Child Sexual Abuse

Working With Survivors of Child Sexual Abuse

Elaine Cook

March 10, 2002

Statistics about child sexual abuse vary. Charles Whitfield says that studies show that "in the United States one girl in three or four has been sexually abused by age 18, and one boy in four to ten has been sexually abused." (Whitfield, 1995, p. 3) Ellen Bass and Louise Thornton report that Parents United estimates that "one out of four girls and one out of seven boys will be sexually abused." (Bass and Thornton, 1983, p. 24) Our textbook estimates that 10-15 percent of "children and adolescents have been sexually victimized by an adult at least once." (Alloy, Jacobson and Acocella, 1999, p. 335) Since childhood sexual abuse can have a severe impact on an adult's ability to relate intimately to another person, I expect that this is an issue which will show up in couples seeking relationship counseling, which is my area of interest. This paper is intended as a personal exploration, to help me understand more about this issue so that I can be more sensitive to it and helpful to survivors, both in my future practice and with friends. I will include material from many sources, including books intended to help survivors, fiction, and personal accounts, as well as more academic works.

The first thing I need to remember is that it is very difficult for victims of child sexual abuse to start talking about what happened to them. Their experience may have been denied by someone like the psychiatrist who told a 14 year old that she had an overactive imagination and made the whole thing up (Bass and Thornton, 1983, p. 18). (This is much less likely to happen today, but still affects adult survivors who may never have talked about the abuse since that type of experience.) They may have been blamed. "YOU DON'T MEAN YOU LET HIM DO THAT! Goddamn, what's wrong with you?" (Grubman-Black, 1990, p. 142) They may feel shame and self-blame. "I must have somehow done something hideously wrong... Otherwise, how could a preacher, the father of my mother's beloved friend, how could he have done that?" (Bass and Thornton, 1983, p. 168) "Confusion and feelings of fear, shame and regret are rampant among sexually victimized boys. Tragically, being a child-victim offered opportunities to feel good, to feel admired, loved and wanted." (Grubman-Black, 1990, p. 17). They wanted attention, so they blame themselves for the sexual abuse that came with it. "Many survivors hold particularly shameful feelings if they needed attention and affection and did not fight off sexual advances because of those needs... The closeness may have felt good to you. You may have adored your abuser." (Bass and Davis, 1988, p. 105) One of our friends told us that his feelings about his incest were very mixed, because the only time his father expressed love and affection was while he was interacting with him sexually. The victims may be afraid. Someone may discover something about them that is "wrong," "bad" or "dirty." If they enjoyed it, even a little, they feel that it's their fault. (Grubman-Black, 1990, p. 25)

A child may try to maintain the integrity of the family, fearing rejection. Dorothy Allison portrays the complexity of a child's feelings in Bastard Out Of Carolina. After her mother separates from Bone's stepfather because of the severity of the beating he had given Bone, Bone blames herself. "It was my fault, everything, Mama's silence and Reese's rage." (Allison, 1993, p. 249) After Daddy Glen brutally rapes her, the sheriff tries to find out what happened and who did it. But she won't tell. "I didn't want anyone to know anything... No one cared about me. I didn't even care about myself any more." (Allison, 1993, p. 297) Her fears are realized at the end of the book, when her mother leaves with Daddy Glen--her attachment to her husband is stronger than her love for her daughter. In other words, the victim's fears of being abandoned may be justified.

Sexual abuse survivors may not remember the abuse, even though they are still affected by it. The event was too traumatic, and they may have been threatened by their abuser or they may be dependent on their abuser. Whitfield quotes memory researcher Jennifer Freyd: "Betrayal-trauma theory suggests that psychogenic amnesia is an adaptive response to childhood abuse. When a parent or other powerful figure violates a fundamental ethic of human relationship, victims may need to remain unaware of the trauma not to reduce suffering but rather to promote survival. Amnesia enables the child to maintain an attachment with a figure vital to survival, development, and thriving." (Whitfield, 1995, p. 28)

When survivors do talk about their abuse, it may sound detached. Mike Lew discusses the "throwaway" style of delivery of information about the incest. "He may speak with a slow, measured tone and grammatical precision that robs his message of spontaneity and feeling. Conversation then takes on an academic tone which serves the double function of overexplaining and ridding the words of the frightening reality of emotion... The most disturbing stories of brutality and neglect are told with what amounts to a verbal shrug of the shoulders... There is the fear that, once opened, the floodgates of emotion will be uncontrollable, washing away both speaker and listener... The effect on the listener can be confusing or chilling. (Lew, 1990, p. 93-4) This is an important observation for me to remember, since I think I have sometimes minimized stories that I have heard because I didn't understand how someone could have so little reaction to what they were telling.

Secrecy about the abuse is enforced by the perpetrator through threats and denial. "The powerful sense of isolation was a direct consequence of being attacked and then being left alone afterwards, following my uncle's threat that he would kill me if I ever told anyone what had happened." (Timms and Connors, 1990, p. 50) "If you scream, I'm gonna kill you. And if you tell, I'm gonna kill Bailey [her brother]." (Angelou, 1969, p. 65) These types of threats are commonly reported - the perpetrator doesn't want anyone else to know what happened. The abuser may also isolate the victim, or tell the child that no one will believe him. (Lew, 1990, p. 149) Janice Doane and Devon Hodges, drawing on the work of Jennifer Freyd, point out that, "When those around her act as though nothing has happened, the child learns to minimize the experience of abusive behavior." (Doane and Hodges, 2001, p. 106)

Breaking the secrecy is seen as one of the most important parts of healing. Ellen Bass and Laura Davis suggest that survivors write about their experiences. "Writing is an important avenue for healing because it gives you the opportunity to define your own reality... You also reexperience feelings and are able to grieve." They suggest, "After you write, read your writing to someone who will listen attentively and be responsive." (Bass and Davis, 1988, p. 27-8) They list ways that telling about your experience is transformative. These include moving through the isolation of shame and secrecy; moving through denial and acknowledging the reality of your abuse; getting in touch with your feelings; making it possible to get understanding and help. (Bass and Davis, 1988, p. 95) Doane and Hodges point out that "Silencing is the trauma." (Doane and Hodges, 2001, p. 52) Lew encourages survivors to "Tell your story again and again." Repeating your story makes it more real, emphasizes its importance, allows new perspectives to emerge, allows more feelings to come up. (Lew, 1990, p. 155) Whitfield states that "Remembering and accurately naming what happened in any traumatic experience is crucial to healing from its harmful effects." (Whitfield, 1995, p. 249)

It's important for survivors to recognize that they are not responsible for the abuse. Laura Davis says that "Over and over, Ellen repeated those simple phrases: 'It wasn't your fault. I believe you. Healing is possible.'" (Bass and Davis, 1988, p. 15) Bass and Davis state that "To heal from child sexual abuse you must believe that you were a victim, that the abuse really did take place... Even if your family insists nothing ever happened, you must still believe yourself." (Bass and Davis, 1988, p. 86-7) They point out that adults may try to make the child responsible. "One small child was even begged by her abuser to stop him. He kept telling her how wrong it was and that she must not let him do it ever again--and then he'd force her once more." (Bass and Davis, 1988, p. 104) They mention a woman who thought that she should have had the power to stop her father when she was only 4. They emphasize that "Nothing you did caused the abuse; nothing within your power could ever have stopped it. Your world was an unsafe place where adults were untrustworthy and out of control." (Bass and Davis, 1988, p. 105) Lew states that, "As long as you continue to accept blame for what happened to you--as long as you buy any part of the lies that you have been told--the abuse is continuing." (Lew, 1990, p. 258) Stephen Grubman-Black points out that "We may hurt ourselves because we blame ourselves...We forget who is the real perpetrator." (Grubman-Black, 1990, p. 74)

Survivors need to recognize that what happened to them was abusive. Lew says that, "I'm always surprised to hear people assume that survivors dramatize their stories... It has been my experience that survivors tend, if anything, to minimize what happened to them... One of my clients, a man whose father would burn him with cigarettes, was startled when I referred to that behavior as abusive. He had never thought of it that way. To him, it was just something that Daddy did." (Lew, 1990, p. 102). Whitfield notes that his clients have "the strong tendency to minimize, deny and otherwise withhold most anything from their inner life about their hurts, losses and traumas... It is only by gently supporting the expression of their experience, over time, including what they remember, that they are able to heal their wounds around the trauma." (Whitfield, 1995, p. 79)

Self-worth is one of the casualties of sexual child abuse. Men have to deal with "the fact that our culture provides no room for a man as victim... A 'real man' is expected to be able to protect himself in any situation... Since men 'are not supposed to be victims,' abuse (and particularly sexual abuse) becomes a process of demasculinization (or emasculation)... Men in my recovery groups have talked of the length to which they have gone to prove their masculinity." (Lew, 1990, p. 41) Sexual abuse violates the child's boundaries, the child's sense of control. The child may have been ignored or blamed. "Many abused kids are told directly that they'll never succeed, that they're stupid, or that they're only good for sex. With messages like these, it's hard to believe in yourself." (Bass and Davis, 1988, p. 34-5)

Since clients are often reluctant to talk about sexual abuse, what do I as a counselor need to be aware of and do? Bass and Davis make several suggestions for counselors:

Intake forms should include questions about sexual abuse
Symptoms such as eating disorders, drug or alcohol addiction, suicidal feelings and sexual problems may be symptoms of early sexual abuse
Ask about sexual abuse. If this might be too threatening to the client, you can ask, "Did anyone touch you in ways you did not want as a child?"
If a client has disclosed abuse, ask questions, ask for details. Let the client know you're willing to hear the worst.
Ask about other abuse.
Ask again later. Recognize that it won't be quickly worked out.
Encourage the client to feel.
Be creative. Crayons, clay, dancing, movement can all be used to help a client get in touch with her feelings.

(Bass and Davis, 1988, p. 349-351) Whitfield also has a section with guidelines for assisting with memories of trauma. His comments include: let the client set the pace; don't say, "You were sexually abused;" document all appropriate material, events and progress; do not suggest confrontation or a legal suit; understanding the essence of a memory and their own perspective is more important than the details; never invalidate the client's inner life or experiences. (Whitfield, 1995, p. 183-7).

Sexual abuse survivors often have sexual difficulties, though the problems manifest in very different ways for different people. Some people may become promiscuous or try to meet non-sexual needs through sex. Others may become asexual, or numb their bodies so they don't respond. (Bass and Davis, 1988, p. 53) One woman I know always seemed to need to be the center of male attention, giving many men (including my husband) the message that she might be interested in them sexually. After I read The Courage to Heal, I gave her a copy and she joined a sexual abuse survivor group. Her behavior at parties and meetings has changed completely since then.

Survivors often misunderstand physical touch. "If touch means sex, and sex means abuse, the child may feel as though he is being abused whenever anyone touches him... When treated affectionately, he reacts with mistrust, becoming withdrawn, suspicious, or antagonistic... He might attempt to sexualize the interaction--and become confused when his behavior is regarded as inappropriate." The child (and the adult he becomes) receives and gives confusing messages to the world (Lew, 1990, p. 128) The incest survivor may have difficulties with sexual boundaries. He may feel like a pervert--sex-obsessed and out of control. He may have excessive preoccupation with sex and arousal, or attempt to deaden all feelings in order to avoid arousal. (Lew, 1990, p. 185-6) Another result of early sexual abuse for many men is a confusion over their sexual orientation (Timms and Connors, 1990, p. 54; Lew, 1990, p. 54-5) As a counselor, I will need to pay attention to sexual difficulties and inappropriate sexual vibes. They may be the result of childhood sexual abuse.

Whitfield points out that "The body stores and re-enacts traumatic memories in gross and subtle ways." (Whitfield, 1995, p. 243) The traumatic memories may manifest themselves in the body through such things as chronic aches and pains; surface numbness; tightness in jaws, pelvis or anus; shallow breathing; accident proneness; or panic attacks (Whitfield, 1995, p. 244) For writer and activist Margaret Randall, a consuming horror of mushrooms, a terror that she might come into contact with some, was the result of her grandfather's incest. It was in addressing this phobia that she finally recovered her memories of his abuse. She now works at the task of recovering in the context of her art. (Randall, 1987, p. 25)

What is needed in the recovery process? Whitfield emphasizes the importance of validating the client's experience. It is healing. "Validation of our experience by others allows us to open ourselves to a painful memory, explore it, and work through it." Validation includes being supportive, mirroring, accepting, loving unconditionally. (Whitfield, 1995, p. 281) Grubman-Black suggests, "When someone tells you that he was the victim of sexual abuse, listen and believe him." (Grubman-Black, 1990, p. 83). One survivor says, "The most healing words said to me were: 'I believe you.' And, 'I'm sorry that any of that happened to you.' ... To be assured by a friend that I was believed, that I wasn't making up any of that awful stuff, helped me unburden myself." (Grubman-Black, 1990, p. 81)

Lew states that "Separating sexuality from shame is a major goal of recovery." (Lew, 1990, p. 58) He has seen many survivors "overcome their sexual dysfunction as part of the natural course of recovery... As they move through their shame, as they continue to rebuild trust and self-esteem, and as they forge healthy friendships and intimacies, their sexual problems begin to diminish." (Lew, 1990, p. 60) Like others, he says that "The way out of the pain is through it." "The survivor must find a safe and encouraging environment in which to feel his emotions, including the painful ones." (Lew, 1990, p. 111) Groups are a good place to learn to feel the feelings, though he points out that "Even though a group is a safe place to be, it is seldom comfortable... The purpose of bringing up the feelings is not to learn to live with them, it is to get through them... Once the pain is felt in a nonabusive atmosphere, it can be examined, understood, put into perspective, and diminished." (Lew, 1990, p. 212-3)

Is it important to forgive as part of recovery? People often tell an incest survivor, "You need to learn to forgive." (Lew, 1990, p. 253) However, Lew emphasizes that "It is not necessary for you to forgive the person who abused you. Do what makes sense to you... The choice to forgive or not to forgive is entirely yours." In fact, "All too often premature forgiveness serves to revictimize the survivor. It takes the form of minimizing the abuse or sharing responsibility for it." (Lew, 1990, p. 254-5) However, "It is necessary for you to 'forgive yourself'" in a way that acknowledges both your basic goodness and celebrates your survival. It's an "important aspect of recovering your self-respect." (Lew, 1990, p. 258)

Bass and Davis concur. "Healing depends a lot on being able to forgive yourself, not on being able to forgive your molester." "If you have strong religious ties... you may feel it is your sacred duty to forgive. This just isn't true." The kind of forgiveness that involves "giving up anger and pardoning the abuser, restoring a relationship of trust--is not necessary in order to heal from the trauma of being sexually abused as a child." (Bass and Davis, 1988, p. 150-1)

Grubman-Black also rejects the idea that forgiveness is necessary. "I think that I associate forgiving with forgetting, and I will not do that since the early losses of certain memories contributed to some of my problems." (Grubman-Black, 1990, p. 159)

Whitfield has a somewhat different approach. He prefers to use a term like letting go rather than forgiving. It can be part of the process of letting go of our pain. For him, "Forgiveness releases the forgiver more than it does the forgiven." (Whitfield, 1995, p. 293-4)

For a different perspective, Diane Duane presents a story in which acceptance and forgiveness is what allows a survivor to access all her abilities. In her fantasy novel, The Door Into Shadow, fear from the abuse she has forgotten cripples the heroine, Segnbora. When Segnbora finally remembers how she was raped as a girl, and faces her rapist, she wants to kill him. But then she recognizes the Goddess in him, as She is in all things. She sees him as "A tool to make me who I am... You were a little rougher on me than you might have been, perhaps. You were the sword. But my hand was on the hilt," and she sets him free. (Duane, 1983, p. 279) Now, finally, Segnbora comes into her power, which has eluded her up until then. So for some people like Duane's heroine, forgiveness may be important, but for others it is not necessary.

A major issue faced by survivors is the question of confrontation. Do they want to confront their abuser? If so, when and how? This issue is complicated by the question of whether the perpetrator may be molesting other children. As Bass and Davis point out, "Sometimes it is difficult to weigh your own needs to be silent or to go at a slower pace against the pressing need to protect children presently at risk. Just as you are opening up to your own pain, feeling overwhelmed with your own experience, you remember a niece or grandson." (Bass and Davis, 1988, p. 140) However, in that type of situation it may be possible to talk with someone other than the perpetrator--other adults whose children may be at risk, or Child Protective Services.

There was unanimity in the books I read that confrontation should not be hurried. As Lew says, "There is no general rule about confrontation. It is a highly individual, personal decision. For some people it is a logical next step in recovery; for others it could be a dangerous and self-destructive act." (Lew, 1990, p. 228) He considers the real meaning of confrontation to be "standing up to the abuse. It indicates that you are giving voice to the reality that you are no longer willing to submit to victimization in any form. It is a statement of self-respect and self-determination." (Lew, 1990, p. 229) He encourages much practice before a confrontation, such as letter writing, guided fantasy of a situation where the survivor is in complete control, and role-play. The choice of location for the confrontation is important, since the perpetrator may attempt further abuse or assault.

Bass and Davis suggest, "Be clear that whatever you do, you are doing it for yourself. Consider your decision thoroughly, and whatever your choice, carry it out in a way that will best allow you to assert your own rights to honesty and visibility." (Bass and Davis, 1988, p. 134) They list some questions for the survivor to think about before making a decision to confront. They also warn the survivor not to have hopes and expectations for the outcome.

Whitfield addresses this issue as well. In his experience, the survivor is usually looking for acknowledgement and an apology, but he estimates the chance of that happening at less than 20%. (Whitfield, 1995, p. 139-40) In addition, there's a risk to the therapist of being sued by the abuser because of "today's climate of FMS [False Memory Syndrome] advocacy, media hype and hair-trigger litigation." (Whitfield, 1995, p. 141) He therefore recommends that the therapist request that the client sign an Informed Consent document prior to confronting the abuser. He then lists both advantages and disadvantages of confrontation.

Confrontation clearly leads to the question of truth. Are the memories true or false? In the early 1990s the parents of a woman who accused her father of sexually abusing her started the False Memory Syndrome Foundation (FMSF). Since that time they have attempted to discredit recovered memories in the press. Whitfield says that "to this date the FMSF functions mostly like a public relations firm." (Whitfield, 1995, p. 5) His book addresses the issue of the truth of memories extensively. He admits that there are some false memories, and he provides guidelines for distinguishing true memories from false. The False Memory Syndrome advocates point to studies which show that memories can easily be implanted. However, Whitfield counters that "There are important differences between ordinary and traumatic memory." (Whitfield, 1995, p. 39) He discusses the difference extensively. An important factor is state-dependent learning and memory, where "state" refers to the kind and intensity of our feelings and emotions. He explains, "If our internal state is different in the present from what it was during the original experience, then we may have difficulty remembering the experience or event." (Whitfield, 1995, p. 45) This explains why hearing the story of another survivor may trigger memories. Objective evidence of sexual abuse is almost never available, so he describes how to look for internal verification and corroboration of traumatic memory. He considers internal verification to be accomplished by observing four or more of the following clinical findings (which he then describes):

"The presence of a high risk disorder or illness
Post-traumatic stress disorder
Age regression and other re-living of the trauma
Repetitions and repetition compulsions
Characteristics of the memories themselves
Other patterns, dynamics and connections"

(Whitfield, 1995, p. 149) Whitfield notes that an abuser may not remember the abuse because of a memory blackout (Whitfield, 1995, p. 185)

The truth of memories is a very tricky issue. The books for survivors of sexual abuse stress the importance of being believed. But what if the accused is innocent? Perhaps the abuse happened, but was committed by a different person. Two case studies from The Family Therapy Networker address this issue when it is a family rather than legal matter. In one, Mary Jo Barrett describes her work as an intermediary between survivors and the family members accused of molesting them. She keeps a strictly neutral stance about the facts, trying to find common ground rather than resolving the issue of what really happened. She helps families make agreements about how they will interact. For example, "A daughter who had not spoken to her father for eight years agreed to sit at the same table at a family wedding, on condition that her father would not hug her and that their conversation would be limited to safe topics, like their careers. (Barrett, 1999, p. 178) In a commentary on another case study, Barrett says she discourages everyone from focusing on whether particular events took place. "It is far more important to get beyond polarization and create a third reality in which all family members together can explore how family relationships led children to grow up feeling powerless, disconnected, and haunted by the pain of the past." (Schissler, 1999, p. 170) This approach sounds promising to me, especially if it avoids the cost and pain of legal suits, and allows some recognition of the injury inflicted on the child. I am very curious to know whether Ellen Bass and Mike Lew would consider it helpful to get an admission of physical and/or mental abuse along with an apology rather than a complete denial, or whether they would consider this a form of invalidating the survivor's experience.

I find court cases much more troublesome, especially criminal cases. Our textbook describes the cases of George Franklin, who was convicted of murder on the basis of the recovered memories of his daughter, and of Paul Ingram, who was convicted of rape on the basis of his daughters' accusation after they retrieved memories of being abused by him. (Alloy et al., 1999, p. 186-7) When I read the textbook, I was convinced. It seemed proper that Franklin's conviction was overturned, and a travesty of justice that Ingram was in prison even though social psychologist Richard Ofshe had demonstrated how suggestible Ingram was. But Whitfield has a very different approach to those cases. Alloy et al. cite a study in which the memory of being lost in a store as a much younger child was instilled in a 14 year old. However, they give no indication that it was accompanied by other signs of trauma, so, if we accept Whitfield's distinction between ordinary and traumatic memory, their experiment is not relevant. In the case of Paul Ingram, Whitfield points out that the judge found Ofshe considerably less qualified than the other three expert witnesses, and found Ofshe's experiment of implanting a false memory to be poorly timed and inappropriate. (Whitfield, 1995, p. 220-1) In the case of George Franklin, Whitfield mentions both external and internal corroborating evidence for his daughter's testimony that he was the murderer, though it wasn't direct proof. (Whitfield, 1995, p. 159-61, p. 218-20)

This is indeed a dilemma. I would be reluctant to convict someone in a criminal case based on possibly faulty memories. However, one problem with disallowing recovered memories is that it makes it harder to address the problem of child sexual abuse effectively. Whitfield quotes therapist Mark Schwartz, "In our perpetrators' program, many individuals who had previously acknowledged their perpetrations have begun carrying around 'false memory' articles to fuel their denial, resulting in more perpetrations." (Whitfield, 1995, p. 229) As Doane and Hodges point out, "Silence frees the field for perpetrators." (Doane and Hodges, 2001, p. 14) They also mention an article by Joan Acocella, one of the authors of our textbook, which claims that incest is a problem of the poor, and then "goes on to suggest that recovered memories and multiple personality disorder primarily appeal to women supposedly left behind by the feminist movement, 'notably a large number of working-class women' who apparently go into therapy to get 'something they could not get from society: an interesting job.' Acocella thus reinforces dominant sociological myths not only about the shiftless poor, but about incest as a working-class problem. These myths are comfortable to [the] middle class." (Doane and Hodges, 2001, p. 101) Is this apparent bias behind the approach our textbook takes to these cases, in which only examples of apparently false memories are mentioned? On the other hand, my viewpoint is colored by the fact that I've mostly been reading the opinions of proponents of Recovered Memories, and have not read any major works of False Memory Syndrome advocates.

The more I read, the more I discover competing sides to the issue of incest and child sexual abuse. It's no longer simply a question of whether to believe the survivor or the accused perpetrator, but which researchers to believe. Who has a hidden agenda? Who has a clearer view of the dynamics of the problem and of recovery? Which arguments are valid? There are no clear-cut answers at this time.

My project has, however, made me much more knowledgeable about this issue and its complexities, and given me a much better background from which to evaluate both suspected cases of abuse as well as research and commentary on sexual abuse. I also have a much better idea of how to work with someone who may have experienced child sexual abuse.

References:

Allison, D. (1993) Bastard Out of Carolina. New York: Penguin Books.

Alloy, L. B., Jacobson, N. S. and Acocella, J (1999) Abnormal Psychology: Current Perspectives. Boston: McGraw-Hill College.

Angelou, M. (1969) I Know Why the Caged Bird Sings. New York: Bantam Books.

Barrett, M. J. (1999) Resolving the Irresolvable: Constructing a Way Out for Families Torn Apart By Struggles Over Recovered Memories. In Simon, R. et al (Eds.) The Art of Psychotherapy: Case Studies from the Family Therapy Networker (pp. 177-184). New York: John Wiley and Sons.

Bass, E. and Davis, L. (1988) The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse. New York: Harper & Row.

Bass, E. and Thornton, L. (ed.) (1983) I Never Told Anyone: Writings by Women Survivors of Child Sexual Abuse. New York: Harper & Row.

Doane, J. and Hodges, D. (2001) Telling Incest: Narratives of Dangerous Remembering from Stein to Sapphire. Ann Arbor, MI: University of Michigan Press.

Duane, D. (1983) The Door Into Shadow. New York: Tor.

Grubman-Black, S. D. (1990) Broken Boys/Mending Men. Bradenton, FL: Human Services Institute.

Lew, M. (1990) Victims No Longer: Men Recovering from Incest and Other Sexual Child Abuse. New York: HarperCollinsPublishers.

Randall, M. (1987) This Is About Incest. Ithaca, NY: Firebrand Books.

Schissler, H. (1999) Avoiding the Truth Trap: Responding to Allegations (and Denials) of Sexual Abuse. In Simon, R. et al (Eds.) The Art of Psychotherapy: Case Studies from the Family Therapy Networker (pp. 164-176). New York: John Wiley and Sons.

Timms, R. J. and Connors, P. (1990) Sexual Abuse of Young Males: Removing the Secret. In Abbott, F. (Ed.) Men & Intimacy: Personal Accounts Exploring the Dilemmas of Modern Male Sexuality (pp. 50-56). Freedom, CA: The Crossing Press.

Whitfield, C. L. (1995) Memory and Abuse: Remembering and Healing the Effects of Trauma. Deerfield Beach, FL: Health Communications Inc.

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