subjects that might influence disclosure of incest. These

background variables were age at onset of incest, close

relationship with someone during childhood, and satisfaction with

counseling experiences during childhood. Descriptions of these

variables are summarized in Table 4. Means, standard deviations,

and ranges of background variables are summarized in Table 5.

Variables related to disclosure of incest during childhood

Variables related to disclosure of incest during childhood

that might be associated with disclosure of incest as adults were

investigated in this study. Descriptions of the variables related

to disclosure of incest during childhood are summarized in Table

6. These variables include whether or not disclosure of incest

occurred during childhood, to whom disclosure was made, and

reactions of persons to whom disclosure was made. It was

determined that of the 37 subjects, 20 (54%) disclosed their












Table 4
Description of Subiects' Background Factors


Age of onset of incest:
Years:


0-4
5-9
10-12
13-15
16-19


D %

3 8
!3 62
7 19
3 8
1 3


Close relationship with someone during childhood: (N=37)

Response:

Yes 29 78
No 8 22


Satisfaction with childhood counseling: (N=11)

Response:

Very satisfied 1 9
Mildly satisfied 3 27
Mildly dissatisfied 0 0
Very dissatisfied 6 55
Did not remember 1 9


Table 5
Mean. Standard Deviation. and Range of Background Factors of
Subjects


Background factor n X SD RANGE

Age (in years) of onset
of incest 37 7.8 3.0 5-16
Satisfaction with
childhood counseling* 11 3.27 2.17 1-5

Note. The item marked had the following scoring range:
1= very satisfied; 2= mildly satisfied; 3= mildly dissatisfied;
4= very dissatisfied; 5= did not remember












incest to someone during childhood while 17 (46%) did not

disclose. The person most frequently disclosed to was Mother

(n=14, 59%), next was Friend below age 18 (n=4, 17%). Other

people disclosed to were professionals, sisters, adult family

members, and boyfriends.

Of the 14 subjects who disclosed to Mother, seven (50%)

experienced positive reactions such as support, belief, and

acceptance, and seven (50%) experienced negative reactions such as

blame, rejection, and anger. Of the total number of subjects who

disclosed during childhood, 12 (54%) experienced positive

reactions from the persons to whom the disclosure was made, nine

(41%) experienced negative reactions, and one (5%) did not

remember the reaction.

Ten subjects remembered seeing counselors during childhood.

Of those 10, nine (90%) did not talk about their incest

experiences with their counselors and one (10%) did. The person

who disclosed to her counselor was believed by the counselor, but

did not explore the incest further during counseling.

Counselor variables

There were two counselor variables that were investigated in

this study that might be related to subjects' disclosure and

discussion of incest during counseling. These variables were

counselor characteristics and counselor reactions to disclosure of












Table 6
Circumstances of First Disclosure of Incest During Childhood

Disclosure took place:

Response: n %
Yes 20 54
No 17 46

To whom disclosure was made:


Mother 14 59
Friend(below 18) 4 17
Professional 2 8
Sister 2 8
Aunt 1 4
Boyfriend 1 4


Reactions of persons to whom disclosure was made:

Reaction:

Positive 12 54
Negative 9 41
Did not remember 1 5


incest. Counselor characteristics such as empathy, congruence,

level of regard, and unconditionality of regard were determined

for each counselor discussed by subjects through the

administration of the Barrett-Lennard Relationship Inventory

(BLRI) to all subjects. Table 7 summarizes the means, standard

deviations, and ranges of the Barrett-Lennard subscales scores.

Counselor gender was another characteristic investigated by

this study. There were 31 contacts with female counselors and 16

with male counselors. Of the contacts with female counselors,

there were 24 disclosures of incest. There were 14 disclosures of

incest to male counselors. Six subjects indicated that they would

not have disclosed to male counselors.












Table 7
Barrett-Lennard Relationship Inventory Means. Standard
Deviations, and Ranges (N=47)

Subscale X SD Range

Congruence 47.25 11.25 20-56
Empathy 43.27 12.21 10-56
Level of Regard 48.38 11.27 8-56
Unconditional Regard 43.48 8.84 27-56


The variable, counselors' reaction to disclosure of incest,

was investigated in two ways. First, subjects were read a list of

17 possible counselor reactions to their disclosure. They were

asked to respond yes or no if they experienced the reactions on

the list. Second, subjects were asked to list additional

counselor reactions they perceived once disclosure of incest

occurred. Subjects reported an additional 21 reactions from their

counselors. A summary of counselor reactions is tabulated in

Table 8.

For the majority of subjects, positive reactions from

counselors were experienced with 35 of the subjects perceiving

calmness, 32 perceiving empathic reactions, and 36 perceiving

concern on the part of their counselors. However, there were some

responses from subjects who perceived negative reactions from

their counselors. Subjects' responses included seven incidences

of counselors minimizing the importance of the incest, five

incidences of counselors minimizing the effects of incest, five

incidences of counselors appearing uncomfortable, and five

incidences of subjects being told to put the incest in the past

and forget about it.












Table 8
Counselors' Reactions to Subjects' Disclosure of Incest

Responses to yes or no questions:

Counselor reactions 1

Encouraged subject to talk more 31
Empathic 32
Calm 35
Concerned about me 36
Uncomfortable 5
Horrified 2
Nervous 3
Judgmental 2
Ignored the topic of incest 5
Fury 4
Blamed 1
Minimized effects of incest 5
Minimized importance of incest 7
Put in the past and forget it 5
Seemed angry with me 3
Overly interested in explicit sexual details 2
Made sexual overtures to me 1

Responses to open-ended question:

Counselor reactions

Supportive 3
Loving 1
Nurturing 1
Drawing me out 1
Comforting 1
Not surprised 3
Caring 2
Offered me a hug 1
Intellectual-not explosive 1
Believed her 1
Surprised she did not mention it before 1
Professional, data gathering 2
Validated anger 2
Prayed for her 1
Validated lack of parental protection 1
Rushed her 2
Seemed to get a thrill out of it 1
Got defensive 1
"Forgive and forget" 1
"Not right to hate father" 1
Couldn't handle own anger got too angry 1












In order to determine what impact counselors' reactions

to subjects' disclosure of incest may have had, subjects were

asked about their feelings and behaviors once disclosure occurred.

With regard to their general feelings, of the 39 subjects who

disclosed, 21 felt better after disclosure and another four felt

worse at first and then better. Five subjects felt worse and

three felt better first and then worse. Six felt about the same

as they did before.

Subjects were given a list of specific feelings and were

asked to indicate "yes" or "no" if they experienced each feeling

after disclosure of incest to their counselors. Subjects'

feelings after disclosure of incest to counselors are summarized

in Table 9. Out of a total of 39 subjects who disclosed, most

(35) indicated feeling believed by their counselors and most (32)

felt relief about disclosing. Although the majority expressed

positive feelings resulting from disclosure, there were some

subjects who experienced negative feelings after disclosure.

There were eight responses that subjects were afraid that the

counselor would use the information to hurt them and seven

responses that subjects felt betrayed by their counselors.

In order to further explore the impact of counselor reactions

to subjects' disclosure of incest, subjects were asked about their

behaviors after disclosing their incest experiences to their

counselors. Thirty-four talked to their counselors further about

the incest, 32 started talking to others about the incest and 28

trusted their counselors more than they did before they mentioned











the incest. However, there were five responses that subjects did

not trust their counselors anymore, three responses that subjects

did not discuss the incest again with their counselors, and three

responses by subjects who stopped seeing their counselors. These

behaviors are summarized in Table 10.

Other variables related to disclosure of incest

Other variables explored that might be related to disclosure

of incest during counseling include impact of incest on adult

functioning, subjects' belief that incest was the main issue to

discuss in counseling, and type of counseling. The impact of

incest on adult functioning was determined by asking subjects how

they perceived the incest impacted them. Table 11 summarizes

subjects' perception of the impact of their incest and compares

the subjects who disclosed their incest to those who did not

disclose their incest.

With regard to subjects' perception of the impact of incest

on their lives, only one subject indicated that the incest had no

impact at all. Thirty-six (97%) of the subjects had negative

impacts from the incest. Twenty-six of the subjects responded

that they had very negative impacts and seven had moderate

impacts. The three subjects who chose the response, "negative

impact, then positive," indicated that they became stronger once

they worked through the negative impact of the incest during

counseling.




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