Working With Adult Incest Survivors

The Healing Journey

Sam Kirschner, Diana Adile Kirschner, Richard Rappaport

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780876306918
• eBook ISBN: 9781317713777
• Topic: Psychologie
• Subtopic: Entwicklungspsychologie

Drawing on their extensive experience, the authors present an approach to the treatment of the adult incest survivor. This combines cognitive- behavioural, psychodynamic, and family treatment perspectives to encompass the full breadth and scope of the healing and recovery process. While acknowledging the need for the survivor to become conscious of the incestuous experience and its impact, the authors view memory retrieval as only the first step in healing; the ultimate goal is letting go of the past to actively reinvent the present. The book presents specific guidelines for the initial, middle and end phases of the therapy, for family-of-origin therapy, and for treatment of the male incest survivor.

Chapter 1

Theincest Survivor Syndrome

“Tonight I stand before you an incest survivor. A list of all my accomplishments, times ten, pales before the most significant accomplishment of my life: I survived incest.”

-Marilyn Van Derbur Atler Miss America, 1958

Julie and David Aarons sat in my office (S.K.) reciting a long litany of complaints. He wasn’t attentive enough, she said, and he claimed that she was overly reactive. The spouses were in their late 30s and had been married for 10 years. They had been referred by their family doctor, to whom Julie had shyly confessed that her sex life was practically nonexistent.

I began to inquire into their dating, courtship, and romantic history. They told me that their sexual life had been very satisfactory before they got married. But after marriage, and especially after the birth of their first child, there was a steady decline in interest. Both spouses agreed that most of the time it was Julie who was not interested, and that she would rebuff her husband’s advances.

Later on the same day that I met Mr. and Mrs. Aarons, I saw another client, a woman of 27, who had resorted to drinking alcoholic beverages to help her sleep. The young woman, Beth Torrence, suffered from insomnia and from anxiety attacks that she would experience while driving, at work, or in social situations.

We had been working together for several months on reducing her dependency on alcohol by having her substitute relaxation exercises at bedtime. Her sleep had generally improved, but she still suffered from a strong and persistent undercurrent of anxiety. The panic attacks remained.

Three days after the foregoing sessions, I received a call from my friends at the juvenile probation department concerning a 16-year-old girl, Laura Green, who had been picked up for school truancy and for joyriding with friends in a stolen vehicle. She told the probation officers who interviewed her that she had run away from home and was living with a friend.

The probation officer asked me if I would do a consult with the girl and her parents. The mother, she said, had confirmed that the daughter had run away from home, but maintained that she didn’t know why. The father was willing to attend the session, but also was at a loss to explain his daughter’s behavior.

Three different cases-a couple with sexual problems, a young woman who was becoming dependent on alcohol and had anxiety attacks, and an adolescent who was a juvenile offender-had all ended up in our offices. Their problems were very different, they were at different stages in the life cycle, and their diagnoses were as different as their stories. However, there was one very important bond that they all shared. The women were all victims of sexual abuse; they were all survivors of incest. And none of them had entered treatment with that as the presenting problem.

In our work with Julie Aarons, the wife in the first case, we found that she had been sexually abused by her father from the time she was 7 until age 13. She said that she had told her husband about it shortly after their marriage. Beth Torrence, the young woman in the second case, had been abused by her stepfather, who would get drunk, become violent, and then force his way into her bedroom. This abusive cycle went on for about 10 years until she reached the age of 16.

At the first family interview with the juvenile offender, only the mother and daughter came. I told Mrs. Green to ask Laura why she had run away from home. The mother turned to the daughter angrily. Laura responded: “She doesn’t care to know why.” After much prompting on my part but little on the mother’s, the girl said: “Because my brothers never left me alone. They were always bothering me, you know.” When I asked Laura to explain further, she said: “They would get drunk and have sex with me. I couldn’t take it there anymore.” In the ensuing weeks, Mrs. Green disclosed that she too, like her daughter, had been a victim of incest.

All clinicians confront the marital, individual, or family problems associated with incest whether they are in private practice or in other clinical settings. Findings from a host of research and clinical studies are presented here that indicate that adult survivors of incest suffer from devastating personal and interpersonal difficulties. The presenting problems that often bring survivors into treatment can be divided into four categories, as described later. These areas of dysfunction and the interactive effects form what we call the incest survivor syndrome-a diagnosis that should suggest the codiagnosis of post-traumatic stress disorder.

The past decade has seen a growing awareness of the prevalence and consequences of childhood sexual abuse. Societal recognition of the severity of the problem has taken place in an atmosphere of open and frank discussions of sexual attitudes, behaviors, and experiences. In this climate, there have been increasing reports of childhood sexual experiences and incest in the general population.

A number of first-person accounts have chronicled the experiences of incest victims. These books, written primarily by women, contain narratives about their incest memories, the aftereffects of the trauma, and their difficulties in recovery. Among the more moving publications are Brady’s (1979) autobiography of father-daughter incest, Bass and Thornton’s (1983) edited stories offemale survivors, Evert’s (1987) struggles to recover from mother-daughter incest, and Bass and Davis’ (1988) guide for female survivors, which also contains numerous first-person reports of incest. Some of these accounts have even found their way into popular magazines, including a former Miss America’s discussion of her incest trauma in People magazine.

As more women have come forward with their detailed descriptions of being molested, a small but growing number of male victims have also published such accounts. Lew (1988) has edited the narratives of some of his male patients who are incest survivors, while GrubmanBlack (1990) has presented both his own case and those of other male victims.

In the past decade, the subject of incest and its aftereffects has become further publicized as a central theme in various novels and movies. Authors like Maya Angelou (1980), herself an incest survivor, and Michelle Morris (1982) have written powerful and moving fictional accounts of women who have been abused. Movies like Barbra Streisand’s Nuts have broken the taboo in Hollywood against dealing with incest and its consequences.

Coincident with the appearance of these autobiographical and fictionalized accounts has been the emergence of epidemiological research on the incidence of incest. According to Russell’s (1986) landmark study, a substantial number of the women in the population, as high as one in five, has had an incestuous experience at some point in childhood. Most of these victims were sexually abused before the age of 14. Other studies, most notably one by Porter (1986), have claimed that one boy out of six will have been sexually victimized by the age of 16, although the incidence of incest has not been established. Russell (1986) has also observed that the majority of perpetrators are male for both male and female victims.

Because incest occurs during childhood, the victim is especially vulnerable to being traumatized for life. An increasing number of investigators have concluded that the victim’s later maturation and development will be adversely affected. Browne and Finkelhor (1986) have reported that about 40% of all survivors end up requiring psychotherapy in adulthood.

There is also an emerging awareness among clinicians in both inpatient and outpatient settings that a substantial portion of their caseloads represent incest survivors. Studies of outpatients have found that from 25% to 44% of all outpatients are survivors (Briere, 1984; Rosenfeld, 1979; Westermeyer, 1978). Carmen, Rieker, and Mills (1984) reported that 43% of the adult inpatients in their sample were victims of childhood physical and/or sexual abuse. Similar results were obtained by Emslie and Rosenfeld (1983) in their study of hospitalized children and adolescents. They found that 37.5% of all nonschizophrenic girls and around 8% of the boys had been incestuously victimized.

As more information has appeared about the prevalence and probable consequences of incest, various theoreticians have called into question some of the sacred cows in psychology. Most notable among these widely held beliefs are Freud’s oedipal and seduction theories, in which he claimed that his patients’ reports of being sexually abused were merely fantasies arising out of their libidinal drives. In the wake of myriad reports on the reality of incest, these theories have been attacked by both feminist writers (Rush, 1980) and psychoanalysts (Masson, 1984; Miller, 1984). Indeed, Miller’s (1981, 1983, 1984, 1990) comprehensive writings on the reality and devastating consequences of child physical and sexual abuse have become best-sellers among the general public and required reading for therapists.

In light of these developments, researchers, clinicians, and theoreticians are studying the relationship between the trauma of incest and the later development of psychopathology. As Miller (1990) points out, it was Freud who first made the connection, about 100 years ago, between adult hysteria and childhood incest, but it was also Freud who turned away from his own discoveries. We are apparently returning to the fertile field of inquiry abandoned by Freud in 1897.

The Incest Survivor Syndrome

While the specific relationship between early traumas and the later development of psychopathology in survivors is still under investigation (Rieker & Carmen, 1986), it has become increasingly clear to clinicians that a host of symptoms are generally related to the complex of experiences surrounding the incest. We need, therefore, to understand better the special needs of this population. In particular, clinicians require a more comprehensive picture of what symptoms their patients bring into treatment and how these presenting problems are related to the incest. Only then can we begin to formulate successful treatment plans. The symptoms include low self-esteem, anxiety disorders and chronic depression, eating disorders, drug and alcohol abuse, sexual dysfunction, and abusive marital or incestuous family relations.

We have tried to classify the most common problems presented by survivors into four areas: cognitive, emotional, physical/somatic, and interpersonal. While other classifications are possible, we have attempted to simplify the task by presenting those issues that most often motivate incest victims to seek psychotherapy. Since most survivors do not describe childhood incest as their reason for seeking treatment, clinicians must be aware of the possibility of incest if their clients present with problems in several of these categories.

But while survivors do not have to present with serious psychopathology in all four areas, they often will fall on a continuum of moderate to high dysfunction in all categories. This nexus of problems from the four areas and their interaction effects form the incest survivor syndrome.

Cognitive Problems

“[‘m dirty . . . bad . . . damaged.”

‘Just a piece of shit-that’s me.”

‘I’m useless, trash. . . good for nothing.”

—Incest survivors

The most pervasive difficulties with which survivors struggle are issues in self-esteem and self-concept. Poor self-esteem and chronically negative self-references are commonly reported. Survivors also believe that they are inherently bad because there is something fundamentally wrong with them. In two separate studies, Herman (1981) and Lundberg-Love (1990) reported that nearly 100% of their female survivors felt stigmatized,·damaged, or irreparably branded.

Survivors also share a predominant belief that they are unlovable. Whether this faulty belief stems from feelings of guilt or of self-blame over the incest is unclear. Nevertheless, as a group, survivors, despite evidence to the contrary from spouses, lovers, children, and therapists, continue to persist in their belief that they are unlovable and bad.

Survivors may also suffer learning difficulties and have poor attention spans. These disabilities often begin in childhood or early adolescence when the abuse is taking place. As adults, the cognitive problems may manifest as gaps in memories, childhood amnesia, thought disorders, or enduring concentration and learning difficulties. Several studies have documented the clinical observation that most survivors suffer from some degree of dissociative disorder. Browne and Finklehor’s (1986) excellent review of the literature concluded that dissociation is a long-term consequence of incest. Briere (1984) reported that 41% of his sample experienced dissociation, 33% derealization, and 21% out-of-body experiences. Lundberg-Love, Crawford, and Geffner’s (1987) study of survivors found that 61% of their

sample exhibited dissociative symptoms.

For example, in the second case described earlier, Beth Torrence reported an elaborate series of out-of-body experiences and dreamlike states that took place at night when she was alone. Although she was a brilliant woman, she found that she couldn’t concentrate sufficiently to do well at school. In addition, Beth had virtually no memories of her early adolescence, although she repeatedly described herself as being “a bad seed.”

Another manifestation of the dissociative disorder is a form of psychological splitting. The survivor develops two distinct aspects of selfrepresentation, a “good me” and a “bad me.” In certain cases, the “good me” will overcompensate for the shameful existence of the “bad me” through overachievement or perfectionism. In its extreme form, the splitting process may result in multiple personality disorder, that is, the birth of a number of distinct personalities of various ages and different genders. A recent study by Putnam (1989) found that about 85% of patients with the diagnosis of multiple personality disorder had a history of sexual abuse.

Emotional Problems

‘I’m terrified of the dark.”

“I want to die. Nothing has any meaning for me.”

“I heard somebody breaking into the house. I started hyperventilating.”

—Incest survivors

Survivors often come to therapy with symptoms of anxiety and depression. Anxiety disorders such as agoraphobia are common among these patients. Chronic depressive reactions may occur in adolescence and persist well into adulthood. In our view, these are long-term posttraumatic reactions to the incest.

Let us look at some common anxiety or fear reactions. Nightmares, night terrors, insomnia, and fears of sleeping alone are typical symptoms. Nightmares and night terrors are usually recurrent in nature, with basic themes of being chased, hunted, captured, or suffocated. Survivors who are also parents may be afraid to be alone at night, as well as manifest anxious vigilance when the children are sleeping.

Some survivors present with fears of losing their loved ones, especially their partners or spouses. Profound separation anxieties or abandonment terrors are expressed by some patients as early as in the first few sessions. Others will report that they are afraid of being killed or annihilated, even in situations in which there is no imminent danger. These fears are often expressed as having arisen in night terrors or nightmares. Clients who are torn between fears of abandonment and of annihilation will often present as lethargic, depressed, and almost paralyzed.

According to a study by Briere and Runtz (1986), survivors are much more likely than controls to consider or attempt suicide. They are also much more prone to self-mutilating behaviors using cigarettes or razor blades. These activities reflect the underlying depression and the lack of a desire to live that are characteristic of this population. Several studies with college-age women have confirmed higher rates of depression among both clinical and nonclinical samples (Sedney & Brooks, 1984; Lundberg-Love et al., 1987).

Some survivors present with deadened affect and a quality of numbness. They can report unspeakable horrors they have undergone without betraying any emotion. These clients have adhered to the family rule, “Don’t talk, don’t trust, don’t feel” (Black, 1981).

Still anothe...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Introduction
• 1 Theincest Survivor Syndrome
• 2 Determining Who Is a Survivor
• 3 Thesurvivor’s Family of Origin
• 4 Trust, Gender, Power, and the Identity of the Survivor
• 5 Family-of-Creation Dynamics
• 6 Role of the Therapist
• 7 Theinitial Phase of Therapy
• 8 Themidphase of Therapy
• 9 Thefamily-of-Origin Work
• 10 Theendphase of Therapy
• 11 Themale Survivor
• Epilogue
• References
• Name Index
• Subject Index