University of Southern California Dissertations and Theses

Intra-familial child sexual abuse: The experience and effects on non-offending mothers

(USC Thesis Other)

Intra-familial child sexual abuse: The experience and effects on non-offending mothers

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content INTRA-FAMILIAL CHILD SEXUAL ABUSE: THE EXPERIENCE AND EFFECTS ON NON-OFFENDING MOTHERS Copyright 2002 by Michal Sela-Amit A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment o f the Requirements o f the Degree DOCTOR OF PHILOSOPHY (SOCIAL WORK) August 2002 Michal Sela-Amit Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UM I Number: 3094401 UMI UMI Microform 3094401 Copyright 2003 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UNIVERSITY OF SOUTHERN CALIFORNIA THE GRADUATE SCHOOL UNIVERSITY PARK LOS ANGELES, CALIFORNIA 90089-1695 This dissertation, written by fH tc h p u L S p Io ^ flO A under the direction o f hZV' dissertation committee, and approved by all its members, has been presented to and accepted by the Director o f Graduate and Professional Programs, in partial fulfillment o f the requirements fo r the degree of DOCTOR OF PHILOSOPHY 56 Director Date_ 4 i / f / 3- O o Dissertation Committee Chair Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ii ACKNOWLEDGMENTS To my dear parents, Rachel and Yetzhak Sela, who find great joy in all their children’s achievements - 1 want to thank for their life-long love, encouragements and commitment to me. To my husband, and true friend, Moshe, thank you for your on going support and for taking it upon yourself to parent and entertain our children during the long weekends I spent at the libraries. To my amazing daughter, Oriah, thank you for your love and for your interest in my work and opinions. To my three- year-old twins, Jonathan and Ariella, thank you for your loving hugs every time I returned loaded with guilt feelings from hours o f studying away from home. I feel very lucky to have been guided by a special mentor, Prof. Maura O’keefe, a great colleague, who made me feel that this project is “doable”, and who contentiously provided me with encouragements, care, and guidance. Thank you, Maura, for being such a wonderful friend. I also feel very lucky to receive much support and guidance from Prof. Michal Mor Barak. Your care and collegiality, Michal, were very helpful. A great thank you goes to Prof. Nelly Stromquist for her valuable feedback. Special thanks to Prof. Bill Meezan and Prof. Zvi Eisikovits, for their excellent mentioning and long friendships. I would also like to thank my siblings: Dr. Revital Sela-Shayovitz, Lidia Hadash, Iris Weber, Sima Sela-Flex and Moshe Sela, for their love, and ongoing support. I feel truly blessed in each and every one o f you. Finally, to my Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iii dear friends: Irit Hershkovits, Tal Cohen, Jutta Minehold, Haya and Yossi Polak, Gail Schwartz, Edna Gottman, Bilha Karpel, Laurie Goodman, Simi Hamami, Randy Philips, and Debbie Gioia - thank you all for your encouragement, support and true friendships. Last but not least, I would like to thank the Los Angeles Department of Children and Family Services, The Los Angeles Family Court, and particularly, the members o f the Los Angeles Sexual Abuse Unit for their help in making the data accessible, and for helping me understand the treatments and department’s procedures regarding non-offending mothers. It is my hope that the results o f this study will enhance the professional work with non-offending mothers o f sexually abused children since these truly courageous and devoted mothers deserve all the help they can get for assisting their children and themselves to heal. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iv TABLE OF CONTENTS ACKNOWLEDGMENTS ..................................................................................... ii LIST OF TABLES .......... viii LIST OF ACRONYMS................... .... .................................................................... x ABSTRACT ............. xi Chapter 1. INTRODUCTION . 1 2. REVIEW OF LITERATURE............................................... 5 The Incestuous Family M odel................................................................. 5 Criticism o f the Incestuous M odel ............................... .......................... 8 Empirical Findings on Non-Offending Mothers ............. 10 Personality Profile o f the Mothers .......................... 11 Mothers' Relationship With Parents in Childhood ................ 14 Mothers' Experience o f Childhood Sexual Abuse ........ 17 Mothers' Patterns o f Familial, Marital, and Sexual Relationships......................................................... 20 Patterns o f Mothers' Reactions to Abuse Disclosure ........... 23 Mothers’ Knowledge o f Abuse ....... 23 Mothers’ Belief in the Abuse Allegations .............................. 24 Mothers’ Actions to Protect Abused Child .......................... 27 Mothers’ Support and Their Child’s Recovery ..... 29 The Incestuous Model: Conclusions .............................................. 32 The Effects o f Child Sexual Abuse on Non-Offending Mothers ................................................... 34 Effects on Mothers With Child Sexual Abuse History ....... 38 Effects on Mothers With Battered Women History ......................................................................... 42 Effects on Single Mothers ........................... ................................ . 45 Effects on Mothers Whose Children Were Detained ................ 47 Social Support ................. 48 Methodological Limitations in Review of Literature ....... 50 Implications for Theory and Research ..................... 52 The Research Questions .................................. 55 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. V Chapter Page 3. STUDY METHODOLOGY ................. 59 Study Design .......... 59 The Agency From Which Sample Was Drawn ............... . 61 The sample ...... 63 Data Collection ......... 64 The Case Extraction Form .................... 65 The Los Angeles Symptom Checklist .................... 68 Validity ............................ 69 Reliability ............................ 70 LACS Usage in Study ...... 71 Data Analysis: An overview .......................... 72 Justification o f Research Methodology ............................ 74 Research Design ....... 75 Source o f Data................................. 75 Instruments for Data Collection.......................... 78 Summary............................... 79 4. RESULTS .......... 82 Descriptive Results .............................. 82 Socio-Demographic Characteristics o f MI A C ............................. 82 Characteristics o f the Abused Children and the Abusive Experience ............................................................. 86 Characteristics o f the Offenders ...... 88 Confirming the Abuse Allegation and Legal Actions Against Offenders ............... 89 Mothers’ Awareness o f the Child’s Abuse and Their Reactions.............................................................. 90 The Official Disclosure and the Investigations o f Police and DCFS ............ 97 Changes in MIAC's Lives and Relationships After the Abuse Disclosure .......... 107 Change in family constellation ............................................ 107 Changes in Mothers’ Work and Income Situation .......... 110 Changes in Mothers’ Relationship with Her Children .................. 112 Mothers’ Relationship with the Offender ...................................... 118 Mothers’ Relationship with Family Relatives ...... 122 Changes in MIAC's Psychological Well Being After Disclosure .............. 124 Mothers’ Stress-Related Symptoms ...... 128 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. vi Chapter Page Mothers’ Relationships with Significant Others Before and After Disclosure .................. 129 Mothers’ Own Experience o f Childhood Sexual Abuse ........ 132 Mothers’ Experiences in Therapy ................................. 133 Mothers’ Information Sharing .................... 134 Mothers’ Ability to Receive/Provide Support................ 135 Changes in Mother-Children Relationships and Reunification .................... 136 Mothers’ Re-Examination o f Their Relationships with Partners ............ 137 Mothers’ Improved Self Care ....................... 137 Mothers’ Benefits From Therapy ............................... 138 Treatment Termination ................................... ........... . 140 Mothers’ Attitudes Toward Treatment ...................... 140 Summary o f Descriptive Results ........................................... 143 Bivariate and Multivariate Analyses .................................. 153 Differences in Psychological Well-Being, Life Change, Relationship Strain and Social Support by Sub-Groups o f Mothers ..................................... 153 Differences By CSA History ....... 153 Differences By Battered women History...................................... 157 Differences By Combined Histories o f CSA and Battered Woman ................................................................ 159 Differences By Single/Shared Parenthood...................... 164 Differences By MIAC’s Relationship With Offender .......................................................... 165 Differences By Children’s Detention ...... 167 Factors Associated With MIAC’s Stress-Related Symptoms: A Multiple Regression Model ..... 170 Summary o f Bivariate and Multivariate Results........................... 176 5. DISCUSSION.......................... 182 MIAC’s Experience o f the Child Sexual Abuse Disclosure and Its Aftermath...................................... 184 Recommendations for Policy and Practice ................ 194 Recommendation for Further Research ................................ 200 BIBLIOGRAPHY ........ 208 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Chapter vii Page Appendix 1. Table 1 : Mothers o f Sexually Abused Children: Personality Childhood Background, Marital Relationship and Response to Child’s Abuse ........ 225 2. Approval o f Study......................................... 233 3 . The Case Extraction Form. .......................... 238 4. Table 2: The Study’s Hypotheses................... 248 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. v iii LIST OF TABLES Table Page 1. Mothers o f Sexually Abused Children: Personality, Childhood Background, Marital Relationship and Responses to the Child’s Abuse ..................................................... 225 2. The Effects o f Child Sexual Abuse on Non-Offending Mothers: Research Hypotheses............................................................................... 248 3. Sources o f Support to the Abuse Allegations ............................................. 89 4. Abused Children and Siblings Detention by Mother’s Minimalization o f Abuse ................ 105 5. Children’s Stay in Foster Care and Mothers’ Length o f Therapy By Mothers’ Belief in the Abuse Allegation ........ 106 6. Placement o f Abused Children and Siblings Following Disclosure ............................... 109 7. Mothers’ Reports on Changes in the Abused Child and Siblings’ Performances After Disclosure ......... 115 8. Psychological Well Being, Life Change, Relationship Strain and Social Support Among MIAC Who Experienced CSA and MIAC Who did not ................................ 156 9. Psychological Well-Being, Life Change, Relationship Strain and Social Support among MIAC Who Are Battered Women and Those Who Are N o t......................................... 159 10. Psychological Well-Being, Life Change, Strain and Social Support among MIAC with CSA and BW History, MIAC with Either CSA or BW History, and MIAC With Non-Abusive History ........ 161 11. Stress-Related Symptoms Among MIAC With CSA and BW History, MIAC with Either CSA or BW History, and MIAC with Non-Abusive History ........ 162 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ix Table Page 12. PTSD-Related Symptoms Among MIAC With CSA and BW History, MIAC With Either CSA or BW History and MIAC With No Abusive History ......................... 163 13. Psychological Well-Being, Life Change and Relationships Strain among MIAC Who Shared Parenting and Those who Were Single Parents ............... 165 14. Psychological Well-Being, Life Change and Relationships Strain Between MIAC Whose Child’s Offender Was Their Male Partner or A Family Relative........................................................ 167 15. Psychological Well-Being, Life Change and Relationships’ Strain Between MIAC Whose Children Were Detained and MIAC Whose Children Remained Home ........ 169 16. Factors Associated With MIAC’s Stress-Related Symptoms: A Multiple Regression Model ................... 175 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF ACRONYMS BA - Battered Woman CPS - Child Protective Services CSA - Childhood Sexual Abuse DCFS - Department o f Children and Family Services LASC - Los Angeles Symptom Checklist MEFAC - Mothers o f Extra-Familially sexually Abused Children MIAC - Mothers o f Incestuously Abused Children PTSD - Post Traumatic Stress Disorder Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. xi ABSTRACT This study examined the experiences and effects o f intra-familial child sexual abuse disclosure and its aftermath on various aspects o f non-offending mothers lives: the marital-familial, economic, occupational, social, parental and emotional- psychological. Factors that may place some mothers at a greater risk of being negatively affected by the sexual abuse of their children including: single-parenthood, maternal history o f childhood sexual victimization, maternal history o f battered woman, and children’s detention after abuse disclosure, were also examined. Grounded in a feminist perspective, the study combines qualitative and quantitative analyses o f data on 62 mothers who participated in treatment in the Los Angeles Child Protective Services. Data were collected using a case extraction form and the Los Angeles Symptom Checklist (King et al., 1995), a measurement o f overall distress and PTSD. The results include a comprehensive description o f the socio-demographic characteristics o f the mothers and the sexual abuse o f their child. The various changes that took place in their lives after the abuse disclosure are examined within the physical, the social and the intra-personal contexts o f the mothers’ lives. Series of group comparisons and multiple regression analysis indicated that maternal child Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. xii sexual abuse history, a battered woman history, the number o f strained relationships experienced after disclosure, and the number of changes in mother’s life after disclosure, are all significantly associated with maternal psychological distress. These variables are risk factors for developing heightened distress, depression, or PTSD, which in turn, may affect maternal functioning. The qualitative analysis indicated that the children’s detention, and the support mothers receive from formal and informal sources also influence their well being. These findings indicate that for mothers, the child’s abuse disclosure is a life-changing event that carries profound consequences and prolonged challenges at a time when their inner, social and economical resources are being seriously depleted. Hence, many mothers may experience it as a major crisis. Decontextualizing mothers’ reactions from their crisis situation created misunderstanding and mistrust between them and their therapists and prevented the provision o f adequate responses for their needs. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1 CHAPTER 1 INTRODUCTION Child sexual abuse has been recognized as an important social problem. The prevalence of child sexual abuse and the documented harsh psychological impact on the victims have contributed to this recognition. A plethora o f research in the field suggests that sexually abused children suffer from a variety o f short- and long-term mental health problems (e.g., Beitchman, Zucker, Hood, DaCosta, Akman, & Cassavia, 1992; Briere & Runtz, 1988; Kendall-Tackett, Williams, & Finkelhor, 1993; Neumann, Houskamp, Pollock, & Briere, 1996). Recently, there has been an increased interest in the role o f non-offending mothers in the child's recovery. Several studies indicate that maternal support o f the sexually abused child is a powerful mitigating factor associated with the child's adjustment and recovery (Adams-Tucker, 1982; Everson, Hunter, Runyon, Edelson, & Coulter, 1989; Lovett, 1995; Morrison & Clavenna-Valleroy; 1998; Tremblay, Herbert & Piche, 1999). Not all mothers are perceived by professionals as supportive of their sexually abused children (Deblinger, Stauffer, & Landsberg, 1994; deYoung, 1994; Leifer, Shapiro, & Kassem, 1993; Lovett, 1995; Stauffer & Deblinger, 1996; Leifer, Kilbane, & Grossman, 2001). Mothers o f intrafamilial abused children (MIAC), in particular, were often viewed by professionals as rejecting their children. Moreover, in clinical Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 settings, they were frequently blamed for "colluding" in the sexual abuse of their children (Cohen, 1983; Crawford, 1999; Herman & Hirschman, 1981; Rist, 1979). Although such attitudes have been seriously challenged in recent years (Joyce, 1997; Crawford, 1999; Nakhle Tamraz, 1996), covert blaming o f non-offending mothers in the abuse o f their child and/or the perception o f the mother as hostile toward and rejecting o f her child is still common among practitioners (Manion, McIntyre, Firestone, Ligezinska, Ensom, & Wells, 1996; Crawford, 1999). Given that MIAC is a population on which little is empirically known and much has been theoretically assumed, factors that may affect MIAC's provision of support to their children are largely unknown and the few studies that empirically addressed this issue yielded inconsistent results (Elliott & Carnes, 2001; Everson et al., 1989; Leifer et al., 1993). The purpose o f this study is to increase the knowledge base on one such factor— the effects o f the child's sexual abuse on the mother. A mother's ability to support her sexually abused child is likely to be related to the emotional and physical resources that she has at the time o f the abuse disclosure. It is therefore important to explore the ways in which the disclosure o f intra-familial child sexual abuse affects the non-offending mother. Additionally, this knowledge will assist in targeting the mother's needs in therapy. Preliminary qualitative and quantitative studies suggest that mothers of children who were sexually abused are emotionally disturbed by the abuse o f their children (Carter, 1993; Hooper, 1992; Davies, 1995; Manion et al., 1996). There is a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3 lack o f knowledge, however, about the overall effects o f child sexual abuse on non- offending mothers and their ability to function in their roles as parents, partners and workers (Massat & Lundy, 1998). Similarly, risk factors that may intensify the effects o f child sexual abuse on non-offending mothers are largely unknown (Elliot & Carnes, 2001). Such risk factors may be a mother’s prior victimization o f childhood sexual abuse or her current victimization o f spousal abuse (Faller, 1989; Deblinger, Stauffer & Landsberg, 1994; Hiebert-Murphy, 1998). Mothers who are single parents and those who experience the removal o f children from their care as a result o f the child’s sexual abuse may also be at a greater risk o f disturbance in their psychological and emotional well being (Carter, 1993; Manion et al., 1996). This current gap in knowledge may seriously hinder professionals' efforts to assist sexually abused children and their families. For example, while many professionals believe that a child's sexual abuse disclosure and the aftermath affects MIAC, it is currently unknown how, in which areas, and to what extent MIAC are effected. Therefore, while professionals recognize that MIAC are often the only care giver who is available to assist in the recovery o f the child, how to assist MIAC to best perform this supporter role is unknown (Deblinger, Stauffer & Steer, 2001). Grounded in a feminist perspective, the purpose o f this study is to focus attention on non-offending mothers and to examine the effects o f intra familial child sexual abuse disclosure and its aftermath on various aspects o f their lives. This study therefore attempted to provide answers to the following questions: What are the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. effects o f a child's sexual abuse disclosure and the aftermath on the well being o f the non-offending mother? More specifically, this study will focus on the marital-familial, economic, occupational, social, parental and emotional- psychological effects o f child sexual abuse disclosure and its aftermath on the mother's life. This study additionally examined a few factors that may place some mothers at a greater risk of being negatively affected by the sexual abuse o f their children: mothers who are single parents, mothers who experienced sexual victimization in childhood, mothers who experience physical abuse by their spouses, and mothers who experience the removal o f their children from home as a result o f the child's sexual abuse. The population o f mothers examined in this study was defined as those mothers (biological or adoptive) who provided parental care to their intra familially sexually abused child/ren before and during the phase o f the disclosure o f the child's sexual abuse. Excluded from the study were foster mothers, mothers of extra familially sexually abused children, and mothers who did not provide direct parental care to the child at the time o f abuse and disclosure. Intra-familial child sexual abuse is defined in this study as one or more reported and investigated incidences o f sexual behavior that occurred between a male who is at least eight years older than the child and who is a family member (nuclear or extended, or a person who lived in the child's home and was treated as a family member) and a child who was younger than 18 years old at the time o f the assault. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 5 CHAPTER 2 REVIEW OF THE LITERATURE The Incestuous Family The incestuous family model is the theoretical model which is most known with regard to mothers o f children who were incestuously abused. While it has been seriously criticized in the last decade, it was, and to a lesser degree still is, most influential on practitioners, service providers and professionals in the field o f child sexual abuse ( Nakhle Tamraz, 1996; Crawford, 1999). It is therefore important to thoroughly review the model’s assumptions and the way it shaped the knowledge on MIAC. The incestuous family model is commonly described in clinical literature (Brooks, 1983; Cohen, 1983; Herman, 1983; Meiselman, 1978; Rist, 1979). At its core, the model views incest as a symptom o f family dysfunction resulting from generations o f inadequate mother-daughter relationships (Brooks, 1983; Justice & Justice, 1979). The "incestuous family" is believed to have a problem with boundary functions. It is seen as a relatively closed system with little input from its surroundings (Alexander, 1985) and no personal boundaries from within: Family members are merged or symbiotically bound together (Koch & Jarvis, 1987). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 6 The mother is often described as being ill, disabled, or absent from home (Herman & Hirschman, 1981), and as an immature, irresponsible, and inadequate parent (Cohen, 1983; Rist, 1979). As such, she either develops an overly close, symbiotic relationship (Browning & Boatman, 1977) or a detached, conflictual, and hostile relationship with her daughter (Brooks, 1983; Herman, 1983; Meiselman, 1978). In her marital relationship, the mother is seen as a sexually frigid and emotionally withdrawn partner (Cohen, 1983; Herman, 1983; Meiselman, 1978; Justice & Justice, 1979). She is believed to have a strong need to become a child again (Brooks, 1983; Justice & Justice, 1979); consequently, she retreats from her role as a mother, housewife, and sexual partner and delegates those responsibilities to her daughter (Cohen, 1983). The daughter becomes a parentified child and assumes the mother's role. This "role reversal" process is completed when father-daughter incest occurs (Rist, 1979). The father is described as an immature and dependent person (Waterman, McFarlane, Conerly, Durfee, & Long, 1986) who uses dominating, authoritarian, and abusive behaviors to control the lives o f other family members (Cohen, 1983). He is believed to suffer from unsatisfied emotional and sexual needs as a result o f the mother's dysfunction (Cohen, 1983; Herman & Hirschman, 1981; Rist, 1979). There are different descriptions o f the mother's exact role in the incest. Some emphasize her passivity, powerlessness, and lack o f ability to protect her child (Herman & Hirschman, 1981). Others hold her equally responsible because she is Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 7 believed to be consciously or unconsciously aware o f the incest but "colludes" by maintaining it as a family secret (Rist, 1979). Yet others believe that the mother is the real abuser because her sexual frigidity makes her husband turn to incest (Meiselman, 1978). The incestuous family model integrates components o f psychoanalytic theory and family systems theory. The influence o f the psychoanalytic perspective is particularly notable in the description o f the mother's psychopathology. The perceptions ofboth her maternal inadequacy and her emotional withdrawnness are derived from the psychoanalytic and psychodynamic literature on child development and child abuse (Browning & Boatman, 1977; Gordan, 1955; Kempe & Kempe, 1984; Reimer, 1940; Steel & Pollock, 1968). In addition, Freud's (1923) conceptualization o f the unconscious part o f the mind where "there reside the darkest wishes o f which mankind is capable" (Blanck & Blanck, 1994, p.4) provided a basis for the model's assumption that the mother unconsciously knows about and agrees to the incest. Family systems theory provides a foundation for the model by assuming that all families where incest has occurred exhibit similar dysfunctional patterns and by focusing on these patterns to explain the causes o f incest (Finkelhor, 1986). Concepts used in the model, such as 'boundaries' and 'role reversal', are also part o f the vocabulary o f family systems theory. The incestuous family model has had a strong influence on therapists, particularly family therapists (Kempe & Kempe, 1984; Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 8 Alexander, 1985; Wattenberg, 1985; Humphreys, 1994). Giarretto (1982) developed a well-known treatment model for working with families where incest has occurred. As part o f the treatment, mothers are asked "to accept their share o f responsibility for the conditions leading to the molestation" (p. 277) and to "convincingly tell the daughter that it was the mother's duty to protect her" (p. 273). In group work, similar aims were set (Hildebrand & Forbes, 1987) and group workers developed programs for enhancing the mother's parental skills based on the assumption that the child's sexual abuse indicated her poor skills in this area (Mara & Winton, 1990; Winton, 1990). Criticism o f the Incestuous Model In the last decade, the incestuous family model has been increasingly criticized by feminists and others for its value-laden assumptions regarding mothers of intrafamilially abused children (MIAC) (e.g., Bims & Meyer, 1993; Elbow & Mayfield, 1991; James & MacKinnon, 1990; Taubman, 1984; Wattenberg, 1985; Joyce, 1997; Crawford, 1999). The criticism is directed toward the assumed equal contribution o f each family member to the abusive dynamics, an assumption that overlooks power relations between family members (James & MacKinnon, 1990; Wattenberg, 1985). The assumption that father-daughter incest is indicative o f family dysfunction has also been criticized. In fact, Glazer and Frosh (1993) claim that a family can become dysfunctional because o f the incest. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. The model is particularly criticized in terms o f the assumed role o f the mother in the abuse (McIntyre, 1981; Dietz & Craft, 1980; Crawford, 1999). In stressing the mother's "contribution" to the abuse, her function as supporter, protector, and mitigator o f the abused child’ s trauma is overlooked. The incestuous family model is therefore believed to promote mother blaming (Elbow & Mayfield, 1991; Hooper, 1992; Joyce, 1997). Humphreys (1994) points to the fact that "literature and mythology portray a polarized view o f women: as madonnas and perfect mothers, or as witches and whores, bad mothers, and fallen women" (p. 53). Several studies have captured the ways in which professionals have been influenced by mother-blaming practices. Caplan and Hall-McCorquodale's study (1985) on mother blaming in major clinical journals revealed that in 125 articles reviewed, mothers were blamed for 72 different kinds o f psychopathology. A five- year follow-up study revealed that mother blaming was still very common, although a less obvious practice (Caplan, 1990). A study o f licensed psychologists indicated that they attribute a substantial amount o f blame to mothers for the sexual abuse o f their daughters (Kalicbman, Craig, & Follingstad, 1990). Deitz & Craft (1980) found that 78% of 200 child protective workers studied (Table 1, Appendix 2) believed that the mother gives her unconscious consent to incest, and 65% believed that she is equally responsible for the abuse. Child protective workers also tended to avoid recommendation for a father’s incarceration whenever they perceived the mother as responsible for the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 10 sexual abuse (Ringwalt & Earp, 1988). Professionals often view the mother as simultaneously an object o f blame for failing to protect her children, to control the perpetrator, and to safeguard her family, and as the subject o f hope for rescuing the victim (Nakhle Tamraz, 1996). The increased criticism o f the incestuous family model has had a growing impact on the field o f child sexual abuse. Some family theoreticians and therapists have partially revisited their perceptions so that overt mother blaming is less common, although it continues in more subtle forms (Caplan, 1990; Hooper, 1992; Joyce, 1997; Crawford, 1999). Overall, a new emphasis is being given to the recognition o f the perpetrator’s responsibility for his acts (James & MacKinnon, 1990). The incestuous model, however, was very influential in directing research concerning MIAC in the past 20 years. The following review o f empirical studies reveals the influence o f the model on the topics and the assumptions that were examined. Empirical Findings on Non-Offending Mothers In the last decade there has been a steady increase in empirical studies on mothers o f sexually abused children (both MIAC and mother o f extra familial abused child (MEFAC). This provides the opportunity for a comprehensive assessment of the empirical knowledge on MIAC. Reviewed here are studies that examined different aspects o f MIAC's characteristics. The studies were organized by the following emerging topics: MIAC's personality profile; family background; marital Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 11 relationship; reactions to the sexual abuse disclosure; support o f the abused child; and the effects of the child’s sexual abuse on the mothers. Table 1 (Appendix 2) presents information on the samples used, the informants, the measurements, and the results of the studies. It is important to note that while the incestuous model focuses on MIAC whose children were abused by a father or father-figure, research on MIAC did not restrict participants to this type o f abuse only, but rather used a broader group of MIAC whose children were abused by different family relatives. Personality Profile o f the Mothers The incestuous model describe the mother's personality as inadequate, immature, dependent, and emotionally withdrawn (Cohen, 1983; Rist, 1979). Eleven studies explored different components o f a mother's personality (Dadds, Smith, Webber, & Robinson, 1991; Dietz and Craft, 1980; Friedrich, 1991; Muram et al., 1994; Myer, 1985; Peterson, Basta & Dykstra, 1993; Salt, et al., 1990; Scott and Stone, 1986; Smith & Saunders, 1995; Wagner, 1991; Wilson, 1995; in Table 1). Dietz and Craft (1980) reported that 41% o f200 child protective workers evaluated MIAC as having a passive-submissive personality; 67% evaluated them as having low self- esteem; and 49% evaluated them as exhibiting depression. Dadds et a l, (1991) found that 47 MIAC did not differ significantly from 36 mothers o f a matched control group in terms o f their self esteem. Myer (1985) studied 43 MIAC and divided the mothers to three groups: borderline personality, dependent personality and narcissistic personality. She found a connection between the mother’s Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 12 personality type and her reaction to the child’s sexual abuse disclosure: mothers with borderline personality (11%) were immobilized by the disclosure; those with dependent personality (18%) tended to protect their daughters; and those with narcissistic personality (9%) tended to reject them. Salt et al., (1990) found that 25% o f MI AC had problems o f emotional lability; 21% exhibited submission; and 19% exhibited social withdrawal No significant differences were found between MIAC and MEFAC on these personality characteristics. The authors concluded that the majority o f MIAC and MEFAC did not exhibit overt psychopathology or serious emotional problems. Scott and Stone (1986) found that 44 MIAC studied did score higher than a comparison group on depression as well as on 11 out o f 13 MMPI scales. In addition, 18% o f MIAC were classified as code type 34/43 which is commonalty associated with dissociative phenomena. Nevertheless, their overall MMPI profile was not in the pathological range and did not differ from that o f the normal population. Similarly, Wagner (1991) found that 50% o f 32 MIAC studied exhibited at least moderate depression; however, no significant differences were found between MIAC, MEFAC, and a clinical outpatient control on this variable. Friedrich's study (1991) indicated that the MMPI results o f MIAC and the outpatient comparison group were significantly elevated on most scales in comparison to those o f a community control group. The code types o f personality profiles of MIAC were very heterogeneous. Two profiles, however, were commonly found in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 13 MIAC: the Spike 4 (18%), and 4-3/3-4 (18%). These profiles are associated with immaturity, egocentric, and aggressive behavior. Yet, MIAC as a group had an MMPI profile within normal limits for all clinical scales. In a comparison between 13 MIAC, 15 MEFAC and 12 community controls, no marked differences were found in personality characteristics (Peterson et al, 1993). Similarly, Muram, Rosenthal, & Beck (1994) found that 65 victims' mothers (both MIAC and MEFAC) did not differ from 65 control mothers in pathology. However, they were significantly more constricted and scored significantly lower on sociability than the comparison mothers. In Smith and Saunders' study (1995), 65 MIAC scored within the non-clinical range on the 16 Personality Factors Questionnaire. However, they scored significantly lower than norms on warmth, emotional stability, and impulsively and higher than norms on self-sufficiency. A minority o f mothers differed from norms on traits reflecting social inadequacy. No personality deviations were prototypical in MIAC, and the most common profile was the "normal" one. Wilson (1995) reported that a sample o f 21 MIAC participating in a therapy group scored at the mid-range of the ego development continuum, and that no link was found between the mother's level of ego development and her active or passive response to stopping the abuse. To conclude, the cumulative findings suggest that MIAC as a group resemble the normal population o f women and do not suffer from any overt psychopathology. There is also no evidence that MIAC as a group display a specific feature o f personality characteristics: some mothers exhibited submission, others exhibited Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 14 aggressive or immature behavior. It appears that the most prominent quality o f the personality of MIAC is diversity. Social withdrawal appears to be over represented in both MIAC and MEFAC mothers (Muram et al, 1994; Salt et a l, 1990; Smith & Saunders, 1995). This may reflect a personality trait or, as suggested by Carter (1993), it may be the result o f the mothers' shame in the abuse and their fear of society's blame and rejection. Problems o f depression and emotional stability also seem to be over represented. This too could reflect the mother's state prior to the abuse or be the results o f it. The finding that MEFAC exhibit depression and emotional lability to the same extent exhibited by MIAC suggests that the latter may be more likely. The results o f these studies do not seem to support further exploration o f MI AC's and MEFAC's psychopathology or personality profile. Such exploration is based upon the assumption that "something must be wrong with women that their children were sexually abused". This direction o f research resembles earlier research on battered women and seems to be part o f an attempt to search for women's fault as an explanation for abuse. The absence o f research on MIAC personality in the last five years may suggest that professionals have abandoned the idea that MIAC’s has a specific, uniformed personality. Mothers' Relationship With Parents in Childhood The mother in the incestuous family model is described as retreating from her role as a parent and the daughter becomes a parentified child (Cohen, 1983). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 15 There are no empirical findings that indicate a typical background o f inadequate parental care for MIAC. Three studies (Leifer et al., 1993; Myer, 1985; Salt et al., 1990) have indicated that a considerable percentage o f MIAC and MEFAC (40-50%) perceived relationships with their parents during childhood as poor. The absence of norms or comparison groups concerning parent-child relationships as perceived in adulthood limits the interpretation o f this finding. In addition, retrospective research such as the ones focusing on mothers' perception o f relationships with parents in childhood may be subject to memory distortions. However, a poor relationship with the mother or the mother's absence was found to be more prevalent among a subgroup o f MIAC who did not protect or support their sexually abused child (deYoung, 1994; Salt et al., 1990; Leifer et al., 2001; Myer, 1985). Connection between unhappiness in family relationships and childhood sexual abuse was explored by Finkelhor, Hotaling, Lewis and Smith (1990). They found that in a random national sample (n = 2,626), those adults who reported an unhappy family life in childhood were twice as likely to have been sexually abused before age 18 than those who reported happy family life in childhood. This finding, along with somewhat a higher prevalence o f sexual abuse found among both MIAC and MEFAC, suggests that reporting a poor relationship with parents may indeed be related to inadequate parental care. A recent study (Leifer et al., 2001) identified some factors in MIAC’s relationships with their own mothers as influential in MIAC’s provision o f support to their abused children. More specifically, troubled Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 16 intergenerational attachment relationships clearly distinguished the non-supportive MIAC from those who were supportive. In addition, non-supportive MIAC reported significantly more separations from their biological parents and less continuity of care. These findings do point in the direction that some MIAC experience poor parental care, discontinuity in the provision o f care by biological mothers and troubled relationship with parents during childhood. Moreover, it seems that few studies indicate that this history is related to a lack o f support and protectiveness among some MIAC toward their sexually abused child. However, it is important to note that only a subgroup of MIAC report such troubled history and that most MIAC , including some MIAC who experienced difficulty with parental care, do support and protect their sexually abused child. Therefore, the model’s generalization that MIAC suffer from generations o f distorted mother-child relationship is not supported. More empirical data on attachment behaviors and its effects on MIAC support and protection o f the child is needed. In addition, it is very important to assess the prevalence o f adults reports on troubled childhood relationship with parental figures and discontinuity o f care o f parental figure in the general population o f mothers. These data would provide a better basis for interpretations ofM IAC’s childhood experiences and their relations to their behaviors as parents to a sexually abused child. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 17 Mothers' Experience o f Childhood Sexual Abuse Fourteen studies assessed the prevalence o f childhood sexual abuse among MIAC and MEFAC (Carter, 1993; Deblinger et al., 1994; Faller, 1989; Friedrich, 1991; Goodwin, McCarthy and DiVasto, 1981; Heriot, 1996; Hiebert-Murphy, 1998; Leifer et al., 1993; Morrison & Clavenna-Valleroy, 1998; Myer, 1985; Sagatun, 1990; Salt, 1990; Smith & Saunders, 1995; Wilson, 1995). The incidence o f child sexual abuse history among MIAC and MEFAC in these studies ranged from 20% to 75% (Goodwin et al., 1981; Friedrich, 1991). However, when examining the prevalence of childhood sexual abuse among MIAC and MEFAC in larger samples (n>50) only, the incidences o f sexual abuse ranged between 40% to 50% (Deblinger et aL, 1994; Faller, 1989; Leifer et al, 1993; Salt et al., 1990). These reported incidences o f sexual abuse among MIAC and MEFAC are not much higher than those obtained by Russel (1983) in her study o f a random group of adult women. She found that 16% had a history o f intra familial sexual abuse and 31% had a history o f extra familial sexual abuse before age 17. Finkelhor et al., (1990) in a nationally representative sample found that 27% percent o f adult women experienced extra familial sexual abuse in childhood and 2% had a history of father/stepfather sexual abuse. In comparison to the findings ofFinkelhor's nationally representative study, MIAC and MEFAC seem to exhibit a higher percentage of sexual abuse history than other adult women (29% verses 40-50%). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 18 The figures found in random and representative samples may, however, be an underestimation of the actual prevalence o f sexual abuse in the general population (Russell, 1983). For example, Finkelhor et al. (1990) found that reported rates of sexual abuse history for men and women were much higher in the West, and particularly in California (42% for women). The authors suggest that more knowledge and exposure to information about sexual abuse may help respondents to be more open in disclosing sexual abuse history. It is possible that the mothers' exposure to their children's sexual abuse helped the mothers remember their own abusive experience and/or feel more comfortable in disclosing it. In addition, reported rate o f sexual abuse are likely to be influenced by the methodology used for data collection. Hiebert-Murphy (1998), for example, explains the high rate (74%) of sexual abuse history among MIAC and MEFAC in her sample as a result o f using face-to-face interviews, a method that was shown to result in higher rates o f self- reported abuse (Russell, 1984). Faller (1989), however, suggests that the findings regarding the mothers' high rates o f sexual abuse in childhood indicate an inter- generational transmission o f sexual abuse. However, methodological flaws in most of the studies reviewed limit the understanding o f these findings. For example, in most studies no operational definition was given o f a "mother's history o f childhood sexual abuse". Moreover, there was no indication whether the mothers were extrafamilially or intrafamilially abused, and in all studies non-probability samples were used. Thus, at this point, it seems that there is not enough evidence to conclude that incest is Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 19 mter-generationally transmitted, especially because mechanisms o f such transmission were neither described nor theoretically explained. Deblinger et al., (1994), Heriot ( 1996), Leifer et al, (2001), Salt et al. (1990), and Wilson (1995) explored whether there is a connection between the mother's response to her child's sexual abuse and her own history o f sexual abuse. In all these studies, the findings indicate no connection between mother's response to the child's abuse and her own background of sexual abuse. Friedrich (1991) did find that MIAC with a history o f childhood sexual abuse differed from MIAC without such a history in that they displayed significantly more anger, familial discord, alienation, and depression. On the other hand, Morrison & Valleroy (1998) found that MIAC with CSA history were perceived by their daughters as more supportive than MIAC without CSA history both at disclosure and at the 3- month follow-up. Some differences between MIAC with/without CSA history were also indicated by Deblinger et al. (1994) and Hiebert-Murphy (1998). Both studies found that MIAC with CSA history felt significantly more emotionally distressed and lonely than MIAC and MEFAC without such a history in the aftermath o f their child’s abuse disclosure. To conclude, the data available so far do not provide sufficient ground to conclude that sexual abuse is inter-generationally transmitted through the mother’s family of origin. A more systematic investigation is needed to conclude if and how such transmission occurs. In addition, the vast majority o f studies did not point to a connection between MIAC’s history o f CSA and her response to her child’s sexual Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 20 abuse. The assertion that families where intrafamilial sexual abuse occur are characterized by inadequate mother-daughter relationships is not supported by the findings about MIAC’s responses to their sexually abused child. Mothers' Patterns o f Familial Marital and Sexual Relationships The incestuous family model provides a specific set o f characteristics o f the family in which incest occur. According to the model, the incestuous family exhibits dysfunctional marital and sexual relationships. The mother is a sexually frigid and emotionally withdrawn partner and the father is an authoritarian, abusive and dominating figure. He uses abusive behaviors towards other family members in order to control them (Meiselman, 1978; Justice & Justice, 1979; Cohen, 1983). He is also believed to suffer from unsatisfied emotional and sexual needs as a result o f the mother’ s dysfunction (Cohen, 1983; Herman & Hirschman, 1981; Rist, 1979). Six studies examined marital and sexual relationships among families where incest occurred (Dadds et a l, 1991; Dietz & Craft, 1980; Lang, Langevin, Van Santen, Billingsley & Wright, 1990; Martinez, 1991; Sagatun, 1990; Smith & Saunders, 1995; in Table 1). Dadds at al. (1991), in a study o f incest families and a comparison group, found no significant differences in marital adjustment as reported by either partner. Martinez (1991), on the other hand, found that in families where incest occurred, both partners expressed high dissatisfaction in their marital and sexual relationship. Similarly, Lang et al. (1990) found that father-offenders reported Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 21 being significantly less satisfied in marital relationships than fathers in a comparison group. No significant differences were found in their sexual satisfaction in marriage, the frequency o f coitus, or the range o f sexual behaviors experienced with their wives. These findings suggest that mothers whose children were incestuously abused may experience unhappy marriages; however, sexual frigidity may not be the reason for this dissatisfaction. Smith and Saunders (1995) found no evidence o f a prevalence of dominant- submissive pairings in the relationships o f 65 father-offenders and their wives. Mothers and father-offenders tended to associate with partners who had similar personality traits. The hypothesis that families where incest occurs lack role differentiation and clear boundaries was not supported. Members of these families perceived their family as more organized and structured than comparison family members (Dadds et al., 1991). Further, the hypothesis that these families exhibit more conflict and less independence was not supported. However, families where incest occurred were characterized by lower cohesiveness, a lack of openness in the expression o f feelings, and emotional withdrawal (Dadds et al., 1991; Sagatun, 1990). These characteristics may or may not be the result o f the sexual abuse disclosure. Domestic violence provides an additional indication o f the marital relationship. Dietz and Craft (1980) reported that child protective workers estimated the rate of wife battering among mothers o f children who were incestuously abused at 78%. Two empirical studies indicate that between 39% to 61% o f the mothers studied were Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 22 battered by their spouses (Deblinger et al., 1994; Salt et al., 1990). While there is a difference in the percentage of wife battering reported in these two studies, it seems clear that a considerable proportion o f MIAC and MEFAC may indeed be in particularly vulnerable situations, where their own physical victimization in marriage is coupled with that o f their sexually abused children. Recently, these situations of multiple victims in a family began to receive attention especially with regard to the mother’s ability to protect herself and her children (LaViolette & Barnett, 2000; McCluskey & Hooper, 2000). Studies o f wife battering suggest that common characteristics identify violent relationships (Bradbury, 1998; Margolin, Geeberman, John, & Ransford, 1987; Stets, 1990; Saunders, 1995; Vivian & O'Leary, 1987; Walker, 2000). Couples in which violence occurs in their relationship were found to exhibit low dyadic adjustment and more conflictual interactions in comparison to non-violent couples (Davies, Lyon & Monti-Catania, 1998; Dutton, 1992; Ellis, 1996; Eisikovits, Guttmann, Sela-Amit, & Edleson, 1993). These couples were also found to exhibit more negative affects such as facial expression o f anger and raised voices in situations requiring problem solving. Additionally, they were also less assertive toward each other, less skilled in problem solving strategies and less likely to reach an agreement in conflicts (Bradbury, 1998; Erel & Burman, 1995; Margolin et al., 1987; Murphy & O’Leary, 1989). Violent couples also express less love, more distance, and even hatred toward each other in comparison to non-violent couples (Baker, Parilla & Norris, 2001; Dutton, 1992). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 23 Given the paucity o f empirical findings regarding marital relationships among MIAC, it is too early to conclude that incestuous families do exhibit a unique familial pattern. However, the studies reviewed here do not support assumptions regarding MIAC being passive or sexually frigid. There is support for the assumption that as a group MIAC do not enjoy a satisfying marriage relationship and that many o f them are likely to be victims of spousal violence. The effects o f child sexual abuse on those mothers who are physically abused in marriage has not been studied. Given that many MIAC are battered women, it is important to determine whether battered MIAC experience greater difficulties emotionally and/or socially than MIAC who are not victims o f spousal violence. Patterns o f Mothers' Reactions to the Disclosure o f Abuse Much o f the research on mothers o f children who were sexually abused has focused on the issues o f whether mothers knew and colluded in the abuse o f their child (Joyce, 1997). Other questions that have been examined are concerned with whether mothers believe their children and offer them support and protection once the abuse is disclosed (Elliott & Carnes, 2001). Mothers’ knowledge o f abuse: Empirically, it is impossible to examine the incestuous family model's propositions o f unconscious knowledge or use o f a denial as defense mechanism. Three studies (Carter, 1993; deYoung, 1994; Myer, 1985) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 24 examined the mothers' knowledge o f the child's sexual abuse prior to disclosure. The majority o f mothers reported that they did not know about this abuse. Ten to 12% of mothers knew and did not report to authorities (Myer, 1985; deYoung, 1994). No empirical study examined this specific subgroup o f mothers. The accounts o f two mothers who knew and did not protect the child reveal women who perceived themselves as extremely powerless (deYoung, 1994). Some attempts have also been made to explain why most mothers do not find out about the sexual abuse o f their child. Elbow & Mayfield (1991) suggest that women are expected to trust their man; therefore, they do not have reasons to suspect that a father would harm his child. In addition, offenders use a variety of manipulative acts to keep the abuse a secret, including creating psychological barriers between the child and the mother (Berliner & Stevens, 1982; Leberg, 1997; Russell, 1986). Moreover, children experience great difficulty in telling because they fear the consequences o f their act (Berliner & Conte, 1995; Leberg, 1997). Mothers’ belief in the abuse allegations: Findings o f 13 studies (Carter, 1993; Deblinger et al., 1994; deYoung, 1994; Elbow & Mayfield, 1991; Heriot, 1996; Myer, 1985; Leifer et al., 1993; Lovett, 1995; Pellegrin & Wagner, 1990; Salt et al, 1990; Sirles & Frank, 1989; Wilson, 1995) concerning mothers’ belief in the child's allegations suggest that most mothers believed their child. The percentage o f mothers found to believe ranged from 56% to 95% (Pellegrin & Wagner, 1990; Carter, 1993). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 25 These variations could be attributed to the common use o f small, clinical samples as well as to exploration o f different groups o f non-offending mothers (e.g., mothers from child protective services vs. mothers from clinical settings). They may also reflect differences in the specific questions that were asked. deYoung (1994), for example, asked about the mother's immediate belief at the time o f disclosure. Believing, however, is described as a process in which the final decision does not always correspond with the mother’s initial reaction (Hooper, 1992). When researchers examined whether the mothers believed at least some aspect o f their children’s allegations the results indicated that 84% o f mothers believed (Elliott & Carnes, 2001). Thus, methodological differences in the way and the timing in which maternal belief was assessed may have contributed to the differences obtained in these studies. Maternal belief was found to be related to a variety o f factors such as the mother’s relationship to the offender (mothers believed most when the offender was a relative, less when he was the biological lather, least when he was a stepfather); the child’s age (mothers believed younger children more than adolescents); the mother's proximity to where the abuse took place (mothers didn't believe the abuse happened when they were in the home); and the nature o f the abuse (mothers believed less when the abuse involved genital-genital contact) (Heriot, 1996; Sirles & Franke, 1989). However, a recent study which re-examined a variety o f factors related to maternal Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 26 belief, including those related to the child’s age, severity o f the abuse, mother’s background and relationship with offender, found only four predictors to be significantly associated with the mother’s belief and protectiveness. Specifically, mothers were more likely to believe and protect the child when they were not a current sexual partner o f the offender, when they postponed giving birth the their first child until reaching adulthood (21 years), when they did not know about the child sexual abuse before official disclosure and when the victimized child did not exhibit sexualized behaviors (Pintello & Zuravin, 2001). The status o f the person that discloses the abuse to the mother (children versus professionals) and the terminology used to describe the abuse also affected the mother's belief (Elbow & Mayfield, 1991). However, no significant differences were found in the percentage o f MIAC who believed the allegation when compared to MEFAC, or between MIAC with history o f childhood sexual abuse and those without (Salt et al., 1990). In conclusion, most MIAC and MEFAC, whether or not they had been subjected to childhood sexual abuse themselves, did not know about the abuse prior to official disclosure and once they learned about it believed their child. Thus, the incestuous model description o f the mother as colluding in the abuse is not supported by findings on maternal knowledge and belief in the abuse allegation. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 27 Mothers’ actions to protect abused child: Ten studies examined the mothers' actions to protect their children once the abuse was disclosed (deYoung, 1994; Elbow & Mayfield, 1991; Faller, 1988; Heriot, 1996; Leifer et al., 1993; Myer, 1985; Pintello & Zuravin 2001; Sagtun, 1990; Salt, et al., 1990; Wilson, 1995; in Table 1). The findings revealed that once abuse was disclosed, mothers took protective actions. However, a great variation exists in the percentage o f mothers who are reported as protective. Sagatun (1990) found that information regarding a mother's protective acts may vary according to different informants. Victimized girls indicated that the mother was the one who reported the abuse to the police in 8% o f the cases. The offenders, similarly to the mothers, indicated that the mother was the reporter in 33% o f the cases. Differences in what is defined as a "protective act" may also contribute to discrepancies among studies. For example, Elbow & Mayfield (1991) provide statistics o f women who disclosed the abuse to a child protective worker. Heriot (1996) defined protectiveness as a mother's acts to separate herself and the child from the perpetrator. Pintello & Zuravin (2001) included only mothers who both protected and believed the allegation although some mothers protect however, did not believe the allegation. Salt et al. (1990), as well as Myer (1985) and deYoung (1994), considered a much wider range o f protective acts, such as removal o f the abuser from the home and taking the child to therapy. Faller (1988) found that there was a significant difference in the mother's protection o f the child according to her relationship with the offender: divorced mothers provided the best protection in cases Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 28 o f abuse by noncustodial fathers. Less protection was offered when the offender was a stepfather, and the least amount o f support was offered when the offender was a biological father and married to the mother. Similarly, Heriot (1996) found that mothers who felt warmly toward and accepting o f the perpetrators were significantly less likely to support their children and take a protective action on their behalf than mothers whose feelings toward perpetrators were rejecting and hostile. Pintello & Zuravin (2001) found that MIAC were significantly more likely to protect the child when they were not in a sexual relationship with the offender. However, it is interesting to note that maternal belief and maternal protectiveness do not always coincide. Not all (but most) mothers who believed the child took actions to protect. Moreover, half o f those MIAC who had ambivalent feelings toward the offender and toward believing the child did actively protect their child (Heriot, 1996; Pintello and Zuravin, 2001). To conclude, the findings suggest that most MIAC provide protection to their abused children. However, “mother’s protection” vary considerably according to who the informant is and how protective actions are defined. Studies suggest that maternal belief is an indicator for maternal protectiveness, however, protectiveness could not be accurately predicted by maternal belief. The one single finding that consistently appears to be significantly related to maternal belief and protectiveness is her relationship with the offender. Mothers find it most difficult to believe that their Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 29 intimate partner has molested their child. Perhaps because o f the dramatic contradiction between what the disclosure revealed o f their partner and what they perceived him to be. Mothers' Support and Their Child's Recovery Findings indicate that a maternal level o f distress is significantly associated with the victimized child's level o f fear and anxiety (Hanson, Saunders, & Lipovsky, 1992). In addition, the mother's support o f her child plays a key role in the child's post-abuse adjustment (Conte & Berliner, 1988; Everson et. al, 1989; Friedrich, 1990). Sexually abused children who are not supported by their mothers are considered to be at risk and could be removed from the home (Conte & Berliner, 1988; Leifer, et al., 1993). Those who are supported by their mothers show less psychological symptomatology and better psychological functioning (Deblinger, Steer & Lippman, 1999; Everson et al, 1989; Leifer et al., 1993; Leifer & Shapiro, 1995). Lovett's study (1995) indicates that the more warmth and acceptance the child receives from her mother, the higher the child’s level o f overall competency. Eleven studies examined mothers' support o f the sexually abused child (Deblinger et al., 1994; Everson et al, 1989; Esparza, 1993; Faller, 1988; Heriot, 1996; Leifer, et al., 1993; Leifer & Shapiro, 1995; Leifer et al 2001; Lovett, 1995; Myer, 1985; Salt et al., 1990; in Table 1). Findings suggest that 90% o f mothers whose children were sexually abused expressed concern for their child (Salt et al., Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 30 1990), and most o f the mothers studied supported their child (Everson et al., 1989; Esparza, 1993; Deblinger et a l, 1994; Heriot, 1996; Leifer et al, 2001). Ninety-one percent o f 60 abused girls perceived their mothers as warm and supportive (Lovett, 1995). Interestingly, professionals in some studies assessed the mothers' support as considerably lower than that reported by these abused girls (Leifer et al., 1993; Lovett, 1995). No significant differences were found in the provision o f maternal support in a comparison between mothers whose children were sexually abused and a comparison group of mothers from clinical settings (Esparza, 1993), and no significant differences were found in three studies that compared maternal support between MIAC and MEFAC (Lovett, 1995; Deblinger et al., 1994; Salt et al., 1990). Further, Lipovsky, Saunders, & Hanson (1992) found no significant differences in the relationship of MIAC with their victimized child in comparison to their relationship with their other children. Similar to findings on maternal belief and protectiveness, Everson et al. (1989) found that maternal support was significantly related to the mother's relationship with the offender: divorced mothers were most supportive; mothers married to offenders were less supportive; and those who had a recent relationship with boyfriends/offenders were least supportive. However, the studies that compared maternal support among MIAC and MEFAC did not support a connection between maternal support and maternal relationship with the offender (Deblinger, 1993; Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 31 deYoung, 1994). Elliott and Cames pointed to the fact that there were many differences in how and by whom maternal support was assessed across studies, as well as in the classification o f maternal relationship with the offender and in the classification o f the sexual abuse as incest versus non-incest abuse (2001). The abused child’s age and gender were also examined as possible factors related to maternal support. Findings in these areas are also preliminary and inconsistent. For example Everson et al. (1989) found that adolescents received more support than younger children. Heriot (1996), however, found that adolescents were offered less protectiveness and support than younger children. Findings by Leifer et al. (1993 and 2001) suggest that maternal substance abuse, poor social support, and inconsistency in providing care for the child during early childhood may also be related to a provision o f little support to the child after disclosure. More explorations in these areas are needed for establishing significance. Overall, the results indicate that the majority o f MIAC and MEFAC are supportive o f their abused child. Thus, the findings contradict the incestuous model portrayal o f a cold, rejecting, and hostile mother. However, all studies documented that some mothers do not support their children and that there are factors, which are not related to the mother's personality, that may influence her ability to support her child. It is still unclear which factors consistently influence maternal support. Yet, it seems that mothers who need to choose between believing two loved ones experience greater difficulty in providing support for their abused child than those who do not. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 32 The area o f maternal belief protectiveness and support seems to receive great attention from researchers. These three dimensions are not only inter-related as has been seen in reviewing the literature, but also, they each represent a construct which requires a theoretical basis and adequate measurements. Most studies did not spell out when, what and how each construct was measured. Given the importance of maternal support to the child, it seems necessary to improve research methodologies in this area. The Incestuous Model: Conclusions The incestuous model's portrayal o f MIAC received much criticism none of which was based on a systematic examination o f the empirical foundation o f the model's assumptions. The above analysis o f studies revealed that the central piece of the model, the portrait o f the incestuous, collusive mother, has no empirical foundation. MIAC as a group were found to have a normal, non pathological personality profile and to exhibit a variety o f personality characteristics. MIAC did not significantly differ from MEFAC in all characteristics examined. More specifically, findings do not support a portrayal o f MIAC as being more pathological than other mothers or as having a passive-submissive personality. The hypothesis that MIAC neglect their role as wives was not examined directly in any o f the studies. However, some MIAC and MEFAC do seem to have had unhappy childhood, unhappy marriages and, in fact, be at risk o f physical abuse. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 33 However, these difficulties were not yet proved to be specifically related to MIAC. The dilemma o f siding with either the abused child or the offending spouse appears to affect MIAC's belief and support o f their child. It also may suggest that MIAC are not uncaring or emotionally detached from their family members. Considering the findings that many MIAC and MEFAC report difficulties in childhood (poor relationship with, and absence o f parents, and somewhat high rates o f child sexual abuse), and their present difficulties (unhappy marriage and physical violence), it is not surprising that MIAC exhibit high rates o f depression and distress (although these could be a reaction to their child’s sexual abuse disclosure rather than precede the abuse). What appears to be remarkable is that in the face o f all these difficulties, the majority o f both MIAC and MEFAC functioned so well in the crisis evoked by their child sexual abuse disclosure: most believed the child's allegation o f abuse, most took a variety o f protective actions, and most provided emotional support to their child. These findings do not provide empirical grounds for the hypothesis that MIAC as a group are colluding, hostile mothers. The incestuous family model's portrayal o f mothers is therefore found to be not supported. These conclusions, however, should be viewed with caution because o f the relative newness o f this field o f research and the many issues that were addressed only by a few empirical studies. In addition, many studies had flawed methodology as will be further explained in the discussion of the research limitations. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 34 Interestingly, the incestuous model which specifically targeted one o f the least common forms o f childhood sexual abuse (according to Finkelhor et al., 1990, father/step-father and daughter incest account for 2% only o f all child sexual abuse cases) gained so much attention by professionals and clinicians (Crowford, 1999; Joyce, 1997). Even more compelling is the fact that so much research focused on issues that are derived from the model’s assumptions on the mother’s personality, childhood background, relationships and functioning in the aftermath o f the abuse disclosure despite the fact that the model was criticized for its value laden assumptions. Even research which explored the provision o f support to the child focused on the mother’s role while ignoring the roles o f fathers, siblings, extended family, teachers and peers. Thus, the exclusive focus on mothers’ belief in the abuse allegation, her protectiveness and her provision o f support to the abused child is perhaps creating new myths about her overwhelming importance in the child’s recovery. Moreover, the focus on MIAC characteristics and on her functioning as a mother have delayed and limited research on the effects o f the child’s abuse on her well-being. The Effects o f Child Sexual Abuse on Non-Offending Mothers It has been previously noted that little is empirically known about the effects o f child sexual abuse on non-offending mothers (Davies, 1995; Dejong, 1986; Newberger, Gremy, Watemaux & Newberger, 1993). While there are growing Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 35 indications that parents o f sexually abused children suffer from emotional difficulties that are associated with the disclosure o f their children's sexual abuse (Elliott & Carnes, 2001; Newberger et al., 1993), it is not clear whether all mothers are affected by their child's abuse to the same extent or the ways in which their child's sexual abuse might affect them Further, it is unknown whether the effects o f child sexual abuse on MIAC differ from those experienced by MEFAC. Regehr (1990) describes the effects o f extra familial sexual abuse on both parents o f 33 abused children as profound. Based on clinical observations, she reports that parents experience conflicting feelings ofblame, shame, anger, and pity toward themselves, the abused child, and the offender. Further, parents had difficulties dealing with the investigation process and the court system It is unknown whether the parents' gender made any difference in terms o f the difficulties they experienced. Two qualitative studies described difficulties experienced by MIAC and MEFAC. Hooper's study (1992) consisted o f 15 MIAC and concentrated on the mothers' processes o f "surviving" their children's sexual abuse. Carter's study (1993) included 24 MIAC and MEFAC and concentrated on refuting the myth that mothers knew about their child's abuse, and on the impact o f the abuse disclosure on them In both studies, the mothers described themselves as experiencing shock, numbness, shame, guilt, confusion, anger, and sadness. They felt blamed for the sexual abuse o f their children, and perceived the institutional response as mostly punitive and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 36 disrespectful. Further, they indicated that the abuse disclosure triggered a breakup in their social contacts and in their relationships with members o f their families. These findings receive support from studies that employed quantitative methodology. Lewin & Bargin (2001) found that in comparison to control groups, non-offending mothers o f sexually abused children experienced significantly more anxiety and heightened depression. Similarly, Peterson et al. (1993) report that 27 MIAC and MEFAC exhibited significantly greater distress than 13 mothers in a comparison group. MIAC and MEFAC were preoccupied with bodily dysfunctions, suffered from low energy and guilt, and exhibited self blame. Further, they exhibited suspiciousness, rejection, anxiety, depression and feelings o f worthlessness. Davies (1995) reports that 30 fathers and mothers o f extrafamilially abused children experienced high levels o f distress, depression, PTSD, anger, loss o f trust in others, loss of significant relationships with friends, marital dissatisfaction, and negative changes in the relationship with the victimized child. Regardless o f the child's recovery, the parents followed their own path to recovery. In a one-year follow-up assessment, some mothers still exhibited major difficulties while their children were already adjusted. Newberger et al. (1993) report that in their sample o f 46 MIAC and MEFAC, the mothers experienced extensive emotional distress following the disclosure o f the sexual abuse o f their children. Over a course o f a year, maternal symptoms declined almost to normal suggesting that the mothers' distress derived from the sexual abuse Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 37 o f their children. A quarter o f the sample (12) still remained at clinically significant levels on the General Symptom Index sub-scales o f depression, somatization, interpersonal sensitivity and hostility. The authors concluded that mothers o f sexually abused children should receive a clinical evaluation and be offered therapy. This conclusion seems especially advisable, since in five different studies at least some MI AC and MEFAC were diagnosed as suffering from PTSD (Davis, 1995; Green et al., 1995; Manion et al., 1996; Newberger et al., 1993; Regehr, 1990). It is unknown, however, whether there are any commonalities among those mothers who were diagnosed with PTSD. The consistency o f the findings reviewed indicate that a child's sexual abuse disclosure and its aftermath produce psychological and emotional difficulties for non offending MIAC and MEFAC. These mothers seems to be suffering from symptoms associated with secondary victimization (Hooper, 1992; Manion et al, 1996). Two follow-up studies suggested that mothers go through a recovery process (Davis, 1995; Newberger et al., 1993), thus, supporting Myer's (1985) notion that MIAC and MEFAC experience loss and grief. Some MIAC and MEFAC seem to experience greater difficulties than others. It is important to examine if specific subgroups of MIAC and MEFAC are more likely to experience more difficulties than others given their vulnerable situation. For example, mothers who are single parents may experience more difficulties in handling the aftermath o f their child’ s sexual abuse in comparison to mothers from two parents families. Mothers whose children were Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 38 detained by Child Protective Services (CPS) after disclosure may also experience more difficulties than mothers whose their children remained home. These hypotheses have not yet been explored. Other groups o f mothers who may experience greater difficulties in coping with their child’ s sexual abuse disclosure and aftermath are those who have a child sexual abuse (CSA) history and those who have been battered. Previous studies on battered women and women with CSA history indicate that these groups o f women may be ina more vulnerable situations. Effects on Mothers with Child Sexual Abuse History Studies MIAC and MEFAC indicate that a fairly large percentage (40-50%) o f them have a CSA history (Deblinger et al., 1994; Faller, 1989; Leifer et al, 1993; Salt et al., 1990). Studies on adult survivors o f CSA reveal a variety o f mental health problems that are associated with the experiences o f sexual abuse in childhood (Beitchman et al., 1992; Briere & Runtz, 1988; Kendall-Tackett et al., 1993). Adults with CSA history are often described as suffering from PTSD. Briere and Runtz (1988), however, claim that a PTSD diagnosis does not accurately describe their symptomatology. They use the term "post-sexual abuse trauma" to emphasize that the victims suffer from symptoms of PTSD combined with self-destructive behavior, personality disorders, sexual dysfunction, dissociation, and proneness towards substance abuse and re-victimization. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 39 Neumann (1994) attempted to classify the many long term symptoms found among CSA survivors into five major categories. The first category groups together affective disruptions, such as difficulties in managing and tolerating strong affect. Adults with CSA history were found to use denial or avoidance o f strong feelings. Alternatively, these individuals may become flooded by affect intrusions. Affective disruption may also take the form o f numbing emotions or re-experiencing events or affects. The most troubling affects that reappear in CSA survivors are anger, anxiety, and depression. Dissociative defenses, obsessions, and somatization were also linked to affective disruptions (Briere & Runtz, 1988, Springs & Friedrich, 1992). The second category groups together interpersonal disturbances. Adults with a history o f CSA often exhibit difficulties in establishing and maintaining intimate relationships. They may experience difficulties trusting others, feel socially inadequacy and choose to live in relative isolation. A disruption o f sexual expression, including avoidance of sex, or a general feeling of sexual dissatisfaction, is common among adults with CSA history. They may also exhibit a tendency for re victimization and consequently may become victims o f rape and/ or wife battering (Briere & Runtz, 1987, Houskamp & Foy, 1991; Wyatt, Gutrie, and Notgrass, 1992). The third group o f symptoms includes indications o f developing an altered frame of reference: adults with a CSA history may adopt an overall pessimistic world view. They may also experience difficulties integrating femininity into their identity. The fourth group o f symptoms include distortion in self perceptions. Adults with a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 40 history o f CSA may experience intense self loathing (Briere, 1989), poor self esteem, severe self criticism, and a tendency to feel shame and guilt (Bagley & Ramsay, 1986). The fifth category includes behavioral indications o f a tendency toward suicide, self mutilation and substance abuse (Briere & Runtz, 1986). Given the many long term difficulties associated with a history o f CSA, it is likely that at least a portion o f MIAC and MEFAC with CSA history suffered, prior to their child's sexual abuse disclosure, from one or more mental health difficulties as a result o f their CSA experiences. In addition, the sexual abuse o f a child is likely to evoke intrusive memories in mothers with CSA history. Re-experiencing the trauma through intrusive memories or flashbacks may result in developing PTSD. However, the sexual abuse o f one's child is not yet recognized as a precipitant o f PTSD (Green et al., 1995). Results regarding the connection between maternal CSA history and greater distress in the aftermath o f their child’s sexual abuse disclosure are not conclusive. Two studies indicate a greater effect o f child's sexual abuse disclosure on these mothers. Deblinger et al. (1994) compared 83 mothers with a history o f CSA with 100 mothers without CSA history. The groups did not differ significantly in their demographic makeup, substance abuse, medical difficulties, exposure to domestic violence or in their support o f their abused child. The only perceivable difference was that mothers with a history o f CSA reported significantly higher levels o f distress and felt more alone in facing the crisis resulting from the abuse o f their child. Friedrich Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 41 (1991) found similar results in his sample o f 37 non-offending mothers. Mothers with CSA history differed from those without such history in that they displayed significantly more anger, familial discord, alienation, and depression. However, a recent study (n= 38) that compared MIAC with/without child sexual abuse history detected elevated scores o f both groups on depression and anxiety, but failed to distinguish between the groups in self reports o f depression, state or trait anxiety. The authors suggested that the initial impact o f the child’s disclosure and the investigation may have override any effect o f the mothers’ own past history (Lewin & Bergin, 2001). However, it is also possible that the small sample limited the comparison. Mothers who never disclosed and/or resolved their own sexual abuse may be in particular danger o f experiencing a crisis as a result o f their child's sexual abuse disclosure. A case-study o f four mothers with undisclosed history o f CSA found that they experienced a flood o f intrusive memories and a re-experiencing of the painful effects o f their own childhood molestation. All four were diagnosed as suffering from PTSD and three became suicidal (Regehr, 1990). To conclude, in light o f these preliminary and inconclusive findings regarding greater distress among mothers with a CSA history, and given what is already known about the long terms effects o f CSA on adults survivors, it is important to further investigate the effects o f child sexual abuse on mothers with a CSA history. Some improvements in the design o f studies may be o f particular value. First, it is important Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 42 to clarify the exact nature o f "childhood sexual abuse history". Secondly, it is necessary to find out what portion o f these mothers revealed their sexual abuse during childhood and whether they received treatment aimed at resolving their traumatic experiences. Further, it is important to determine what long-term symptoms mothers with CSA history experienced prior to their child's sexual abuse disclosure. Finally it is important to describe exactly how the child's sexual abuse impacted these mothers compared to mothers without a history o f CSA. Effects on Mothers With Battered Women History One group of mothers that deserves researchers' attention is battered women who are also the non-offending mothers o f sexually abused children. Child protection workers believe that about three quarters o f all MIAC are battered women (Dietz & Craft, 1980). Empirical findings o f two studies indicate the percentage o f battered women among mixed groups o f MIAC and MEFAC to be between 39 to 61% (Deblinger et al., 1994; Salt et al., 1990). However, the effects o f child sexual abuse on mothers who are battered women has never been addressed. Similarly, there is a lack o f knowledge regarding battered women's ability to support and protect their sexually abused children. There are reasons to believe that battered women whose children are sexually abused experience greater difficulties in handling the aftermath o f the child’s sexual abuse disclosure in comparison to mothers who are not battered. Typically, physically abused women also suffer from emotional and psychological Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 43 abuse (Walker, 2000). They may also be the victims o f sexual assaults and rape by their abusive partners (Finkelhor & Yllo, 1992; McCluskey & Hooper, 2000). Battered women are often subject to threats of harm to themselves and their children (LaViolette & Barnett, 2000; Tolman, 1992; Walker, 2000). Often, they report being subject to ridicule and verbal harassment, possessive and jealous behaviors, and behaviors intended to isolate them from social support (McCluskey & Hooper, 2000; Follingsted et al., 1990; LaViolette & Barnett, 2000; Tolman, 1992). They also experience serious assaults that require medical attention and may even result in death (Browne, 1992; Campbell, 1995; Walker, 1991). The psychological effects o f battering are well documented. Research on battered women reveals that physical abuse instills fear in the victim and creates dependency on the abuser. Battered women often take responsibility for the abuse; they blame themselves for being abused, for staying in the violent relationship, and for exposing their children to violence in the home (Acerman and Pickering, 1989; Astin et al., 1995; Barnett, Martinez & Keyson, 1996; Miller & Porter, 1983; O’ Neill & Kerig, 2000). Battered women are often ashamed o f themselves and their situation, (Thome-Finch, 1992). Battered women in shelters and in the community often exhibit anxiety, depression and suicidal ideation (Cascardi & O'Leary, 1992; Kemp, Green & Hovanitz, 1995). Many have been found to meet the diagnostic criteria for PTSD (Astin, Lawerence and Foy, 1993; Kemp, Rawlings and Green, 1991; Kemp et al., Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 44 1995; Walker, 2000). The extent o f exposure and the severity o f domestic violence have been found to be significantly related to the severity o f PTSD symptoms experienced (Astin et al., 1993; McCluskey & Hooper, 2000; O’Neill & Kerig, 2000). Two terms are often used to describe the overall psychological effects of battering. The term "battered woman syndrome" is used to describe a host of symptoms usually found in battered women, including fear, depression, guilt, low self esteem, feelings o f powerlessness, and impaired coping mechanisms, as well as the belief that the abuse is inescapable (Follingsted, Brennan, Hause, Ploek, & Rutledge, 1991; McCluskey & Hooper, 2000). The term "learned helplessness" was chosen to characterize battered women who are psychologically affected by living under threats and unpredictable violence and who, consequently, believe that they can do nothing to stop it (Dutton, 1992; LaViolette & Barnett, 2000; Strube, 1988, Saunders, 1994). Given these harsh documented effects o f wife battering, it might be that battered women, in comparison to women who are not battered, have fewer psychological, emotional and social resources to handle the crisis resulting from their child's sexual abuse. Moreover, the child's sexual abuse may endanger the mother's physical well being and present a threat to her life. Men who batter were found to raise violent conflicts around issues o f child care and child rearing (Edleson, Eisikovits, Guttmaim, and Sela-Amit, 1991; Thome-Finch, 1992). Therefore, men who batter may be more likely to blame the mother for the sexual abuse o f the child. In cases where the mother's abuser is also the child's sexual offender, the offender is Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 45 likely to perceive the mother as being responsible for reporting the sexual abuse or for influencing the child to report it to authorities (Leberg, 1997). Such accusations may lead to further battering and threats to the mother's, and possibly, the child's life. Battered women may be preoccupied by the consequences o f the child's sexual abuse for themselves. Professionals, however, may perceive mothers of sexually abused children who expressed concerns about themselves as impaired and/or neglectful mothers (Dutton, 1992; Gilfus, 1999; Myer, 1985; Pelletier & Handy, 1986), not as mothers in a life threatening situation. Effects on Single Mothers Mothers o f sexually abused children may either be part of a two-parent family or be a single parent at the time o f the sexual abuse disclosure. Many mothers became a single parent as a result o f the sexual abuse disclosure (usually this happens when the father is the offender). Single mothers face several specific difficulties which may interact or magnify the hardship experienced in the aftermath o f their child’s abuse. First, there is still a controversy whether lone mothers can provide good enough mothering (Gillespie & Primavera, 2000; Smart, 1996). Therefore, where as single mothers carry the full responsibilities for raising their children, they lack social support and appreciation (Miller, 1996; Schmitz & Steiger, 1999). As a result, single mothers are more likely to be stressed and twice as likely to experience depression in comparison to mothers who share parenting (Brown & Moran, 1977; Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 46 Renwick, 1998). In addition, low self esteem is more common among single mothers in comparison to mothers who share parenting (Gillespie & Primavera, 2000; Miller, 1996). Single mothers are also more prone to experience financial hardship and poverty in comparison to mothers from two-parents families, even though they are twice as likely to be in full time employment (Meyer & Sullivan, 2001; Renwick,1998). In the US, for example, half o f all households o f single mother families are below the poverty line (Down, 1997; Meyer & Sullivan, 2001). In spite o f the fact that many mothers (as much as 50 % in the US) go through phases during child rearing years during which they are raising children by themselves, single mothers often face moral stigmatization (Bortolaia, 1996). They are often blamed for social ills such as juvenile delinquency and crime (Down, 1997; Schmitz & Steiger, 1999) and the difficulties and problems that their children face (such as child sexual abuse) are often attributed to the fact that the family is headed by a single mother. Therefore, the assumption is that mothers who were single parents prior to the child’s sexual abuse disclosure will experience greater difficulties than mothers from families headed by two parents in which both parents continued to share their parental responsibilities after the child’s sexual abuse disclosure. It is also believed that mothers who became single parents as a result o f the child sexual abuse disclosure experience greater difficulties in comparison to mothers who share the role o f parenting after the child’s abuse. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 47 Effects on Mothers Whose Children Were Detained The impact o f foster care on sexually abused children has only recently been addressed, thus the results are preliminary and inconclusive. While some studies found that children who were removed from their homes experienced greater psychological distress and behavioral problems (Salt et al., 1990), others found no difference between those who stayed home and those who were detained in terms o f their psychological and behavioral functioning (Leifer et al., 1993). The mothers whose children were detained were perceived as non-supportive, non-protective and child- endangering mothers by child protective workers (Leifer & Shapiro, 1995). However, there has not been a study that addressed the effects o f the detention of sexually abused children on their mothers. It has been previously noted that mothers seems to express a lot o f anger toward Child Protective Services (Carter, 1993). It is likely that the separation from the abused child and his siblings has an impact on the mothers’ distress as well as her perception o f herself as a mother. Therefore, it is important to assess the vulnerability o f these mothers as well. In addition, it is important to explore variables that may exacerbate or alleviate the effects of the child’s sexual abuse on the mothers. One such variable that has not yet been explore with regard to its effects on MIAC and MEFAC is social support. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 48 Social Support Social support is a very broad construct and different theoretical frameworks explore different component o f it (Vaux, 1988). Social support involves interpersonal transactions experienced as helpM by the recipient, or intended as helpM by the provider. It can take the form o f emotional support, advice, guidance, as well as material aid and services (Pierce, Sarason & Sarason, 1990). Social support literature has been grouped into three, sometimes overlapping categories o f social networks, received, and perceived support (Barrera, 1986; Vaux, 1988). Social network is defined as “a subset o f the larger social surrounding to which an individual routinely turns or could turn for assistance in managing demands and achieving goals” (Vaux, 1988, p26). However, the mere presence o f a network does not necessarily mean that it provides support or that an individual will chose to receive support from it in time o f need (Cobb, 1976). For example, in the case of MIAC, some may choose not to tell people in their network about the abuse o f their child and therefore limit the opportunities to receive support. Received support is an approach that examine various behaviors such as problem solving, information and advice, love, social integration and belonging that can be measured or described. It especially involves the perception o f the provider o f the support. However, providers, observers and receivers o f support were found to have little agreement on the support given (Antonucci, 1990). Finally, perceived support is a perspective which explores the subjective, evaluative assessments o f a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 49 person’s supportive relationships and supportive behaviors that occurs within them (Vaux, 1988). This framework holds the assumption that both stress and social support are cognitively processed, and that these cognitions are more important for the understanding o f individuals under stress than the “objective reality”. This perspectives focuses on the receiver o f the support and his/her subjective perception. Two different models theorize how social support affects the well being of individuals. In the first, the direct model, social support is perceived as having a beneficial impact on individuals regardless of the presence o f life stress or role strain in their lives. It is assumed that when individuals experience difficulty, social support will continue to act independently in the opposite direction to enhance his/her well being by providing meaningful interaction and feedback regarding social norms and aspirations, recognition and self-esteem (Vaux, 1988). In the second model, the “ buffer model” social support refers to the interaction o f social support with life stress or role strain, which has the effect of reducing the individual’s distress (Turner, 1992; Vaux, 1988). For example, when a MIAC receives encouragement and/or practical help, this may boost her coping and functioning. Little is known about MIAC social network and received and perceive support in the aftermath o f their child’s sexual abuse. Research has indicated that adults with CSA history tend to prefer relative social isolation (Neumann, 1994). Battered women were also found to report social isolation and/or little social support (Barnett et a l, 1996; Tan, Basta, Sullivan, & Davidson, 1995; Thome-Finch, 1992). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 50 A large proportion o f MIAC are battered women and/or adults with CSA history, thus they may experience difficulty with accessing and receiving social support. This issue, however, has not yet been explored. To conclude, increasing the knowledge about child sexual abuse and improving the treatment to sexually abused children and their families cannot be achieved without a better understanding o f non-offending mothers and the impact of the sexual abuse on them. Two major drawbacks o f the empirical knowledge on mothers o f sexually abused children are the limitations o f research methodologies and the prevailing theoretical model of the incestuous family. While the limitations o f the theoretical model were demonstrated through the consistent failure o f empirical findings to support the model’s assumptions, a closer look at the methodological limitations is still required. Methodological Limitations in Review o f Literature The two most common limitations in research on mothers o f children who were sexually abused are the lack o f operational definitions provided for variables studied and the use o f small clinical samples. Operational definitions are particularly important when there is no agreement on the exact meaning o f a concept (Hooper, 1992). In the field o f child sexual abuse, even the phenomenon itself, that is, what is considered to be 'sexual abuse,' is subject to different definitions. Prevalence rates are therefore tied to the specific definition employed. Finkelhor et al.(1990), for example, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 51 define sexual abuse as any experience happening before age 18 that the respondent considers as sexual abuse. In Russell's (1983) study, definitions o f extra familial abuse varied by age (petting is included as sexual abuse before age 14, but only completed or attempted forcible rape is considered as abuse after age 14). Exhibitionism is excluded, and intra familial abuse has its own definition. Similarly, each study examined (Table 1) had its own definition o f sexual abuse. The lack o f operational definition to variables such as 'mother's history o f child sexual abuse' and 'mother's physical abuse' is also very common, thereby hindering efforts to compare results o f studies and form grounded conclusions. Relatively small clinical samples are also most common in research comparing MIAC and MEFAC (Davies, 1995; Deblinger et al, 2001; deYoung, 1994; Elbow & Mayfield, 1991; Esparza, 1993; Lewin & Bergin, 2001; Wilson, 1995). The main reason for this practice is difficulty in gaining access to subjects. Small clinical samples present problems in inferring from the specific sample to the overall population o f mothers whose children were sexually abused. While some recent studies present efforts to overcome these limitations by using larger samples and more stringent methodologies including several measures and comparison groups (Deblinger et al., 1994; Pintello & Zuravin, 2001; Salt, 1990; Sirles & Franke, 1989), more systematic work is needed in explicating the operational definitions used and in including not only larger but more socio-economically and geographically diverse samples o f MIAC and MEFAC. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 52 Implications for Theory and Research Based on the findings o f this review, the usefulness o f the incestuous family model in directing further research and interventions with mothers o f sexually abused children is called into question. Moreover, the review also indicated that in the lack o f a theoretical background to guide research, many studies end up testing hypotheses on maternal pathology and maternal dysfunction which originated from or closely resembled the incestuous model. An alternative paradigm, that this study is based on, suggests that because child sexual abuse is a common social problem, it should be viewed in the context o f the patriarchal societies in which we live. Here, most males are brought up to believe that they are superior to and have rights over women and children (Anderson, 1993). Mothers are taught that they should satisfy the husband's and children's needs first, and that their own needs come last (McIntyre, 1981). Given these cultural belief systems, men who perceive themselves as deprived o f their "rights" may choose to use verbal, psychological, physical, and/or sexual abuse toward women and children. Further, they may justify their actions by focusing on the victims responsibility for their own abuse (Bograd, 1988; Denzin, 1984; Leberg, 1997). From this feminist perspective, research and interventions often reflect the patriarchal ideology o f the culture (Jagger, 1988; McIntyre, 1981). Studies that attempt to capture the pathology o f MIAC as a group and their inadequacy as mothers, or interventions that focus on the mother's share o f the responsibility for the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 53 sexual abuse o f her child, provide examples o f tendencies to justify men's misconduct by placing the responsibility on women. Following the tradition o f "mothers' needs come last," MIAC and MEFAC received little attention as individuals in their own right. Research conducted from a feminist perspective strives to place these mothers as the focus o f analysis (Cook & Fonow, 1990). Such research is defined here as "research devoted to a description, analysis, explanation and interpretation o f the female world" (Bernard, 1979; p. 274). Therefore, studies are recommended that will attempt to describe the mothers perception o f their complex realities, their trauma, their needs, and their struggles and strengths in their different roles. Such research may employ in-depth interviews with MIAC and MEFAC in order to describe how they view themselves and their families before and after the abuse disclosure (e.g., Carter, 1993; Hooper, 1992). Alternatively, it may employ quantitative methodologies in the attempt to refute prevalent perceptions regarding mothers' inadequacy (e.g., Everson et al., 1989; Lovett, 1995). Both can be considered as methods in feminist research (Reinharz, 1992). Given the importance o f child-mother relationships and the mother's well being to the child's recovery, ensuring interventions in accordance with mothers' needs as they perceive them is most likely to benefit both the mothers and the children. Research should be redirected by focusing on the short- and long-term effects o f the child's abuse on the mother and her relationship with significant others. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 54 Different subgroups such as mothers with a history o f child sexual abuse or mothers who are physically abused may have different needs and different experiences with what may be seen as a similar event. Efforts to study the various factors that influence the mother's well-being and her responses to the crisis in her family should be continued. In light o f the above, this study focuses on the effects o f intra-familial child sexual abuse on non-offending mothers. The purpose o f this research is to provide preliminary descriptive information on MIAC. Since elementary information about MIAC is still unavailable, this study aims to provide information about MIAC's age, occupation, marital status, number o f children, employment, and social support. This research is also interested in looking at the percentage o f battered women, MIAC with history o f CSA, single mothers and MIAC who are married to the child's offender. While research on the effects o f child sexual abuse on MEFAC is also limited, research on the effects o f the sexual abuse on MIAC is minimal. Intra- familial child sexual abuse may have different and/or greater effects on MIAC because they experience two compounding events simultaneously: the sexual abuse o f their child and the identification o f a close family member, often a spouse, as a sex offender who chose to victimize a child from his own family. This study also aims at providing descriptive information not only on the emotional and psychological effects o f the child sexual abuse on the mother, but also on the ways in which the abuse disclosure affected her life as a women, a worker, a partner and a mother. It aims at Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 55 documenting the specific changes that occur in the mother's life after the abuse disclosure, because such descriptions may shed light on the reasons for the mother's distress. This descriptive information may better portray the complex reality of MIAC after the abuse disclosure, and thereby assist in the evaluation o f their specific needs. An examination o f the possibility to a priori identify sub-groups o f mothers who may be at a greater risk o f distress and PTSD will also be performed. Based on the findings about adult survivors o f CSA and battered women, this study aims at exploring whether these two groups o f women differ from other mothers in terms of the effects o f the child sexual abuse on them. The study also aims at exploring whether MIAC who are single mothers and those who are married to the child's offender as well as those whose children were detained differ from other MIAC in terms o f the effects o f the child’s abuse on them. The results o f this research may help in better directing services to MIAC according to their specific needs. This research will focus on MIAC who participated in therapy after their child's sexual abuse disclosure. The Research Questions The purpose o f this exploratory study was to address several initial research questions on mothers o f children who were sexually abused. The research questions are presented under three major areas o f interest: The first area is the socio Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 56 demographic characteristics o f the mother, her abused child, and the family. The second area is the overall documented changes that occurred in the mother’s life after the child’s sexual abuse disclosure. The third area of interest is the differences in the documented changes that occurred after the child’s sexual abuse among the following sub-groups o f MIAC: MIAC that were sexually abused in childhood, MIAC who had a battered woman history, MIAC who were single mothers, MIAC whose their children were detained and MIAC whose child was abused by their partner. Table 2 (Appendix 5) summarizes the specific hypotheses and the statistical tests that correspond with the following questions: 1. What are the socio-demographic characteristics of MIAC? 1.1 What are the demographic characteristics o f MIAC who participated in therapy following their child's sexual abuse disclosure? 1.2 What are the characteristics o f the abused child, the offender, the sexual abuse and the abuse disclosure? 2. What are the changes that occurred after the abuse disclosure in MIAC’s living arrangements, MIAC’s relations with family members and friends, and in MIAC’s well being? 2.1 What are the documented changes that occurred in MIAC's lives after the abuse disclosure? 2.2 What are the documented changes that happened in MIAC's relations with family members and friends after the abuse disclosure? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 57 2.3 What are the documented changes in MIAC's psychological well being after their child’s abuse disclosure? 3. Do some groups o f MIAC experience more changes in their lives than other groups? 3.1 Do MIAC who were sexually abused in childhood experience more changes in their psychological well being after their child's sexual abuse disclosure than MIAC who were not sexually abused in childhood? 3.2 Do MIAC who are physically abused by their spouse experience more or less change in their lives after the disclosure o f their child’s sexual abuse than MIAC who were not physically abused? Do these two groups o f MIAC differ with regard to their well being after their child sexual abuse disclosure? 3.3 Are there differences among these three groups of MIAC: those who experienced BOTH sexual abuse in childhood and physical abuse by a spouse, those who experienced either sexual abuse in childhood or physical abuse by a spouse, and those who did not experience any o f these victimizing events in their well being, their social relationships, and the amount o f change in their lives after their child’s sexual abuse disclosure? 3.4 Do MIAC who are single parents differ from MIAC who share parenting in experiencing difficulties in their psychological well being, their social relationships, and the number o f changes that occur in their lives after their child's sexual abuse disclosure? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 58 3.5 Do MIAC who are married (or co-habiting with) the child’s offender differ than MIAC who are not married or (co-habiting with the child’s offender) in the changes that occurred in their psychological well being, changes that occurred in their social relationships and changes that occur in their lives after their child’s sexual abuse disclosure? 3.6 Do MIAC whose children were placed in supervised care after the abuse disclosure differ from MIAC whose children stayed at home in the difficulties they experience in their psychological well being, their social relationships, and the number o f changes that occur in their lives after their child’s sexual abuse disclosure? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 59 CHAPTER 3 STUDY METHODOLOGY Study Design This is an exploratory study of a population about which little is known. The study focuses on the experience and the effects o f intra-familial sexual abuse of children on their non-offending mothers. Data were gathered from documents found in therapy records files o f non-offending MIAC. The study intends to yield descriptive data on MIAC and to examine relationships between variables that pertain to MIAC’s lives and well being in the aftermath o f the abuse disclosure. Increasing the knowledge base on MIAC can serve clinicians, program planners and policy makers who intervene with sexually abused children and their families. The design o f this study combines qualitative and quantitative analyses o f data that were qualitative in nature. The qualitative data were used to find the themes that arose from the data, to formulate questions that could be answered by the data, to find the categories or “answer-options” for each question, and, to illustrate, explain, or provide a context to the statistical findings o f the quantitative analysis. Qualitative methodologies were chosen because o f the lack ofbasic knowledge on MIAC in the aftermath o f their child’s sexual abuse disclosure. These methodologies enable the exposure o f complex world o f MIAC by using “thick Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 60 descriptions” (Padgett, 1998; Denzin & Lincoln, 1994). Based on the belief that there are “many ways of knowing”, quantitative methodologies were added to offer statistical analyses of the categorical data, to test differences among sub-groups of MIAC and the relationships among variables pertaining to MIAC situation in the aftermath o f the abuse disclosure (Berlin, 1990; Padgett, 1998). The study included several stages. First, 15 record files were read and analyzed to find main themes that emerged. Then an instrument for data extraction was constructed based on the information gathered from the record files regarding the socio-demographic situation o f the family, the mother's history as a child, the mother's well-being prior to the abuse disclosure, the abused child, the abuse disclosure and the overall impact o f the disclosure on the mothers. Starting on January 1994 and ending August 1998, data were collected from all available closed cases o f MIAC who participated in treatment at the agency where the study took place. All together, data were collected from 62 closed files using the constructed instrument and an additional, PTSD and stress-related measurement. Data were then analyzed according to plan. Outcomes o f the qualitative and quantitative findings were presented and interwoven together. As a result, in most cases, the quantitative and qualitative findings provided a consolidated findings where the qualitative results complemented and enriched the quantitative ones. In a few cases, however, the qualitative results contradicted and contrasted the quantitative results. These contradictions presented Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 61 challenges for true understanding o f the data as well as some directions for further research. Following is a description o f the agency from which data were collected, the source o f data, the measurements for data collection and the justification o f the research methodologies. The Agency From Which Sample Was Drawn The Los Angeles Department o f Children and Family Services (DCFS) is a large organization focusing on public child welfare. DCFS offers family maintenance and reunification services, foster care, and adoption services. The Central Los Angeles Sexual Abuse Unit(CLASAU) is one o f two specialized sexual abuse counseling programs within DCFS. Formed in 1984, CLASAU consists o f one supervisor and four licensed MSW/MFCC workers who provide training and supervision to approximately ten therapists who work directly with the families where child sexual abuse has occurred. CLASAU offers treatment programs to the child victim, the non-offending parent(s), the offender(s), the sibling(s), extended family members or/and foster parent(s). The goals o f the agency are stated as "to end the child's sexual abuse, to heal the trauma, to make positive life changes, and to help develop healthy relationships within the family and the community" (CLASAU Brochure, 1997). The Unit offers free and voluntary psychotherapeutic treatment in the form of group, individual, and family therapy to those fomilies in which intra familial sexual Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 62 abuse occurred and was reported to DCFS in West, Central, and South Los Angeles. Many low-income non-offending mothers and their children attend the program in order to comply with court orders. During intake, non-offending mothers are assessed in terms o f their ability to fit into a group. Usually mothers join a non-offending parents group. Less often, they are offered individual or family therapy in addition to group therapy based on their needs and the availability o f therapists. Most MIAC have their victimized child and siblings treated at the agency as well. The non-offending parents groups are closed groups that may consist o f 5-8 members and two therapists. The groups meet weekly for one and a half hours for 10- 12 weeks. MIAC are encouraged to stay in treatment for at least one year and to participate in more than one o f four modules. Mothers may also participate in a victims-mothers group after attending at least one group for non-offending parents. All therapists at CLASAU are either MSWs or MFCCs who work at various other units in DCFS. Frequently they are supervised toward receiving their professional license. They make a commitment to work in the unit for at least one year and in return, receive paid overtime hours and supervision by CLASAU's workers. New therapists attend a six-week treatment program prior to starting their work at the CLASAU, followed by structured, on-going supervision before and after each group session. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 63 The Sample The sample consisted o f all closed files o f MIAC (62) who participated in treatment at the agency between January 1994 and August 1998 and answered the following inclusion criteria o f the study: 1. All files were o f non-offending mothers o f children 2-17 years old who were intra- familially sexually abused. 2. All mothers were parenting the children during the time the abuse occurred and was disclosed. 3. All mothers agreed to participate in treatment. 4. All mothers were interviewed for intake and the intake report as well as a signed informed consent form were included in the record file. 5. All mothers spoke English sufficiently well to enable them to participate in an English speaking mothers' group or were assigned to Spanish speaking groups in which the therapists were fluent in both English and Spanish and documented the mother's progress in therapy in English. 6. Treatment with the mother was terminated between January 1994 and August 1998. 7. All mothers completed at least one group treatment module and/or participated in individual or family therapy for at least five months (the approximate time needed to complete one module). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 64 Data Collection Data were collected from all available closed case files o f MIAC who participated in therapy at the CLASAU and fitted the requirements o f the study. Therapists maintain a record file for each client and when the abused child and/or sibling(s) are also treated at the unit, their files are usually attached to that o f the mother. Files were closed after all contact and treatment with the client and her family had been terminated. The files usually consist o f a report about the child's sexual abuse, information gathered during intake with the mother, police and medical examination reports, court hearing reports, and short weekly descriptions o f the mother's difficulties/progress in treatment as documented by the therapists who facilitate MIAC groups. The files may also include reports on individual or family therapy sessions whenever these therapies took place. In addition, all files contained informed consent forms signed by the mother that allowed DCFS to share information given by the mother and her children with other therapists and professionals for the purposes ofbenefitting children and their families. Confidentiality is strictly kept so that names or other identifying information that may be linked to the mother and/or her family would always remain confidential. Access to the information in the files and permission to use the files for the purpose o f this study were granted to the researchers at U.S.C. by the Los Angeles Department o f Children and Family Services and by the Los Angeles Family Court. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Data collection was performed using the case extraction form which was developed specifically for this study. In addition, a version o f the Los Angeles Symptom Checklist was used to assess the mothers’ psychological well-being after disclosure. The Case Extraction Form The Case Extraction Form (Appendix 4) was developed for the purpose of collecting data from the treatment record files. A thorough reading of the literature on MIAC was performed prior to reading the files in order to determine what areas were neglected, however important, regarding the experience and impact o f a child's sexual abuse on the non-offending mother. Some general questions were formed at this stage regarding information that seemed to be important based on the literature review. Next, fifteen closed files containing treatment records o f non-offending mothers were read. It was found that each file contained an intake interview which is a structured questionnaire. The questions from this “Intake Questionnaire” were incorporated into the instrument for data collection. In addition, themes and questions in the areas o f interest were formed based on the information available in the files. New domains and new questions were added as each o f the files was read (Strauss, 1987; Taylor & Bogdan, 1984). After reading eight o f the closed files, the Case Extraction Form was saturated. The additional seven files were, nevertheless, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 66 read to ensure that new uncovered domains did not arise. Only a few additional questions emerged at this stage, confirming that the Case Extraction Form was as comprehensive as possible regarding the areas o f interest and within the limitations of the data available in the files (Krippendorff, 1980). Once the instrument was saturated, the questions were first arranged according to domains and than re arranged within each domain in a logical, chronological order. Similar questions were merged to avoid repetition (Taylor & Bogdan, 1984). The next stage included a return to the literature to closely compare the issues that were previously examined with the questions in the Case Extraction Form. More specifically, those questions that were not asked previously in the literature or were only partially addressed were examined with respect to their potential to provide information that may add to the knowledge in the field. As a result, few questions were restructured to cover domains that were still not fully researched but could be answered by the data (Strauss, 1987). After the instrument was completed in term o f the areas and the specific questions it covered, a sub-sample o f 22 cases was used to categorize and code the answers o f the open-ended questions to find the specific set o f mutually exclusive answers o f each variable/question as they appeared in the data itself ( Taylor & Bogdan, 1984; Rozenboom, 1966). All questions were given few possible answers based on the analysis o f the data. The instrument was left with an additional option of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 67 "other" for almost each o f the variables to accommodate those cases where the data did not fit any o f the specific options given (Schuman & Presser, 1981). Following the completion o f the Case Extraction Form as a fairly closed instrument, the remaining 40 files were read and coded. Although data were collected and coded by the same researcher, to insure consistency in the data coding process, three randomly selected files were re-read and re-coded at the midpoint o f the data collection. Overall, the re-coding process revealed highly consistent data recording. Two questions were not consistently coded. They were re-examined and re-structured to overcome the confusion. Consequently, all data that were coded were re examined on these specific areas and re-coded when needed. An additional issue that arose was discrepancy in data, where in one re-coded case, the first coding had few details that the second coding did not reveal. In this case, it seems that the second reading was less thorough than the first one, resulting in missing information. Overall, the recoding process revealed that it was possible to achieve a consistent and reliable process o f data collection and coding. The preliminary data obtained from the Case Extraction Form at its open- ended stage (22 cases) were used to obtain specific examples and description of situations, "short stories" of, or about, MIAC that illustrated, explained and enriched the statistical findings o f the study (Bell, 1988; Lincoln & Guba, 1985). Such data were continuously collected from the rest o f the sample to provide a comprehensive Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 68 understanding o f the situations described (Pedhazur & Pedhazur, 1991; Schuman & Presser, 1981). The Los Angeles Symptom Checklist Psychological well-being was operationalized in this study as the relative freedom from symptoms o f stress, as measured by the Los Angeles Symptom Checklist (King, King, Leskin, & Foy, 1995). Since non-offending parents o f sexually abused children were reported to experience distress and/or PTSD (Davis, 1995; Kelley, 1990), it was important to examine the extent to which MIAC exhibited general distress, as well as possibly PTSD-related symptoms, in the aftermath o f their child sexual abuse disclosure. The LASC was chosen since it includes both a general score o f stress-related symptoms and a sub-scale specifically design to identify PTSD-related symptoms. The LASC is a 43-item self-reported list o f various psychological and physiological distress symptoms. It asks respondents to rate the degree to which a problem has troubled them in the last two weeks. It provide both a global stress- related symptom score and a specific PTSD-related symptoms score. The severity o f each item is rated on a five point scale ranging from 0, “none” to 4, “extremely”. Two methods for scoring are offered. In the first, PTSD is determined if a subject has scored 2 points or higher on one intrusion item, three avoidance items and two arousal items. In the second, and most commonly used Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 69 method, the items are summed up to provide a specific 17-item PTSD severity score and a 43-item global score o f overall stress. The LASC was designed to identify PTSD, a condition emanating from exposure to extraordinarily stressful events. LASC includes the three identified PTSD-related clusters o f symptoms o f intrusion, avoidance, and hyperarousal. The intrusion cluster taps into reoccurring intrusive thoughts and memories or re- experiencing o f the traumatic event. The avoidance cluster examines avoidance tendencies, withdrawal from social contacts and numbing affects, and the hyperarousal cluster examines irritability, restlessness, and other arousal related to psychological and physiological symptoms. Since the LASC was first introduced in 1980, it has been used broadly with a variety o f trauma groups including veteran and non-veteran populations such as Vietnam veterans, battered women, and survivors o f child sexual abuse. Thus, it acquired a psychometric history that support its application to groups suffering from different traumas (King et a l, 1995). Validity: The LASC has demonstrated convergent validity as evidenced by moderately to highly correlating (.30 to .51) with other well-established measures o f PTSD on veteran and non-veteran populations (Resnick et al, 1989) as well as by correlating to the extent o f .34 with duration o f trauma exposure in a battered women sample (Houskamp & Foy, 1991). The LASC has also demonstrated between 70 to 84% correspondence rates with clinical diagnostic ratings on PTSD and distress (Gallers, Foy, Donahoe, & Goldfarb, 1988; Houskamp & Foy 1991). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 70 Reliability: A variety o f studies using the LASC and its PTSD sub-scale reported good internal consistency and test-retest reliability (i.e., Resnick et al., 1989; Houskamp et al.,1991). King et al. (1995) examined the LASC internal consistency reliability for the 17-item PTSD sub-scale and the full 43-item scale on a pooled multi-sample data set o f 874 respondents. The Coefficient alphas for the 17-item PTSD scale and the 43-item LASC were .94 and .95. respectively. Internal consistency was also examined for the combined all-female group of battered women, adult survivors o f child sexual abuse, military distressed women and psychiatric outpatients. The Coefficient alphas for the 17-item PTSD scale and the 43-item LASC were .89 and .94 respectively. The LASC And the 17-item sub-scale both appear to be highly internally consistent for the overall populations studied as well as for the specific population o f distressed women (King et al., 1995). Alternate forms reliability is unknown since the LASC does not have alternate forms. However, test-retest reliability for the LASC and its 17-item PTSD scale was reported at .94 and .90 respectively, indicating acceptable stability over time (King et a l, 1995). In summary, the LASC has shown good reliability in a wide variety o f studies and with diverse samples. The instrument has norms based on clinical and non-clinical samples including women. The LASC provides an assessment o f stress and PTSD related symptoms, or the lack o f such symptoms, and fits in good with the purpose of this study to differentiate MIAC who are in distress from those who are not and to identify those who are more likely to be suffering from PTSD. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 71 LASC Usage in Study: Data in this study were collected from closed files. Therefore, MIAC did not self-report their symptoms directly as the LASC requires. Rather, every psychological or physical symptom that was reported by MIAC to their therapists was entered unless it was a symptom that was not part o f the original scale. Thus, it was difficult to obtain a comprehensive and accurate information on the extent to which each symptom troubled the mothers. Instead, a symptom was recorded if the mother reported it to her therapist and the therapist recorded it in the file. If the mother reported that same symptom as a persistent or reoccurring difficulty in more than one therapeutic session then the number o f times which she reported the same symptoms was recorded. The majority o f mothers reported a symptom just once and rarely reported a symptom more than twice. Coding for the LASC in this study was as follows: 0= “mother never reported suffering from this symptom”, 1 = “mother reported the symptom once (in one session)”, 2 = mother reported the same symptom in two different sessions. 3 = mother reported the symptom during three different sessions. 4 = mother reported the symptom in four or more times. Therefore, in this study, the numbers indicated the persistence o f a symptom during Intake and the first three months of therapy. This coding does not tap into the severity o f mothers’ symptoms. This method o f using the LASC presents problem with regard to the comparability o f the results to that o f other studies because it is only possible to learn about the persistence o f the mothers’ report to therapists about symptoms, not about the severity o f their symptoms, from the LASC in this study. However, it is possible Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 72 to assess the type o f symptoms and difficulties that MIAC experienced and reported after their child’s abuse disclosure. It is also possible to compare subgroups o f MIAC within this sample. The results o f MIAC on the LASC are more likely to be an underestimation rather than an overestimation o f their symptoms because mothers were not aware of the study and there is no reason to believe that either MIAC or the therapists over- reported symptoms. In addition, because MIAC were unaware o f all 43 possible symptoms o f the measurement, they may have failed to recognized and report situations that they experienced as “symptoms”. MIAC were also unaware o f the importance o f reporting symptoms since they were not required to or encouraged by their therapists to report symptoms. It is also possible that therapists underreported on MIAC’s symptoms because they considered some as unimportant or because they neglected to document the information. Underestimation o f MIAC’s stress-related symptoms prevents a true and accurate assessment o f the level of MIAC’s distress associated with the sexual abuse disclosure. It also hinders an assessment o f the reliability and validity o f the instrument as it was used in this study. Data Analysis: An Overview The following represents an outline o f the analytic strategies that corresponded with the specific aims o f the research questions. The first aim o f the study was to provide a comprehensive description o f the socio-demographic characteristic o f the mothers and the sexual abuse o f their child. In accordance with Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 73 this aim, descriptive statistics were provided for socio-demographic variables on the mother, the child, the offender and the child’s sexual abuse and disclosure. The second aim o f this study was to describe in detail the impact o f the child's sexual abuse disclosure and its aftermath on the non-offending mothers. Descriptive statistics were provided on: Changes in the mother’s role and difficulties related to parenting the abused child and the siblings; changes in the family constellation; change in the family income; changes in MIAC’s vocational situation; changes in residential situations and changes in their intimate and social relationships. In addition, descriptive statistics on MIAC's physical and emotional well being in the aftermath of the abuse disclosure were provided along with the qualitative description o f the mothers’ experiences. In addition to the description o f each o f the variables, statistics were also provided for the overall number of areas in which change in the mother's lives were reported as well as the overall score received on the LASC and the PTSD sub-scale. The third purpose o f this study was to examine the experiences o f specific sub-groups o f MIAC in order to determine if it is possible to identify specific areas of need or vulnerability. The groups that were compared included: MIAC with/without CSA history; MIAC with/without a history o f being a battered woman; MIAC who were/were not single parents; MIAC who were/were not married or co-habitated with the child’s offender; and MIAC whose children were/were not detained after the abuse disclosure. The research questions, hypotheses, and the statistical tests that were performed are provided in Table 2 (Appendix 5). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 74 Since the t-test has been shown through extensive computer simulation to be very robust, in the sense that violations o f normality and equality o f variance do not greatly affect the accuracy o f the resulting probability statements (Kachigan, 1986, pg. 461), the chosen analysis performed in all two-group comparison was a t-test except when the assumptions o f parametric tests were not met. In these cases, the non-parametric statistical test o f Mann-Whitney-U was used instead. In addition, MIAC who were both battered women and had a CSA history were also compared to MIAC who had one such abusive condition in their lives and MIAC who had no abusive histories using a one-way ANOVA tests. The information regarding the specific research questions and the hypotheses for these group comparison is also summarized in Table 2. Finally, a multiple regression was conducted to determine the extent to which various variables such as MIAC child sexual abuse history and reported strain in relationship after disclosure predicts mother’s stress related symptom’s level. Justification o f Research Methodology It is important to examine the advantages and limitations o f this study given the preliminary stage o f knowledge and theory on non-offending mothers (Elliot & Carnes, 2001) and the difficulty in accessing non-offending mothers during the aftermath o f disclosure. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 75 Research Design This study is exploratory in nature where research questions were formed both before and during the stages o f qualitative and quantitative data analysis. The advantage in this form o f approach to research is that the researcher stay “open” with regard to the data and questions that come up from the “field”, rather than impose a previously held theory on the data. The limitation o f this design is that givin the lack o f solid theory to guide exploration, the research questions are very general and broad. Source o f Data Collecting data from closed record files o f non-offending mothers in treatment had both advantages and limitations for the purpose o f this study. On the one hand, it provided an opportunity to learn about the subjects o f the research from professional therapists who were trained to identify problems and assess clients' difficulties and strengths. In addition, these therapists followed and documented the subjects' progress on a weekly basis beginning shortly after the official abuse disclosure and all through treatment. Since mothers shared their difficulties in treatment sessions, the records provided detailed accounts o f the effects o f child sexual abuse on the mothers as the disclosure and the aftermath o f the abuse unfolded. Thus, the case records provided more information than would a single interview conducted with either the mother or the therapist because documentation occurred all through treatment. This method allowed some exploration o f processes o f MIAC’s belief and MIAC’s ability to support her child. It also provided a view into the process o f mothers’ treatment Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 76 and recovery from the time o f disclosure and until the termination from CPS/or therapy. Another advantage o f using data from files was that neither the workers nor the mothers knew about the purpose o f this study at the time o f treatment. Therefore, the data is free from problems of social desirability and intentional disinformation of either the workers or the mothers with regard to the effects o f child sexual abuse on the mothers or other findings related to mother’s treatment. The data enabled an open window into MIAC’s evolving process of dealing with the reality o f the abuse disclosure aftermath. Direct interviews with the mothers at the time o f disclosure and throughout the aftermath would be desirable especially because this research used a feminist framework that acknowledges the importance of presenting the women’ s own perspective about events in their lives. There are, however, great difficulties in gaining access to mothers at time o f treatment through agencies. In studies where women were interviewed, the interviews took place at least one year after disclosure. Hence, the data were gathered retrospectively (Hooper, 1992; Carter, 1993, Deblinger et al., 1999). Information that is provided retrospectively is subject to memory distortions o f omission, addition and inaccuracy (Bailey, 1978). The data in the closed record files fit the purpose o f the research because it focuses on the mothers and because it was gathered by professionals on an on-going basis at the time when the events o f disclosure and the aftermath took place. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 77 There are, however, several limitations o f using data from closed record files. First, the records files were not specifically designed for the purpose of this study. Therefore, some o f the areas that were deemed important for the purpose o f this study such as the degree o f the mothers’ distress, or the mothers’ informal support network could not be investigated in the desired depth because o f the limited information in the files. Secondly, since different therapists recorded the information, there were differences in the degree o f documentation in each o f the files. Within each file, the extent o f documentation also changed from one meeting to another. As a result, the data that were collected were only those which appeared in almost all cases. Data that appeared more sporadically in files were not collected for the statistical process. An additional limitation o f the data is that all that is known about MIAC is filtered trough public officials such as the police officers, the CPS workers and therapists. Therefore, the data reflect what those individuals believed is important to document about the mothers. A better approach for the purposes of learning about MIAC in the aftermath o f their child’s sexual abuse disclosure would be a longitudinal research following MIAC throughout the process until recovery is obtained. Such research, however, is costly and has not yet been performed. An additional limitation pertains to the generalizability o f the results o f this study. Since the sample consisted only o f MIAC who were in treatment within the Child Sexual Abuse Unit o f DCFS, it is not representative o f all non-offending mothers o f sexually abused children. There are non-offending mothers of incestuously abused children who refused treatment altogether, others who chose to Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 78 obtain treatment in clinics which are not related to Child Protective Services and yet others who managed to avoid detection by public agencies. Subjects from middle to upper class, in particular, are known to avoid detection and exposure o f public agencies (Crawford, 1999). The Central Los Angles Sexual Abuse Unit is supposed to provide services for a very wide urban population, nevertheless, mothers who participated in treatment at the unit typically came from low socio-economic classes. It is likely that MIAC from populations that were not sampled in this study differ from those who did in their reactions, in the impact of the child’s sexual abuse on them since they may have access to more resources. Since the number o f identified cases o f children who were sexually abuse steadily increases, however, more children and mothers from low socio-economic class receive treatment in CPS. Therefore, this study still provides important information about a large segment o f MIAC. Given the preliminary nature o f the knowledge in this field, the difficulties in accessing subjects at time o f disclosure, and the fact that current treatments that are offered to MIAC are still at the formative stage (Deblinger et al., 2001), this study can contribute to the knowledge base in the field despite its limitations. Instruments For Data Collection The advantages o f the Case Extraction Form are that It was designed to fit the specific needs o f collecting data regarding the impact o f the abuse disclosure on the MIAC. It was constructed after reading the literature and the treatment files and identifying the specific themes and questions which are o f importance to Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 79 understanding MIAC. A long and careful process was used for developing the instrument and it was designed to extract the maximum information available on MIAC from the files. Thus, it is believed to achieve good content validity. Given the nature o f the data source, it proved to provide comprehensive descriptions on the various areas o f interest and therefore serve the purpose o f this research. Since statistical analyses were used in this study, it is also important to assess the instrument from a quantitative research standpoint. The major limitation o f the instrument for data collection, from this point o f view, is that it is a non-standardized measurement. The overall validity and reliability o f the measurement are, therefore, unknown (Pedhazur & Pedhazur, 1991). However, because there are still no specific measurements that were design for detecting the impact o f the child's sexual abuse disclosure on MIAC, it seemed important to code and re-code qualitative data into quantitative measurement in order to provide maximum information on MIAC. Summary The advantage o f this research is that it looks at three major questions that were overlooked in previous studies: 1. The overall impact o f intra familial sexual abuse on the non-offending mother's psychological well being, her relationships with significant others and the changes that occurred in her life following the disclosure o f the child's abuse. 2. The possibility that victimization o f the mother (in the forms o f sexual abuse in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 80 childhood and/or physical abuse in intimate relationships) increases the effects o f the disclosure of the sexual abuse o f the child on the mother. 3. The possibility that different subgroups o f MIAC such as MIAC who are single parents and those whose children were detained experience more difficulties than other MIAC and therefore should be receiving additional assistance in the aftermath o f their child’s sexual abuse. In addition, the exploratory and qualitative nature o f the study, allows for new, important issues for the mothers and their situation to be revealed. The advantages o f the research methodology are: 1. Information on a relatively large group o f mothers o f intra familial sexually abused children at the time when abuse disclosure and aftermath unfolded. 2. Data relatively free from memory distortion, social disability and purposeful disinformation o f subjects. 3. Data were collected using an instrument that was specifically designed to fit the research questions and the nature o f the information available. In addition, the instrument is designed for both quantitative and qualitative data to be collected. It therefore allows for a comprehensive and rich descriptions o f the effects on the mother to be included, hence serving well the purpose o f this research. This study is conducted within the parameters o f a feminist perspective (Cook & Fonow, 1990). The mothers are not interviewed directly. However, it is MIAC, their psychological well being and their lives in the aftermath o f their child’s sexual Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 81 abuse disclosure who are the focus o f this research. The study is designed to give recognition to these women and their situations. It neither focuses on their pathologies nor exclusively on their role as a parent to an abused child. It strives to present the women in their situation from a non-judgmental standpoint. The results of this study are likely to benefit non-offending mothers in contributing to professionals’ knowledge on the effects o f child's sexual abuse on MIAC and highlight their specific needs. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 82 CHAPTER 4 RESULTS The presentation of the results of this study corresponds to the research questions and includes two parts: the descriptive results, and the bivariate and multivariate results. In the first part, descriptions o f the socio-demographic characteristics o f MIAC, their abused child, the offender are provided along with descriptions o f the investigation and the changes that occurred in the mothers’ lives after disclosure are presented. In the second part, the differences among sub-groups o f MIAC, and the relationships between several identified variables and MIAC’s stress-related symptoms are presented. Descriptive Results Socio-Demographic Characteristics o f MIAC This sample consisted o f 62 Mothers o f Incestuously Abused Children (MIAC). The mothers ranged in age from 24-50 years old (M=33). Fifty-six percent o f the sample was o f Hispanic origin, 21% were Caucasians, 19% were African- Americans and 4% were from Pacific Islands origin. The population of the sample reflects the ethnic makeup o f South and South Central Los Angeles, the area served by the agency from which data were collected. About 55% o f the mothers in this Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 83 sample were immigrants with a mean o f 6 years residency in the USA. Forty-seven percent o f the mothers were married, 27% were co-habitating with a male partner, and 26% were single mothers due to separation, divorce or widowhood. The vast majority o f the women (84%) became mothers at a very young age; more than half o f the women (53%) had their firstborn before age 18. The mothers had 3.5 children on average. Twenty-eight percent o f the mothers had no formal education; 14% had less than or eighth grade school education; 24% graduated eighth grade or had a few years o f high school, and 23% earned a high school diploma or completed the GED. The remaining 9% had some or full college education, with one mother having an advanced degree. The majority (66%) o f these mothers were employed. Most of them were working lull time and about 18% were working part-time. Twenty-two percent were unskilled workers, typically working as janitors or as housemaids. Thirty-one percent were semi-skilled, typically working in assembly lines or other production factories and 8% were skilled manual workers such as bakers or secretaries. About 5% were working as technicians or clerical sales workers and 8% owned small businesses or worked as business managers. The reported monthly income o f the sample before disclosure was fairly low with 42% o f the families having a monthly income below $1,500, and only 12% of the sample having an income higher than $2,501 per month. In 34% o f the households the mother was the main provider and in an equal percentage o f households the father was the main provider. In 26% o f the households both parents Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 84 contributed about equally to the income. Twenty-one percent o f the families in which one or both parents worked received some type o f government assistance to their income and 6% o f the families relied on government assistance as their main source o f income. Physically, the vast majority (90%) o f the mothers reported being healthy before disclosure, with 10% reporting some physical problems such as high blood pressure or other chronic illness. More mothers (18%) , however, reported experiencing mental health difficulties such as depression, mood-swings, and chronic fatigue. Eight percent o f these mothers also reported abusing drugs or a combination of drugs and alcohol before disclosure. In summary, this sample consisted o f healthy, functioning and relatively young mothers with 3 to 4 children on the average, from a mixed ethnical background, with Latina immigrants being over represented. Most mothers were from a low to low-middle socio-economic background with low educational backgrounds and low occupational statuses. The family’s income before disclosure was typically low and most mothers worked outside the home. This sample is similar to other samples o f MIAC in characteristics such as mother’s age, number o f children, health, and education and economical backeround fCarter. 1993: Dadds et al.. 1991: Heriat. 1996: Hiebert-Murnhv. 1998V Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Interestingly, a reliance on public welfare as a source o f income for the family is remarkably lower in this sample in comparison to others (10% vs. <30% ) perhaps because a larger percentage o f mothers in this sample were employed (66% vs. 30-40%) and a smaller number o f families were headed by one parent (26% vs. <35%), a condition associated with reliance on public assistance (Lovett, 1995; Hiebert-Murphy, 1998; Salt et al., 1998). The most striking difference between this sample and others is the larger proportion o f minorities (79% vs. 20-30%). More specifically, while other studies included a similar percentage o f African Americans (20-25%), this study is the first to include such a large percentage o f Latina MIAC. This is likely the result o f the agency’s location in South Central Los-Angeles, an area which is predominantly populated by minority communities, in particular, immigrants from South and Central America. Even though it is very difficult to achieve a truly representative sample o f MIAC because so many cases o f child sexual abuse remain undetected, it is believed that child sexual abuse is a phenomena that is equally common among the different races and social classes (Salt et al., 1990). Due to the modest number o f mothers studied and the unequal representation o f the socio-economic and racial groups in this sample, an adequate exploration o f the association between mother’s class and mother’s cultural backgrounds and her experience o f and reaction to the sexual abuse o f her child is impossible and awaits further research. Nevertheless, this sample is believed to be representative o f MIAC that are likely to come to the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 86 attention o f law enforcement agencies and child protective services in other culturally-diverse urban areas. Characteristics o f the Abused Children and the Abusive Experience The majority of abused children in this sample were females (89%). The children ranged in age from 2-17 years old at time o f the abuse onset (M = 9, SD = 4.5) and from 3-17 years old at time o f disclosure (M = 10, SD = 4.1). About half o f the children (54%) experienced sexual abuse with multiple occurrences. Twenty-six percent experienced less than five separate incidences o f sexual abuse and the remaining (21%) experienced one incidence o f sexual abuse. Twenty-six percent experienced sexual abuse that lasted up to six months. Twenty-two percent experienced abuse that lasted from six to twelve months and 31% experienced long lasting abuse, anywhere from one year to 8 years. In most cases (68%), the offender had access to the child when the mother was away from the house, typically while she was at work. In an additional 27% o f the cases, the abuse happened when the mother was sleeping or working in the house. In 5% of the cases, the abuse happened when the child was visiting with a divorced father. The abused children in this sample were exposed to a wide range o f sexual acts. The vast majority o f children were exposed to more than one type o f sexual abuse. The most frequent type o f sexual abuse consisted o f fondling (95%). In 45% o f the sample, the sexual abuse included oral copulation and in 43% the children were subject to exhibitionism. Forty-three percent were subject to inappropriate Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 87 kissing and 41% experienced digital penetration. In about 28% o f the cases, the abuse included sex games or exposure to pornographic materials. Additionally, twenty-six percent o f the children were subject to sodomy and four girls (7%) were raped (i.e., the abuser did not use seduction, there was no progression of sexualization and abuse included vaginal penetration). About a third (32%) were subject to intercourse, resulting in five girls becoming pregnant (8%) and four giving birth to live babies. For a considerable number o f children in the sample, the abusive experiences were not limited to those associated with the disclosed sexual abuse. Twenty-one percent o f the children reported that prior to the abuse that was disclosed, they were sexually abused by a different family relative (13%) or a stranger (8%). Twenty-one percent o f the children reported being physically abused by either one or both parents, 13% were reported to experience neglect and 57% lived in households where they could witness domestic violence. Another interesting socio-demographic characteristic is that 27% o f the abused children experienced long-term separation from their mothers. Typically, they resided with extended family in their country o f origin while their mothers tried to re-settle in the USA. Five percent o f the children had lived away from their mothers for up to one year. Thirteen percent had lived away for up to three years and 8% had lived away between three and eight years. In all cases, the abuse occurred after the reunion and while the children were living with their mothers. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 88 In summary, the children in this sample were mostly females between 2-17 years o f age, with about half being younger than 10 years o f age. One-third had lived away from their mothers for some part o f their growing up years. A considerable number o f the children experienced severe and continuous abuse and more than one quarter experienced multiple types o f abusive experiences by different offenders in different periods in their childhood. Characteristics o f the Offenders All sex offenders in this study were males. In 37% of the cases, the sexual offender was the mother’s husband; an additional 27% o f offenders were the mother’s live-in partner and father to some o f her children. In 9% of the cases, the offender was a separated husband and father o f all or some o f her children. Together, in 73% o f the cases the abuser was a biological, step, or a father-figure male living with the child. Sixteen percent o f offenders were MI AC’s sons or step sons in which case the difference in age between the offender and the victim was at least 8 years. Eleven percent o f the offenders were the mother’s father, brother or another male relative living in her house or who had regular access to the child. The majority o f the offenders (69%) had no criminal history prior to disclosure; however, 20% had criminal histories o f violence and 11% had criminal histories of pedophilia or other sex crimes. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 89 Confirming the Ahuse Allegation and Legal Actions Against Offenders Right after the official disclosure o f the abuse, a police investigation took place. The main task o f this investigation is to collect as much possible evidence about the alleged abuse. There were three sources o f possible support for the child’s allegation: medical examination, witnesses, and offender’s Confirmation (Table 3). Table 3 Sources o f Support to the Abuse Allegations Source o f Support n % Medical exam No exam 29 46 Support allegation 26 42 Inconclusive results 6 10 No support to allegation 1 2 Total 62 100 Witness No witness 42 68 Support allegation 18 29 No support to allegation 2 3 Total 62 100 Offender Deny 36 58 Confirm 23 37 Missing data 3 5 Total 62 100 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 90 Medical exams were performed right after police interview. However, in some cases when the child complained o f abdominal pain, the doctor was the first to learn about the sexual abuse. In nearly half o f the cases no medical exam was performed either because the child described the abuse as fondling or because the abuse happened a considerable amount o f time before disclosure. In about a third o f all cases, there was a witness to the abuse, typically a sibling. The vast majority o f witnesses (91%) supported the abuse allegations. Forty percent o f offenders confirmed sexually abusing the child during the police investigation while 60% denied. Following the investigation, 31% o f the offenders were incarcerated and 11% fled. Thirty-four percent agreed to leave the family residence voluntarily and 24% refused. Finally, charges were filed against 60% o f offenders and 40% o f them were found guilty. Mothers’ Awareness o f the Child’s Abuse and Their Reactions Almost half (49%) o f the mothers reported that they were not aware that their children were sexually abused before there was a disclosure to officials. Most of them (39%) reported that they did not notice signs o f distress or unusual behaviors in their child. For most mothers this lack o f awareness o f the abuse was associated with sadness, self-blaming and/or self questioning about their parenting practices, in particular, their relationship with the child: Mother expressed sadness over the fact that she did not know that her child was abused. She believes that she could have known about the abuse if only she would [have] spend more time with her child. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 91 Few mothers, such as the one cited below, expressed frustration over the fact that the child did not exhibit any signs o f being abused, therefore, making it unlikely for them to find out: I was shocked to learn that he abused her. She never complained. She is a happy, healthy girl and a very good student. How could I possibly guess that she was abused? Ten percent o f the mothers who did not know about the abuse reported that they had suspicions or clues that they misinterpreted. All but one, blamed themselves for not understanding that the child was abused: Every time I left to work she’d cry: mommy don’t go. My tummy hurts. I don’t want to stay with daddy. I did not ask myself why she objected to staying with him. I just thought she is too attached to me and it’s normal for a girl her age (4 years old) to have difficulties separating from her mother. In a few cases, the mothers were uncertain about the special bond that seemed to develop between their male partners and their adolescent daughters. While they welcomed a loving child /father-figure relationship, they still did not feel quite right. This mother’s experience exemplifies the way in which a mother can became an outsider in her own family as a result o f sexual abuse and still blame herself for misunderstanding the clues: I was a fool not to see what was going on. I was blind. They would talk in English and giggle and I did not understand. I would tell them to stop. I never thought he would sleep with her. She is only 13 years old. She told me she loves him. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 92 Only one mother felt strongly that she acted upon her suspicions and did what she could to bring about the abuse disclosure. She, however, was frustrated by her daughter’s denial: She loved him differently. He is her father, but still, she got more presents than her brothers [did], I asked her a few times but she denied [it]. I told the social worker about it and she talked with her too, but she kept on denying. To conclude, most mothers who were not aware o f the abuse prior to formal disclosure and all those who had clues (which they misinterpreted) were disturbed by the fact that they did not find out about the abuse earlier. Mothers explained that children were affected in different ways by the sexual abuse; some exhibited symptoms that were clearly different from their normal behavior, however, these symptoms were similar to those which might be associated with normal developmental stages such as a toddler’s attachment behavior or a teenager’s moodiness. Moreover, some did not exhibit any clear symptom o f distress, and others seemed to enjoy the offender’s attention to the point they concealed and denied the abuse in order to maintain the relationship. Many mothers, however, did not seem to be eased by their own explanations. They expressed sadness, grief, self-criticism, and self blame associated with their lack of awareness that their children were abused. A little more than half (51%) o f the mothers knew about the sexual abuse of their children before there was a formal disclosure. In most cases, the abused child informed the mothers (39%); in 4%, the child’s care-giver or a relative informed the mother, and in 8% o f the cases mothers witnessed the abuse themselves. All Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 93 mothers exhibited difficulties accepting the fact that their children were abused. Many searched for more information in an attempt to understand how the abuse could have happened. The mother cited here describes her need for a more extensive explanation o f how and what exactly happened: I asked her teacher many questions because even though I believe my child, it did not make sense. Then I talked with my daughter and I asked her again because I had to make sure that it really happened. Those mothers who witnessed the abuse were traumatized. They often repeated their story o f witnessing the abuse several times during therapy perhaps as a way o f better understanding it. Even when what they saw left little room for doubt, they still exhibited difficulty accepting the fact that the abuse happened. Typical of other cases in which the offender was the child’s own biological father, this mother’s disbelief is associated with the fact that the children were the offender’s own “flesh and blood”: I know they say the truth. I know he touched all o f them. I saw him standing in the bathroom with the child and I saw the look on the child’s lace and I knew something bad happened. Then I ran to the neighbor to call the police But I just can not believe he really did it. These are his own sons! Of the 31 mothers (51%) who found out about the abuse before authorities did, 31% reported the abuse to authorities themselves during the day of disclosure or the next day. Twenty percent o f the mothers knew and chose not to report. These mothers mostly tried to stop the abuse themselves either by removing the child and /or by confronting the abuser. Thirty-two percent o f mothers, confronted the abuser. In almost all o f these cases, the offender denied abusing the child which most Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 94 frequently resulted in the mother becoming more confused because o f the offender’s decisive denial. Therefore, confrontation was not a good method of finding out more about the abuse or stopping it. Only in about half o f the cases (16%) did the sexual abuse successfully stop as a result o f this method o f intervention. The following citation describes a typical confrontation between a mother and a denying offender. Untypically, this mother used a weapon to threaten the offender and she was not impressed with his denial: I took a knife and I told him: “You did it...you’ve been touching her”. And he said: ‘No, I didn’t. Maybe someone touched her at school’. And I said, I know you did and if you ever touch her again I swear I (will) kill you. This mother was already convinced that her child was abused by her male partner. Other mothers searched for more information during the confrontation. Their openness enabled further manipulations by the offenders. However, few mothers were fully convinced by the offender. Some reported the abuse to public authorities after the confrontation while others blocked the offender’s access to the child as a safety precaution. In 36% (n = 21) o f the cases, mothers attempted to end the child’s sexual abuse by removing the child from the offender or by blocking access to the child. Fifteen mothers were successful in terminating the abuse as a result of this intervention. While neither confronting nor blocking access to the child was fully successful, confronting was less successful because offenders convinced the mothers that the child misinterpreted the events and while mothers experienced greater doubts, the child was less inclined to tell the mother that sexual abuse reoccurred. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 95 Typically, children did not receive professional help to recover until the abuse was reported to authorities. It is unclear why mothers did not seek psychological help for their children. Mothers may not have known about the adverse effects o f sexual abuse on the victims or may have been culturally disinclined to turn to therapy for assistance. Mothers may have also feared the consequences of a disclosure to authorities. The data in most cases do not support the notion that it was the result o f lack o f care for the children’s well-being. The following citation provides an example o f a mother’s struggle to protect her older daughter (from previous marriage) and at the same time enable her younger children to enjoy the affectionate relationship they had with their father who was the offender: When she told me what he did I cried. I did not know what to do. Then I sent her to live with my mother and he never touched her since. I love my daughter and I see her every day but I had to think about my other children. They are young and they need their father. Unlike DCFS workers who view offenders as having no redeeming qualities and as endangering all the children in the family, some mothers viewed offenders as family members who have strengths as fathers, providers or companions alongside their manipulative and abusive behaviors. This multidimensional perception of offenders by mothers, at time o f disclosure, was often perceived by DCFS workers as signs o f the dependency on the offender and as endangering the children. Only two mothers, who were told that the child was abused prior to the official disclosure, completely disregarded the information and consistently Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 96 disbelieved the allegation while in therapy. Both mothers had a strong bond to the offender and experienced reoccurring difficulties in their relationship with the abused child. In both cases, the abused child was an adolescent who had lived away from the mother for more than one year. The mothers who did not know about the abuse before disclosure to authorities were most frequently informed by police officers (19%); DCFS workers and physicians informed them in 16% o f the cases; family relatives in 13 % and therapists in 7% o f the cases. To conclude, the vast majority o f mothers in this study were neither careless nor neglectful regarding the abuse allegations. Those who did not know about the abuse (whether or not they had clues) tended to blame themselves for not finding out about it. Once mothers learned about the abuse, they experienced much difficulty accepting the fact that the children were abused by a family member whom they trusted and loved. All (but two) o f those who learned about the abuse before authorities attempted to protect the child. In many cases once the mother intervened the abuse stopped. In almost all cases, mothers did not actively seek professional help for the children or themselves, although they did try to learn and understand what happened. Typically, those mothers who sought explanations from the offenders experienced even greater confusion. Confusion was also experienced by mothers who loved the offenders and viewed the offender as a successful husband, father and/or provider. Those mothers had a harder time believing the child than did Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 97 those who held a negative perception o f the offender or those who felt ambivalence toward their relationship with the offender. The Official Disclosure and the Investigations o f Police and DCFS Once the sexual abuse of the child was disclosed, the offenders and the children as well as the mothers became subjects o f investigation and scrutiny by law enforcing social institutions: the police, DCFS, and the court. During these investigations the mothers were stripped o f their multi-dimensional identity and were referred to as “the non-offending parents”. At this stage, at least half of the mothers had little knowledge about the abuse. In addition, almost all mothers had little knowledge about the professionals who questioned them and the purpose o f the investigation. Moreover, mothers did not know that the outcome o f these investigations would profoundly affect their lives and the lives of their children. In the process o f DCFS’s investigations, the mothers were asked to describe their family’s history and their relationship with all family members, particularly the offender and the abused child. Special attention was given to whether they knew about the abuse, and how come they did not know. Regardless o f mothers’ own attempts to protect the child prior to the official disclosure, their parenting skills were profoundly questioned during the investigatioa Their adequacy as parents and their ability to further protect the child were evaluated in light o f their perceived failure to prevent the abuse in the first place or to detect and stop it right away. As a result o f the evaluation, almost all mothers (95%) had a case opened at DCFS and their children became dependents of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 98 mothers (95%) had a case opened at DCFS and their children became dependents of the court. Their natural right to parent their children was either restricted and monitored by DCFS and the court, or temporarily removed following the children’s detention to foster care. The remaining mothers (5%) continued to assume full responsibility for their children and accepted DCFS’s offer to join therapy voluntarily. Forty-eight percent o f the mothers were ordered to join parenting classes in addition to receiving therapy for the sexual abuse. The mothers remained dependent on DCFS and the court until their case was closed (usually anywhere between 18 months and up to four years). At the core o f DCFS’s investigations were the issues o f believing the child and the mother’s feelings toward the offender after the abuse disclosure. Based primarily on the information gathered regarding these issues, the decision o f whether to remove the children to foster care was made. Mothers who expressed a firm belief that their child was indeed abused, and therefore needed extensive therapeutic help, coupled with expressing anger at the offender, and a wish to have no further contact with him, had the best chances o f keeping their children at home. However, at this stage, many mothers were confused by the abuse disclosure, the rapid process o f the investigations and the offender’s incarceration. At the midst o f this unfolding drama, they were neither clear about what exactly happened to the child nor what was going to happened to the child, the offender or themselves. Moreover, they were not aware o f the workers’ expectation that they Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 99 must clearly condemn and reject the offender and express belief in and protect of the child. Mothers were therefore puzzled by the unexpected and rapid detention of their children. The following citation exemplifies how a mother experienced her interaction with a DCFS worker. While the mother was caught between her loyalties to the offender and the child the worker interpreted this divided loyalty as unsupportive o f the child: The worker asked me if I believe my daughter. I said: I don’t know who to believe. She said her father molested her but he said he would never do something like that. She is crying and he is really upset. I don’t know what to think. Then the worker said: I am going to detain the children. Is there a family relative that may be willing to take them in? Mothers whose children were detained indicated during therapy that they did not know why the decision was made. Often they wondered whether they could have said or done something to prevent it. They expressed frustration at not being clearly told why their children were detained. The following citation provides an example o f a mother who mistakenly believed that once the offender was no longer around, the children had no reason to be detained: Mother is very angry “at the system”. She asked over and over again why all her children were send to foster care when the perpetrator was already incarcerated. In fact, workers also detained children whose mothers were perceived as likely to put pressure on them to recount the allegations as well as children who indicated that they were afraid o f their mothers’ reactions. Mothers whose children Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 100 were detained felt helpless. They believed that they could and should be the one to help their children and were angry that workers prevented them from doing so by sending the children to foster care. Many mothers felt punished by the workers: I believe my daughter, but I don’t believe he did it. I don’t want him to go to jail. If he really did it then he is sick; he needs help not prison. Why they took my daughter? I am her mother. I can help her. Since the decision to detain the children was heavily influenced by the mother’s position with regard to believing the child, it is important to look at the different ways in which mothers reacted when they first learned about the abuse. The majority (61%) o f the mothers said that they believed the sexual abuse allegations when they first heard it. Twenty-nine percent o f the mothers did not believe and 10% were described as confused and unsure whether or not to believe the abuse allegations. Thirteen mothers (21%) who did not believe the allegations at first, changed their position and believed the allegation when they received the results of the police investigation, the medical exams or during the time they were in therapy. Mothers who were informed about the abuse after the official disclosure to authorities often did not have a chance to talk privately with the child because police officers and DCFS workers’ feared that the mother would urge or threaten the child to recount the abuse allegation. Many mothers who had a chance to talk directly and privately with their child believed the abuse allegation. The following example demonstrates the process by which a mother changed positions based on Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 101 her interactions with the child. Here, the mother relied on her previous knowledge o f the child’s character and behaviors in her decision to believe: When the doctor told me I said: No. It can not be. He is a good man and he would never do that. Only when the doctor left and my daughter told me herself what he did and how he threatened her not to tell [did] I believe her, because I know my daughter and I knew she was telling the truth. Three mothers who first believed the allegations became doubtful later on, and two who were confused continued to hold this position all throughout therapy. Sixteen percent of the mothers (n=10) were very consistent in not believing the allegations. These mothers had different reasons for not believing the allegations. Some believed that the child had a hidden agenda for blaming the offender. Often, as the following mother describes, these mothers experienced difficulties in their relationship with the child prior to the disclosure: My daughter is a liar. She always lies to me. She had sex with her boyfriend and she is afraid o f me. [That is why] she blames my husband... I believe him because he told me he would never do something like that. He loves her like his own daughter and forgives her for blaming him. Some mothers could not believe that children that young could be sexually abused. Here again, the mother relied on her knowledge o f the child’s characteristics (imagination) for not believing: She is not even three years old. She is too young to tell such allegations. She has rich imagination and she must be making up stories. Others found it hard to believe that their partners were abusive toward their child during the same time they were loving with them. In this citation, the mother Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 102 also believes that the child’s hatred toward the offender brought about the sexual abuse allegation: I did not believe my daughter because she hated him since she came to live with us. I could not believe that he would touch her and still be intimate with me. Some mothers were viewed by therapists as being very bonded with the offender. These mothers did not believe the allegations and found it hard to change their perception o f the offender, especially in cases where the mother believed that her relationship with the offender was very good. My husband was always good to me. He never hurt me. He told me he is innocent and I believe him. A few others, such as this mother, had a different definition or understanding o f what sexual abuse is: When she told me that he touches her breasts and kisses her I said: No... This is not abuse, I know because when I was young I was raped twice... Now (after therapy) I know what it is abuse and I believe my daughter. To conclude, most mothers believed their children. Those mothers who did not believe their child provided explanations within the context o f their perceptions of the characters o f the child and o f the offender. They also considered the relationships among the offender, the child and her mother prior to disclosure. Mothers’ negative perception o f their child’s character or negative relationship with the offender, coupled with a perceived positive relationship between the offender and her were commonly a basis for the mothers’ disbelief. Almost one third o f the mothers changed their positioning with regard to believing the allegation. New Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 103 information, time to think and reflect during therapy as well as a chance to talk openly and directly with the child about the abuse tended to help mothers believe that their children were indeed abused. A substantial number o f mothers (44%) were viewed by DCFS workers and therapists as “minimizing” the abuse consequences for the abused child. “Minimizing” is a term used by CPS workers to justify the children’s detention because more than the term “disbelieve”, it implies that the mother endangers the child by underestimating the detrimental consequences o f the sexual abuse or the possibility o f abuse reoccurrence. Mothers who disbelieved the abuse allegation were all said to be “minimizing” the abuse o f their children. In addition to those who initially disbelieved, mothers who believed but were viewed as lacking in understanding o f the effects o f the abuse on the child, and those who disagreed with DCFS’s workers regarding the definition and/or the severity o f their child’s sexual abuse were also termed “minimizing”. For example, mothers whose teenagers reported that they were “in love” with the offender and that sex was consensual tended to view these situations as inappropriate love affairs, not as sexual abuse. Disagreements around the definition o f sexual abuse are common among professionals, however, mothers’ diversion from the therapists’ perception o f sexual abuse was not tolerated. Mothers’ comments about the economical, familial and personal contexts in which the abuse occurred were also used to determine whether the mother was “minimizing” the abuse. For example, mothers who indicated that they needed the abuser to provide financially for the family and those who wanted him to stay home because younger children were Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 104 attached to him were also perceived as “minimizing”. The workers’ perception of mothers as minimizing the abuse had immediate consequences for the abused child. Table 4 presents the differences in children’s detention between MI AC who were perceived as minimizing and those who were not. Table 4 indicates that while believing the child did not guarantee that the child would stay in the mothers’ care, being perceived as “minimizing” almost always brought about the child’s detention. Siblings were less likely to be detained in both groups in comparison to abused children and the incidents o f siblings’ detentions among the two groups were fairly similar. Two chi-square tests were performed. The results indicated that the differences between the observed and the expected abused children detention cases between mothers who minimized the abuse and those who did not was significant. There were significantly more detained children in the group o f mothers who minimized than were expected. However, the differences between the expected and observed cases o f the siblings detention between the two groups o f mothers were not significant. Even though some mothers who believed the child were viewed as “minimizing” at time o f detention, the issue o f belief in the abuse allegation seemed to be most important to therapists and workers. They were more willing to accept that the mothers did not quite understand the consequences o f abuse for her child, but not believing the child indicated to them that the child was in great danger. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 105 Table 4 Abused Children and Siblings Detention by Mother’s Minimalization o f Abuse Group: No Minim (n = 35) Minimalization (a = 27) S % 1 % Abused Child: Detained 20* 59 24 92 Stayed w/Mother 15 41 3 8 Total 35 100 27 100 Sibling/s: Detained 13 38 9 35 Stayed w/Mother 22 62 18 65 Total 35 100 27 100 * p> M Using t-tests for differences in means, mothers who initially believed the allegations were compared to those who initially did not believe on the length of their therapy and the children’s length o f stay in foster care. Table 5 presents the results of the t-tests with the Levene’s test for equal variance. When the Levene’s test showed no violation o f the equal variance assumption, the pooled-variance t- test was used. Otherwise, the separate-variance t-test was used. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 106 Table 5 in the Abuse Allegation Believing Mothers Disbelieving Mothers ( n - 38) (a = 24) Mean SD Mean SD Months in Foster Care: Abused child 4.8* 7.4 14.6 9.3 Siblings 3.0** 5.8 8.1 5.6 Mother’s Therapy Sessions: 33.6** 17.3 46.2 28.6 * p < .01, * *p< .02 The results indicated that there was a significant difference in the length of stay in foster care for the abused child and the siblings (t = -2.061, p <.01, and t = -2.408, p< .02, respectively). Mothers who did not believe the abuse had their children stay in foster care significantly longer than did those who believed the abuse. In addition, mothers who did not believe were ordered to stay in therapy significantly longer than mothers who believed the abuse (t = 2.306,/? <.02). Overall, 23% o f the detained abused children and 17% o f their siblings were returned to their mothers’ care within a month. An additional 24% of abused children and 40% o f siblings were returned in six months, and another 13% of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 107 abused children and 20% o f siblings returned in a year. The rest, 40% of abused children and 23% o f siblings, stayed in foster care longer than one year. Changes in MIAC's Lives and Relationships After the Abuse Disclosure The sexual abuse disclosure marked a time o f major changes in the mothers’ lives and relationships. In the following sections, these changes in the mothers’ family constellation, work and income situation, as well as changes in her relationships with nuclear and extended family members are presented. Change in family constellation: Substantial changes in the family constellation occurred immediately following disclosure. In 76% o f the sample, the offender left the family residence. Seventy-three percent o f the sexually abused children and 50% o f the siblings were taken into foster care immediately after disclosure. Table 6 presents the placement o f the sexually abused children and their siblings following disclosure. The children’s detention was a cause for a much distress for the mothers. While workers believed that removing the children from the home guaranteed their safety, most mothers whose children were detained expressed extreme concern for the child’s physical and emotional well being. The citations below exemplify the effects of the separation on the mothers’ emotional state as well as their concerns for their children: Mother was very emotional tonight. She sobbed and expressed her frustration with the decision to keep her daughter in foster care. She said she felt unheard by the workers and that she did not know why her daughter had to be separated from her. She is worried that her daughter is not receiving the care she needs in the foster home... Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 108 All my children are away. I can not sleep at night. I am thinking about them. What if they are sick? What if they are sad? Notably, the mothers cited above, similar to other mothers whose children were detained, concentrated on the detention more than on the children’s sexual abuse. Mothers often expressed their belief that the detention added to their children’s trauma and prevented their healing. The following data on the children’s experiences in foster care may provide some validation for mothers’ concerns regarding detention. Twenty-one percent of the abused children in the sample (n=13) were placed in more than one setting (and up to three different foster care arrangements) before they returned to their mother’s care. Thirteen percent o f the siblings (n=8) were placed in more than one setting before they returned to their mothers. Ten percent o f the abused children who were detained were re-abused sexually by a different offender while they were in placement. In addition, while in placement, 7% o f the abused children were physically abused, 5% o f the detained siblings were physically abused, and 7% were neglected. In comparison to children who stayed with their mothers, those who were detained suffered lack o f stability, and experienced more sexual and physical abuse and neglect. None o f the children who stayed with their mothers were re-abused sexually or physically. Even when children were adequately cared for in foster care, many had difficulty adjusting and wished to return to their mothers. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 109 Table 6 Placement of Abused Children and Siblings Following Disclosure Abused children Siblings n % n % Left at mother’s care 16 27 29 47 Placed with relatives 19 31 12 20 Placed with non-relative 21 33 15 23 Placed at group home 5 8 2 3 Missing/ No siblings 1 2 4 7 Total 62 100 62 100 Children, especially the younger ones, often believed (even though they were given different explanations) that the detention was a punishment for their misbehavior. Children’s plea to their mothers, such as the one cited below, intensified the mother’s distress and feelings o f helplessness: My child is crying every time I visit her. She says: Mommy please take me home...I will be good...please don’t leave me here. Given that so many abused children and siblings were placed outside their home, only 21% of the mothers in the sample were not subject to role change. In 31% o f the sample, the mother became a single-parent right after disclosure. In most cases, the mothers handled this role change well. However, two mothers were overwhelmed by single parenting and their children were removed after a short Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 110 period during which the mother was unsuccessful in meeting the financial and caring demands o f the children. All but two mothers in this sample experienced changes in the family constellation. These two mothers were single-parents and the offender was a relative who was not living with the family. The rest, experienced the detention of the abuse child, the siblings, and/or the departure o f the offender. Thirty-nine percent o f the mothers were left by themselves because all their children were detained and the offenders were incarcerated or left the household right after disclosure. Mothers did not talk much about their own feelings about the offenders’ departure from the family. Perhaps it was because they feared the consequences of revealing their feelings about this issue to workers and therapists. They did, however, expressed deep agony, frustration and helplessness about the forced separations from their children. Once offender and children left, more than one third (35%) o f the mothers moved into new residences. Eighteen percent moved more than once during the three year period after disclosure. The main reason for moving was the mothers’ inability to pay rent after the offender stopped contributing financially. Other reasons included moving close to relatives for emotional, financial and/or practical assistance with child rearing responsibilities. Changes in Mothers’ Work and Income Situation: Most working mothers found that it was necessary to make changes in their work situation in order to accommodate the new situation created after the sexual abuse disclosure. Fifteen percent stopped working altogether after disclosure. Eleven percent changed their Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Ill working place. Ten percent moved from full-time to part-time positions within their working place and an additional 9% decreased their working hours per week. An additional 10% percent went from part-time to full-time positions in order to increase the family income. One mother who had not been working previously, took a full-time job due to the provider’s incarceration. Thirty-four percent o f the mothers reported that they experienced difficulty in their jobs due to the children’s situation and 23% reported that they experienced difficulty in their job due to their own mental health condition. The sexual abuse disclosure and the aftermath had a major impact on the family income. Only 32% did not report any change in their income. Almost 32% reported somewhat o f a decrease and 31% reported on a significant decrease in income. Only two mothers (5%) experienced an increase in income due to government’s assistance programs. The reasons mentioned for change in income were: changes in the mothers working situation (39%); the offenders’ lack of contributing to the family’s income; and the need to pay double rent and houses expenses due to court order stipulating that the offender reside away from the children. Overall, mothers in this sample varied considerably with regard to the amount o f changes that occurred in their lives after the child’s sexual abuse disclosure. The number o f changes ranged from 0 - 9 with a mean o f 4.98 changes (SD= 2.39). Few mothers whose children were left at home and the offender was already living away from the home experienced none or very little change. However, many experienced profound changes in their family structure, their place o f residence, their work and income situation. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 112 Changes in Mothers’ Relationship with Her Children: The issue o f the mothers’ relationship with their children received great attention from therapists and was also very important for the mothers. Several aspects o f the relationship were discussed in the records. First, mothers’ relationships with the abused child before and after disclosure were examined and described. Relationships were described as good when there was mutual trust and free communication between the child and the mother. Second, changes in mothers’ relationship with their non abused children were described. Specifically, mothers’ dilemmas o f what and how to tell the siblings about the sexual abuse and the offender were documented. Mothers often talked about what they do to keep the relationship with their children during the time they were detained. Mothers extensively described the changes and difficulties that they noticed in their children’s behaviors. In addition, therapists assessed the support that each o f the mothers provided to her abused child. Finally, the mother-child relationships were described toward the end o f therapy. Aspects o f the mother-children relationship will be briefly discussed in here. Nineteen percent o f the mothers reported that their relationship with their child was good to begin with, and continued to be good after disclosure and throughout therapy. The vast majority o f mothers (81%) reported that their relationship with the abused child became problematic after disclosure. Children were often reluctant to share information with their mothers. Some openly blamed the mothers and/or expressed much anger and resentment toward them. Twenty percent o f these mothers reported that the relationship continued to be problematic, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 113 while the majority reported that there was either some (36%) or major (24%) improvement in the relationship following therapy. Those mothers whose children were placed in foster care (73%), reported that the detention affected their relationship with their children because o f the distance and the limited communication with the children. All mothers were monitored in terms o f their visitation practices, but 10% o f the mothers could see their children only during monitored visitation. In these cases, the court was concerned that the mother visits would cause the child distress or that the mother would try to coerce the child to recount the abuse allegation. Ten percent o f mothers managed to continue their involvement in the children’s lives by visiting them every day. Five percent did not visit their children since they managed to receive them back within less than a week. Two mothers saw their children less than once a week because o f the distance involved and the mothers’ difficulty arranging transportation. The majority, however, visited their children at least once a week. Relationships between the mother and her non-abused children (the siblings) were also subject to change following disclosure. Sixty-one percent o f the mothers reported that their relationship with the abused child’s siblings became problematic after the abuse. Mothers were faced with the dilemma o f whether or not to tell the other children. Mothers who had older children, teenagers or young adults, did share the information with them and in all cases (13%) the grown up children supported their mothers and their abused siblings. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Most mothers, however, had younger children. In 27% o f the cases one or more siblings reported that they directly witnessed or otherwise became aware of the abusive relationships between their sibling and the offender before disclosure. Those who were not aware o f abuse, understood that something bad happened to their sibling, but they were not directly told by the mothers. Mothers did not tell young children for many reasons. Some believed that the children were too young to understand. Others were concerned that this information would hurt the children’s bond with their biological lather (the offender) or create hatred between the abused child and the siblings who would blame her for their father’s incarceration. Young children almost always figured out what was going on from conversations at home and during the therapy groups in which they participated. Since they were not directly told, it took them some time to figure it out. In most cases their knowledge was incomplete and not always accurate. Some siblings directed anger and disbelief toward the abused child. Others provided support and love. However, often siblings were confused and expressed disbelief and anger as well as support and love for their abused brother or sister. Most mothers reported that the siblings directed their anger for the loss o f their fathers, or brothers, who were offenders, as well as for their own detention, toward the mothers. Since the mothers were the one who were left to take care o f the children they had to deal with the children’s grief and frustration that was associated with the loss o f security and predictability after the abuse disclosure. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 115 Almost all mothers (89%) reported experiencing increased difficulties parenting the abused child and 65% reported having some increased difficulties parenting the siblings after disclosure. Table 7 presents the percentages o f mothers who reported that their children experienced difficulties (according to areas). Multiple difficulties were reported and thus they do not add to 100%. Table 7 Mothers’ Report on Changes in the Children’s Performances After Disclosure Abused child Sibling(s) (£= 62) (n= 55) Area o f Change: ___________ ____________ Behavioral: At home 71% 51% At foster care 27% 26% At school 57% 23% Lower performance at school 61% 21% Depression/ withdrawal behavior 72% 38% Sexualized behavior* 36% — Unrealistic fears & regression 44% 43% Relationship with: Mother 81% 58% Offender 96% 26% Siblings* 55% Extended family* 36% — Peers 35% 9% Difficulties - Court/DCFS 37% 36%* * Mothers did not report on change/ difficulties in the sibling(s) behaviors. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 116 Since in seven cases the abused child had no siblings living in the house, the number o f mothers reporting on sibling(s) behaviors is smaller (n = 55). As can be seen, MIAC’s reported that the abused children exhibited difficulties in many areas (M = 6.7; SD=2.1). Most siblings also exhibited difficulties in similar areas (M = 4.0; SD = 2.3). Some o f the difficulties that children in this study experienced were well- documented in previous studies as the short-term effects of child sexual abuse (e.g., relationship with the offender and the mother, or depression/withdrawal and sexualized behaviors). Others, were less expected and were either overlooked or rarely discussed in previous studies (e.g., relationships with peers, siblings and extended family). Moreover, the table indicates that siblings also were profoundly affected by the abuse disclosure. This can be explained by the changes that the siblings themselves were experiencing such as detention from mother, the offender’s departure from the family, change in residency and family income etc. The majority o f mothers (59%) were viewed by their therapists as consistent in supporting the abused child. These mothers were concerned with the child’s physical, emotional and psychological well being and encouraged the child’s participation in therapy and other activities that contributed to healing and adjustment. When children were detained, supportive mothers kept close contact with the child and continued their involvement in his/her life. The following description o f a therapist provides an example o f a relationship between a supportive mother and her child: Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 117 Ms. S. clearly saw herself as the person who was primarily responsible for the child’s welfare and acted accordingly. Child and her mother appear to enjoy a close relationship. They were affectionate and candid with each other. Some supportive mothers were viewed by therapist as becoming over-protective after the abuse disclosure and needed help in assessing the safety of their children in daily situations: Ms. C. believed her daughter and continues to be very supportive of her. She is able to empathize with her daughter’s pain as well as that o f other group members. She has made the protection o f her children her first priority, however, she appears to have gone to the extreme. For example, she believes it is unsafe for her daughter to walk to school alone. Twenty-two percent o f the mothers were non-supportive o f the abused child throughout. An additional 19% o f the mothers were non-supportive at first, but became either somewhat (9%) or very supportive (10%) during treatment. Mothers who became supportive were those who had more opportunity to be with the child in therapeutic settings and/or participated in mothers-victims group therapy. These mothers actively used therapy to understand more about their own feelings and their child’s experiences of, and reactions to, the abuse. Toward the end o f mothers’ therapy, 68% o f mothers reported that their relationships with the abused child had improved. Additionally, 42% reported improved relationships with the non-abused children. Mothers whose relationships improved, seemed to feel better about their parenting practices and found the child’s progress gratifying and signaling healing. Twenty-six percent o f MI AC did not report an improvement. It is unclear if they chose not to report or if the relationship Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 118 did not improved. The citations provided below exemplify the differences between the two groups o f mothers: My child is progressing very good. She is more involved with friends and she looks happier now. We do things together and I feel that she enjoys talking with me. My daughter is very rebellious now. She told me that she does not want to explain things because I won’t understand anyway. She screams at me and at her younger brother and prefers staying in her room by herself. Seven percent reported they enjoyed good relationships with their children prior to the abuse as well as after the disclosure. These few mothers who enjoyed stability in their relationships with the abused child seemed to have overcome other difficulties in the children’s performances earlier and with less difficulties than those who did not. To conclude, mothers’ relationships with the abused child and the siblings were affected not only by the child sexual abuse and the children’s detention, but also by the difficulties which the children exhibited after the abuse disclosure. Most relationships with the children were reported to be negatively affected, although with therapy many mothers experienced improvement in their relationships with the children. Regardless o f the difficulties experienced in these relationships, most mothers were supportive o f the children and some became supportive though the help o f therapy. Mothers’ Relationship with the Offenders: The majority (66%) of offenders in this sample were the mothers’ significant other. Almost all mothers expressed Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 119 anger at the offenders for abusing the child and for leaving the mother to deal with the consequences: I am very angry at him. Now he is just gone and I am the one who has to deal with her, with how moody and upset she gets. I am the one when she has bad dreams and can’t sleep that has to deal with it. Similar to this mother, those mothers who believed the child associated the child’s difficulty with the abuse and blamed the offender. However, 11% o f the mothers were consistently supportive o f their offending significant other. These mothers who did not believe that the offender abused the child, viewed the offender and themselves as the victims: My husband is innocent and he is the one who needs help. Now he lives away from the family and there is no one to cook his meals or wash his cloths... all this is a conspiracy o f my sisters, but I am standing by him until he’ll be able to come back home. Ten percent continued their relationship with the offender, however, they were continuously ambivalent and uncomfortable with the relationship. The reasons for staying in the relationship were mainly child-related. These mothers, as the following citation implies, viewed their stay in the relationship with the offender as temporary: I will never trust this man again. We were married for ten years and I am carrying his second child - I will stay with him for now, but I will never forgive him. Twenty-four percent terminated the relationship. These mothers consisted o f those who were not very happy with the relationship even before they learned about the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 120 child abuse. The mother cited below, for example, experienced violent attacks from her husband: I am sad to leave my husband but physically I feel good that I have left a bad situation. I feel as if a big burden was lifted from my shoulders. Some mothers who terminated the relationships felt happy before the abuse disclosure. However, after disclosure and during therapy they found out that they could no longer be happy in the relationship. Twenty-one percent expressed anger and separated from the offender, but they either considered reunification in the future (11%) or allowed conditional reunification after the offender completed therapy and the family developed a safety plan for the children (10%): I believe her ...but I don’t want him to go to jail for his mistake. He needs therapy and he needs to change. If he will comply (with court’s orders), then he can come back home because he needs to provide for his children and be with them. None o f the mothers were supportive o f offenders who were not significant others. These offenders were family relatives and while all mothers except one (30%) expressed deep anger at these offenders, only four mothers (7%) terminated the relationship with them The rest continued the relationship which became problematic. Mothers whose sons were the abusers o f a younger sibling expressed anger mixed with concerns for the physical and the emotional well being o f the offender as well as the abused child. Some o f these mothers often wondered if their sons, the offenders, were abused themselves, and /or whether they would turn out to be pedophiles. These mothers were interested in their sons receiving therapeutic help. However, in all cases but one, the sons left the family and fled from police: Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 121 Mother said she is very angry at her son for hurting his sister. She said that he ran away the moment he learned that the police was looking for him. She does not know where he is and feels worried about him. Mothers whose sons were the offenders felt responsible for the support of both the offender and the victim. The fact that all but one son-offender fled made the mother more worried and less angry with them. Mothers whose significant other were not the offenders experienced changes in the relationship with them as well. Eight percent experienced long-term conflict and alienation after the abuse disclosure. While the change in the relationship was related to the mother’s energy, time and concerns revolving around the abused child, it was also related to the blame these husbands placed on the mothers for the abuse o f the child. The following citation describes the way in which the abuse fueled old conflicts between mother’s family o f origin and her significant other: My husband blames me for leaving my child at my sister’s. He said your family is trash. I told you to keep away from them. Five percent experienced some difficulty in their relationships with significant others after disclosure. These significant others did not see the mothers as responsible, however, they were affected by the child’s detention and the mother’s agony. These relationship grew closer and more supportive with time and therapy. Only one mother whose significant other was not an offender reported no change her relationship with him. In terms o f mothers receiving emotional support from their significant others, 61% of those who were in relationships reported receiving no support (In many Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 122 cases, those partners or husbands were the children’s offenders.) Sixteen percent reported receiving limited support and 7% reported that they received good support from their significant other. In these cases, typically the mother believed the denying offender and the couple supported each other. Mothers’ Relationship with Family Relatives: After disclosure, the mothers’ first dilemma with regard to family relatives was whether or not they should be informed about the sexual abuse o f the child. In 10% o f the cases, the offender was part o f the extended family, therefore, the family already knew. Mothers considered the ways in which such information could change the relatives’ attitudes toward the abused child, the offender and the mother. Mothers also considered the possibility o f receiving support from their relatives. Twenty-three percent o f the mothers chose not to tell the family and 30% chose to tell only one or two members, but keep it as a secret from the rest. Thirty-seven percent told the family and consequently received help, but were also exposed to criticism and conflict with family members. In all, 76% o f the mothers reported changes in relationships with extended family members from either their side or their significant other’s side o f the family. Forty-six percent o f mothers received support and assistance from their side o f the family. Some mothers received more assistance than what they asked for. The mother cited below describes the way in which her brother reassured her: My brother took us in. He told me not to worry. He said as long as he lives he will always help me and my children. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 123 Family support, such as this, provided mothers who had just experienced betrayal, much comfort and reassurance. Unfortunately, very few mothers received similar, unconditional support. Many mothers who received family assistance, for example, taking the detained children to their homes, were at the same time blamed and criticized. The following citation demonstrate how punitive reactions from family members affected the mother’s perception o f self- worth and her feelings of social isolation: I am no good. I cannot even take care o f my own children. My family is angry with me. They blame me. My sister said: ‘You never listen, we told you your man is no good’. Now I have no one to talk to. I have no friends. I feel lonely. Twenty-six percent who turned to family members for help, did not receive it and in turn were blamed and rejected by their side o f the family. The following mother (who was also a battered woman) describes how she was turned off by her family. This mother’s family had previously helped her, but now criticized her for choosing the wrong partner: My parents said that I only know them when I need them. They think they already helped me enough and that I need [to] find other ways to help myself. Two mothers reported being supported and helped by members from the offenders’ side o f the family. Many more (23%) experienced blame and rejection from the offender’s side o f the family. His mother cursed me and my children. She thinks her son is an angel...that he was blamed for nothing. She thinks I told the police because I want to destroy him. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 124 When mothers received family assistance, it came in different forms. Eighteen percent took in the detained children and became their foster care families. Thirty-four percent provided emotional support and advice. Twenty-six provided financial support and/or temporary shelter for mothers and their children. Forty- eight percent o f mothers indicated that the assistance they received from members o f their family contributed to their recovery. Almost fifty percent indicated that blaming or problematic relationships with family members were a cause for their distress. To conclude, all mothers in this sample reported that relationships with at least some family members changed after disclosure. The number o f changes in relationships ranged from 1 to 12 (M= 6; SD = 2.4). The direction of the change varied. Some mothers created distance in their relationships with family members by keeping the abuse a secret. Others shared and received practical assistance, but less emotional support. Many mothers experienced blame, criticism and rejection. Mothers seemed to be especially pained by these changes. Some experienced increases in self blame and felt lonely and isolated. Overall, the therapists reported that 16% o f the mothers received no support from their social environment, 42% received limited support, 31% received good support and 11% were receiving excellent support after disclosure. Changes in MIAC's Physical and Psychological Well-Being After Disclosure: The therapists’ evaluations o f mothers’ well being at intake is usually the first report o f how the mothers were coping emotionally with disclosure. Fifty-three Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 125 percent o f the mothers were described by the therapist as being in shock during the intake. Sixty-eight percent were described as suffering from heightened anxiety or fears. The following citation, taken from the therapist’s evaluation o f a mother at intake describes her shock, fears and the effects of disclosure on her health. Most therapists addressed the mothers’ emotional state at intake. Few inquired about changes in their physical health: Mother was devastated. She cried constantly and expressed fears from what awaits her daughter. Apparently, she has been neglecting her health... She reported difficulty falling asleep. She lost a lot of weight and her menstrual cycle has stopped. During the first stage o f therapy, 20% o f mothers were reported to be physically ill. Mother’s illness ranged from common infections to high blood- pressure and other chronic diseases. A substantial number (71%) o f MI AC were assessed as being depressed at intake and 76% were described as expressing anger and/or blame toward self, child, the abuser and/or the system. Mothers, such as the one cited below, often described how the sexual abuse affected their self- esteem: I feel very bad and very upset. I think that if my child could not tell me what happened to her then la m a bad mother. I used to think I am a good mother, but now I do not think so anymore because I could not help my child. The despair, anger, and self blame brought about feelings o f hopelessness and a wish to die in almost one third o f the sample. Thirty-one percent o f the mothers reported thinking about committing suicide and 10% o f them made one or more suicide attempts. In the following citation, a child reports about her mother’s attempted suicide the day o f disclosure. Unlike other mothers who attempted suicide Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 126 away from the children’s sight, this mother, shattered by the news, was oblivious to her children and the public’s presence: After, I told my mom what happened, we left the restaurant and we walked in the street. Mother was very quiet, then she ran to the street and lied at the middle o f the road in front o f a bus. She cried: Kill me. Kill me... I want to die I asked her to stop because my young brother and sister were present. The bus driver picked her up and called the police. Everyone left the bus...She was crying all the time. That night she took the pills. Her sister came...found the bottle and called 911. Mothers’ suicide attempts were not very successful in drawing attention to their psychological state. None o f these mothers was hospitalized. None was reported to receive anti-depressant medications. Two received several one-on-one counseling sessions to stabilize their emotional state. Mothers (8%) who used drugs and/or alcohol before disclosure were reported to continue the use o f substances as a coping aid after disclosure. However, some o f these mothers (3 cases) were motivated later by the child’s removal, court and therapy to attend rehabilitation programs and successfully complete treatment for their substance abuse problems. None o f the mothers in this sample began to abuse substances as a result o f disclosure and none o f the mothers who abused substances was reported to consider or attempt suicide. Many o f the mothers were overwhelmed by the departure o f the offenders and the detention o f the children, especially because their lives were centered around their roles as wives and parents. This new situation was associated with mothers’ Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 127 feelings o f emptiness and loneliness. The mother cited below describes how she found herself confused and lost without her family around: My children are not with me, my husband is not with me: I am all by myself in the house and I do not know what to do. I feel like my whole family is tom in pieces. The one most distressful event for almost all mothers was the children’s removal to foster care. These mothers consistently talked about their pain associated with the detention, their wish to reunite, and their actions geared toward this goal. These mothers did not deal with their children’s abuse as much as they focused on the detention and their suffering they endured from it. Similar to many o f these mothers, the one cited below explained in group therapy why she believe that she deserve to get her children back and how unjustified it was not to return them: I begged the worker to return the children. I love my children. I know what they need. When my daughter told me what happened I believed her. I do not endanger the children. I care for them. I can not sleep at night thinking about them I would do anything to get the children back. I complied with the court, I go to therapy and I do all they told me to do. Why are the children still not home? To conclude, therapists’ reports on the mothers’ distress, physical illness, suicidal ideation and depression clearly indicate that this sample o f MI AC was profoundly affected by the child sexual abuse disclosure and its aftermath. The following section provides a different way o f assessing the mothers’ psychological and emotional well-being during the aftermath o f the abuse disclosure. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 128 Mothers’ Stress-Related Svmntoms: In addition to the therapists’ reports of the mothers well being at intake, all reported symptoms o f the mothers in the record files were registered in the “LA Symptom Check List”. This instrument, as described in the methodology section, was designed to detect PTSD and other stress- related symptoms among adults who experience traumatic events. The mothers’ overall symptoms scores ranged from 4 to 48 (M=21.1; SD.= 11.6). In addition to the overall score, two sub-scales were used to detect specific difficulties o f the mothers: the 17-items PTSD severity sub-scale and the 18-Items psychosomatic sub-scale. MIAC’s scores on the 17- items PTSD-severity sub-scale ranged from 2-16 (M= 10; SD.= 5.7) and their scores on the 18 psychosomatic items o f the LA Symptom Checklist ranged from 0- 6 (M =1.9; SD =1 .6) with severity (number o f times mother was reported to exhibited a psychosomatic symptom) ranged from 0-22 (M= 4.5; SD = 4 .6). MIACs’ results on the LA Symptom Checklist revealed that many (but not all) MIAC were suffering from high stress as exhibited in the specified measurements o f psychosomatic symptomatology, the PTSD severity sub-scale and the overall LA Symptom Checklist results. This sample results however, were much lower than the results o f other reported distressed samples. For example, female survivors o f child sexual abuse and battered women scored M=29.5, and M - 27.15 respectively on the 17-item severity scales, and 56.83 and 54.09 respectively on the complete 43-item scale (Astin et al, 1993; Houskamp et a l, 1991). The difference in the results between this MIAC’s study and other studies is most likely related to differences in data collection practices. In other studies, the LA Symptom Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 129 Checklist was used as a self reported measurement whereas in this study, the scores were collected from the therapists’ reports. Therapists did not focus in their reports on the mothers’ symptoms, rather, they were interested in her progress in addressing the children’s protection and their emotional-developmental needs. Therefore, it is believed that the mothers’ symptoms were only partly documented in their files and that the mothers themselves may have been better informants about their symptoms. These indicators point to the conclusions that MIAC’s psychological well being changed to the worse after their child’s sexual abuse disclosure. Mothers were reported to suffer from shock and depression, and experienced anger and loss. Some experienced physical illness, while many others exhibited psychosomatic symptoms. A considerable number o f mothers thought about death or considered suicide, and a few attempted suicide. In the next section, MIAC’s abusive history prior to their child sexual abuse disclosure is described in order to provide a relevant context to their experiences after their child sexual abuse disclosure. Mothers’ Relationships with Significant Others Before and After Disclosure Most mothers in this sample were in a relationship with significant others at the time o f disclosure. Only twelve mothers (20%) were not in a relationship at that time. Those who were in such relationships were asked about the quality o f their relationships at intake. Thirty percent o f the mothers described the relationships with their significant other before disclosure as being good. Twenty-seven percent o f the mothers described the relationships as somewhat conflictuaL, but also Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 130 somewhat satisfying, and 23% o f the mothers described the relationship as being mostly conflictual and unsatisfying. Thirty-four percent o f the sample reported incidences o f infidelity. Infidelity was mostly reported as initiated by the male partner (28%). Forty-three percent o f the mothers (25 mothers) separated from their significant other after disclosure, however, in more than half o f these cases the relationships were not stable and the couple had a pattern o f separations and reunifications. A high percent o f the mothers (57%) reported suffering physical abuse by their male partners before their child sexual abuse disclosure. Thirty-six percent reported the battering to be continuous and 23% described severe physical abuse (i.e., physical abuse that inflicted bruises or other injuries requiring medical attention). The following therapist’s documentation describes a MIAC in violent relationship: The mother is a young (26) woman who has three children with the offender. She suffers from contentious and severe domestic violence which resulted in hospitalization and miscarriage. She describes a love-hate relationship with her husband. Many mothers who were physically abused by their partners also reported being fearful for their lives and/or the lives o f their children. Thirty-seven percent o f MIACs’ partners were reported to threaten the mothers and/or the children before disclosure and 12% o f them used a weapon while threatening. Twenty-eight percent o f the mothers reported leaving their homes prior to the disclosure o f the child’s sexual abuse as a result o f domestic violence. Most mothers chose to temporarily reside at their family or friends’ houses. In addition, 13% of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 131 the mothers reported getting a restraining order against their significant other after an incidence o f domestic violence and before the child’s sexual abuse disclosure. Twenty-three percent o f the mothers and a similar percentage o f the children were threatened after the child’s sexual abuse disclosure, and 8% o f the mothers were subject to domestic violence by the offender after disclosure. The limited number o f mothers who suffered from abuse after disclosure is explained by the fact that in most cases the mothers’ abusers were also the child’s offenders who were incarcerated or fled immediately following disclosure. In cases where the violent husband was not the child’s sexual offender, mothers such as the one cited below described severe violence centered around the child’s abuse: He blamed me. He said I am the one who’s responsible for the abuse o f the child. He hit me and tried to kill me by choking me. My neighbor came in and stopped him. Nine percent o f the mothers got restraining orders against their significant others (who were also the child’s offender) after the child’s sexual abuse disclosure. For many mothers (49%), the abuse disclosure and the separation from the offender (who was also the violent spouse) put a stop to the mothers’ physical abuse. The overall percentage o f physical violence among mothers o f sexually abused children in this sample is higher than in the overall population, but similar to other samples o f M AC (Deblinger, 1994; Salt et al., 1990). The next section provides a description o f the prevalence and characteristics o f the other most commonly reported abuse experience of MI AC, sexual abuse in childhood. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 132 Mothers’ Own Experience o f Childhood Sexual Abuse Forty-eight percent o f the mothers reported that they never experienced child sexual abuse. Thirty-four percent o f the mothers reported being sexually abused before they turned 18 and 11 mothers (18%) were either not asked or did not tell whether they were subject to child sexual abuse. Eighteen o f the abused mothers reported the identity o f their offender. Three o f the mothers (14%) were abused by a father or a stepfather, three (14%) were abused by a different member o f the nuclear family and seven (34%) were abused by a member o f the extended family. Five mothers (24%) were abused by non-family offenders such as neighbors, family’s friend or strangers. The rest (14%) did not report the identity o f their offender. Seven (33%) o f the mothers reported that they were abused by more than one offender. Therefore, most mothers who disclosed the identity o f their offenders were abused by family members, although only a small group were abused by father or father figures. Most abused mothers (66%) reported that sexual abuse was long term and consisted o f intercourse. Twenty percent reported short-term abuse (less than five incidences) and 14% reported one-incidence o f rape. Finally, five mothers indicated that they became pregnant and four o f them delivered a child as a result o f the sexual abuse. Sixteen percent o f the sexually abused mothers did not disclose abuse when they were young. Thirteen percent disclosed abuse and reported that they were blamed or punished by their family. One mother revealed a particularly harsh experience o f being abandoned and re-abused as a result o f abuse disclosure: Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 133 Mother reported that she was raped and abused during childhood and that her family blamed her and throw her out to the street. She had no place to sleep and an older man took her in but he too sexually abused her until she ran away. Only one mother reported that she was supported by her family after disclosure. None o f the mothers received therapy following disclosure when young. This MIAC sample reported somewhat more histories o f CSA in comparison to the women’s nationally representative sample (29%), but less than the 44%- 50% found in other samples o f MIAC and MEFAC (Deblinger et al., 1994; Finkelhor, 1990; Leifer et al., 1993). It is believed that these differences in percentage reflect differences in methods o f data collection. For example, in this sample, not all mothers were directly asked whether they were sexually abused in childhood. In addition, some MIAC may have chosen not to report CSA to DCFS workers because of concerns over its possible effects on workers’ attitudes or their therapy ( Hiebert- Murphy, 1998). All mothers in this study, whether they were abused themselves or not, participated in therapy (at least 10 sessions). The next section describes the main characteristics o f mothers’ experiences in therapy. Mothers’ Experiences in Therapy The vast majority (95%) participated in therapy following court orders (i.e., non-voluntary) after the abuse disclosure. Eighty-five percent o f the mothers were held responsible for bringing the abused child to therapy alone or together with siblings. The agency provided various therapies for non-offending mothers. Ninety- Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 134 two percent o f MIAC received group therapy for non-offending parents. In addition, 33% participated in mixed groups o f mothers’ and victims. About half (47%) received some sessions o f family counseling and 55% received some sessions of individual counseling. Mothers’ length o f therapy varied from 11-127 sessions (M— 39 sessions, SD =23) and lasted from a few months to four years. In most cases (82%), mothers’ attendance in therapy was described by therapists as reliable ( i.e., the mother came regularly to therapy sessions). In a qualitative content analysis performed on mothers’ therapy documents, several aspects o f the mothers’ participation in therapy were identified. These aspects were documented by therapists in order to evaluate the mothers’ progress in therapy: mother’s willingness to share information with therapists and group members; mothers’ ability to receive/ provide support; changes in mother-children relationships and reunification; mother’s re-examination o f her relationship with partner; mother’s self care and mothers’ benefits from therapy. In addition, the files contained information about therapy termination and mothers’ attitudes toward therapy. Following is a short description o f these aspects o f mothers’ therapy. Mothers’ Information Sharing: Mothers varied in their willingness to share information with therapists and group members. About 45% o f the mothers were described as openly sharing information about their child’s sexual abuse and its impact on their lives. An additional 40% were described as sharing some information when approached, however, being somewhat guarded in their participation. The rest (15%) did not share or take an active part in their therapy. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 135 The following three citations from therapists files illustrate the differences between mothers who willingly shared information, those who were somewhat guarded and those who objected to therapy: Tonight, for the first time, Ms. X talked about her son’s molestation. She explained her difficulty in accepting the fact that he was abused. She also shared her worries regarding his sexualized and aggressive behaviors. Mother still does not talk in group sessions although she listens attentively to other group members. Ms. X kept silent the whole evening. When asked, she said she has nothing to say. She looked uninterested and left early. Many mothers were hesitant at the initial stage o f therapy, however, the percentages given above represent the mothers’ behaviors in therapy after the beginning stage. Many mothers who were physically and/or sexually abused shared their abusive experiences in therapy and consequently were offered additional therapeutic assistance. However, 16% o f the mothers, who prior to therapy, were identified in police and/or intake records as having a history o f child sexual abuse and/or spousal battering, chose not to share this information with their therapists and group members. Mothers’ Ability to Receive/Provide Support: About forty-seven percent o f MIAC mentioned that they were receiving good support from their therapists/ group members. Thirty percent indicated that they were receiving some support and about 21% indicated that they did not feel supported in therapy. The following two citations provide examples o f the different experiences o f those who enjoyed support Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 136 and those who did not. Notable is the contrast between those who felt part o f the group and those who did not fit the group. Mothers who did not believe the abuse allegation often experienced group pressure to believe: The group helped me a lot. The therapists care about me and the mothers listen and sometimes they have (a) good advice for me because they know how hard it is when something like that happens to you. Mother said she feels lonely and uncomfortable in the group. She is currently the only group member who is in denial o f the child’s sexual abuse. She was encouraged to talk about her feelings during the session. Changes in Mother-Children Relationships and Reunification: At the time of therapy termination, more than half o f the mothers (56%) whose children were detained received all their children back; 10% had some o f their children returned and 10% had none o f their children returned. For many mothers (54%), the happiness associated with the children’s return was mixed with the increased difficulty o f readjustment at home and feelings o f parental inadequacy. The mothers, cited below, typical o f those whose children were detained, mainly focused on receiving the children back. Only after the children were home again, did the mothers begin to fully experience the challenges o f parenting children who were abused and detained: I am so happy she is back with me even though it is not easy. Now she yells at her brothers to leave her alone. She refuses to help with house chores and she does not talk to me much. I know she still has a lot o f pain and I don’t know how to help her. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 137 Mothers also shared with their therapists and groups information regarding improvement in their relationship with the children. This information is presented under the section o f mothers’ relationship with their children. Mothers’ Re-Examination o f Their Relationships with Partners: Information about the mothers’ relationship with their partners is presented in a previous section, however, mothers’ participation in therapy allowed them to re-examine their relationships with their partners during therapy. Thirty-six percent o f mothers used this opportunity. Consequently, most terminated the relationships with their partners, but a few agreed to reunification. Mothers who chose reunification, such as the one cited below, often felt a need to use lengthy explanations for their choice, perhaps because they felt the therapists did not welcome it: He knows he was wrong. He cried and begged me to let him back. He completed his therapy and signed the protection plan... My daughter said she forgave him. I said: you may return home but I will never trust you with the children as before. Mothers’ Improved Self Care: Mothers’ appearance, energy level, daily functioning and moods were documented in the therapy files regularly. Twelve percent o f the mothers were reported to significantly increase their self care, energy level or daily functioning during therapy and 31% were reported to somewhat improve. The following citation reveals a connection between the mother’s self-care and the children’s return home: Ms X. was well-dressed and groomed this evening. She had a flower in her hair. She said she feels happy that her children are coming home for a sixty-day visit. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 138 However, more than half (56%) were reported by their therapists to experience prolonged difficulties in self care, energy level and/or daily functioning. The following citation also demonstrate the connection between the children’s situation and the mother’s situation: Mother looked sad and fell asleep during therapy. She reported experiencing difficulty eating and sleeping since her daughter ran away. It seems she blames her self. Mothers’ Benefits From Therapy: Mothers may have benefited from their therapy in different ways. They received support and information from group members and therapists. They were able to discuss and process their difficulties, increase their social contacts and establish new friendships. In their reports, however, the therapists largely focused on evaluating mothers’ progress in acquiring knowledge about sexual abuse and its impact on the children, improving parental skills, and increasing motivation to protect the children. The vast majority o f mothers (95%) were believed by therapists to have increased their knowledge o f sexual abuse and its impact on children. However, only 57% were believed to have “sufficiently increase their motivation to better protect the child from further abuse”. Only about one quarter o f the mothers (24%) were believed to have substantially improved their parenting skills. At time of treatment termination, 25% o f the mothers were assessed by the therapists as having met their therapy goals. More than half (56%) partially met their goals, and 19% did not meet therapy goals. Clearly, even at time o f termination, therapists still believed that most MIAC lacked parental skills and almost half o f them lacked motivation to protect their Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 139 children from further abuse. Once DCFS cases were closed, more than half o f the mothers were advised to continue therapy voluntarily. The following citations capture two different situations for which continued therapy was recommended. The first, describes a mother who did not benefit from group-therapy, and the second, a mother who benefited in many ways, yet was still advised to continue therapy: Mrs. A’s therapy was stopped due to the structural damage in the agency’s building. Mrs. A. attended 22 group sessions, however she felt uncomfortable opening up in a group, had difficulty in accessing her feelings and remained in denial regarding the severity o f her child’s abuse. She may have done better in individual therapy. It is recommended that the children will remain under court’s supervision and that mother will continue therapy in another agency. Mother has made good progress in treatment, becoming less depressed, less fearful, less timid and more assertive. Her low self esteem has improved and her ability to care for her children improved too... It is recommended that mother will continue to attend therapy voluntarily to strengthen her skills. Interestingly, while mothers often talked about the child’s abuse as a betrayal o f their trust, they did not talk about the betrayal they felt as their intimate partners sought sexual gratification outside o f their relationship. They did not talk about the effect of the abuse on their sexuality. Mothers also did not talk about being victims o f wife battering although some experienced severe violence and threats both before and after disclosure. Domestic violence was discussed only in the context of terminating relationships with a partner who was the child’s offender as well as violent toward the mother. Otherwise, these issues were largely neglected in therapy perhaps because therapists perceived them as not being directly linked to protecting the children from further abuse. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 140 Treatment. Termination: Thirteen percent o f MI AC left the agency early (after 10-15 sessions) when the DCFS case was still open. The reasons mentioned were: unhappiness with the quality o f services received, feeling uncomfortable being treated at the same agency where the offender was treated, or found an agency closer to their residence. About half o f MI AC (47%) told therapists they felt ready/or wished to terminate therapy and 40% indicated a need for further therapeutic assistance. In spite o f the therapists’ recommendations that 57% o f MI AC continue therapy on a voluntarily basis, only 17% chose to do so. Mothers’ Attitudes Toward Treatment: Regardless o f the benefits associated with MIAC’s therapy, most mothers experienced ambivalence toward therapy and some were described as resenting it altogether. Only a few openly expressed their discontent and objections. However, many mothers kept guarded during therapy and left the agency as soon as they were no longer obligated to come. Mothers’ ambivalence/objection was clearly evident in the therapists’ description o f mothers’ anger toward the “system” and in their reactions when their efforts to participate in therapy failed to result in reunification with the children. In the following case, the mother made it clear that she found no value in therapy other then receiving her children back: Ms. S. has made great efforts to attend and participate regularly in therapy. She was deeply disappointed from court’s decision to keep the children in foster care. She has been absent for the last three weeks and in a phone conversation she said she feels there is nothing she can do to get her children back. It is recommended that mother Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 141 will be visited at her home to increase her motivation to continue efforts in therapy. The following citation further demonstrates the way in which a recommendation for reunification was set as a reward for mother’s participating in therapy: Mother is very angry at the “system”. She does not connect her behaviors to the children’s detention. Mother’s attendance in therapy is sporadic...She claims she did not know she was supposed to come every week. Those mothers whose children were never detained or were returned to their care within a week to a couple o f months seemed to be more open and somewhat less ambivalent toward participation in therapy. MIACs’ attitude may have been influenced by their lack o f familiarity with counseling services. Most mothers participated in counseling for the first time after their child sexual abuse disclosure. Given the background o f these mothers, i.e., mostly non-Caucasian, and low to low- middle classes, mothers may not have had the resources to obtain counseling services or may not have believed in their usefulness in the first place. The fact that mothers were ordered, as opposed to being offered, to attend therapy likely contributed to their ambivalence. However, the influence of therapists’ progress reports on the court’s decisions regarding reunification with the children and case termination most likely contributed the most to their ambivalence. Since MIAC were at the time o f disclosure in great distress and in need o f assistance, therapy may have been welcomed at first. However, soon thereafter, mothers learned that there was a strong connection between their behaviors in Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 142 therapy and the therapists’ approval. Mothers became aware that specific behaviors were expected from them. They were expected to actively participate, share details about their children’s abuse again and again in group sessions, express belief in, empathy and concern for their children, and anger and rejection toward offenders. Mothers were perceived to be doing well in therapy when they did not express any doubts about the child’s abuse allegation. The expression of some self doubt or self blame regarding their protection o f the child or the quality o f their parenting was welcomed. They were also expected to express interest in becoming better parents and especially increase their protectiveness. These non-explicit expectations from mothers may have limited their exploration o f the meaning of their child’s sexual abuse disclosure in their lives and to their parenthood. The mothers learned (by observing other group members and by experience) that those who do not comply do not receive desired recommendations from the therapists. Their children stayed in foster care longer and they were required to participate in more therapy sessions than those who complied. Most mothers, therefore, complied, however, their objections were evident in the records: Ms. T said she felt therapy required too much time and did not help her much. I do not know these people and I do not want to tell it all over again. The worker told me I should come here every week. I need to get out o f work and come listen to other people talk about their problems. [?] I have enough o f my own. Therapists and MI AC were both doubtful o f each other. The therapists believed that most MIAC were not good-enough mothers. They called MI AC “the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 143 non-offending parents” however, they acted toward them as if they were “the non- protective parents”. Their descriptions o f the mothers revealed the belief that MIAC lacked parenting skills and failed to prevent the child abuse. Moreover, therapists believed that mothers still needed to increase their protectiveness and improve their parenting skills even when courts discharged the children to their mothers. Most MIAC participated in therapy unwillingly, but consistently, just as long as it took them to get the children back and have their case in DCFS closed. Many did not receive adequate support from therapy, for various reasons including: poor attendance, poor adjustment to group therapy, and therapists’ focus on performance as parents and protectors rather than on their psychological well-being. Summary o f Descriptive Results This study examined 62 mothers o f incestuously abused children. The mothers were physically healthy, fimctioning, relatively young, low-income, working-class parents from various origins with over-representation o f Latina immigrants. Most (80%) had a male partner. Some (30%) reported these partnerships were good, while many were either somewhat dissatisfied (27%) or very unhappy (23%) with the relationships. Unsatisfying relationships were associated with infidelity and violence from the male partners and a pattern of separation-reunification in the relationships. Most mothers had limited educational, economical, and social resources and these disadvantages may have increased their vulnerability to exploitation and victimization in childhood (sexual abuse 34%) and adulthood (domestic abuse 54%). The prevalence o f these types o f victimizations Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 144 among MIAC in this sample is greater than that in the general population of women (Finkelhore,1990). The abused children were also subject to harsh life experiences including sexual abuse by more than one offender (20%), physical abuse or neglect (25%), witnessing wife abuse (54%), and experiencing long separation from mothers (33%), prior to the sexual abuse disclosure. The sexual abuse varied considerably in severity and duration, however, more than half experienced continuous and severe abuse including digital penetration, intercourse, sodomy or rape. The offenders were mainly father/father-figures (73%); the rest were stepbrothers, brothers, grandfathers or other male relatives. One third o f offenders had a previous criminal history related to violence or sex crimes. Even though abuse allegations were supported by medical exams (42%), witnesses (30%) and offenders’ own confirmations (37%), charges were filed against 60% o f offenders and only 40% were found guilty. The study focused on the mothers’ experiences and behaviors after disclosure. Mothers’ behaviors revealed that the vast majority o f MIAC were neither neglectful nor careless. Those who became aware o f their children’s abuse before authorities tried to stop the abuse by confronting the offenders, blocking access to the child and/or reporting abuse to authorities immediately after they became aware o f it. In most cases, the abuse stopped following mothers’ interventions. It always stopped following mothers’ report to authorities. Some mothers (21%) tried to help their children without reporting to authorities. These mothers did not seek professional help for their children or themselves perhaps because o f cultural and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 145 class related beliefs about the usefulness and/or availability o f these services. Those who were not aware o f the abuse prior to formal disclosure tended to blame themselves for not identifying children’s behaviors as symptoms o f abuse. They often expressed sadness, grief and self-criticism with regard to their lack o f awareness o f the children’s abuse. Once abuse was disclosed, MIAC were investigated by police and DCFS workers. Their adequacy as parents was assessed with special importance given to their belief in the abuse allegations and their relationship with the offender. The majority o f mothers (61%) believed the allegations when they first heard it. However, a large number o f mothers (29%) initially did not believe the allegations. Almost all mothers whose partners were not the children’s offenders believed the allegations while those whose partners were the offenders had a harder time believing that their child was abused by them. Those who viewed the offender as a successful husband and/or father and those who were bonded with offenders tended to believe less than those who had a negative or ambivalent relationships with offenders. Mothers’ reasons for not believing the child were related to their understanding o f sexual abuse and on their perception o f the child’s character, and the child-offender relationships. A chance to directly and privately talk with the child immediately after formal disclosure as well as new information and evidence helped mothers believe their child was abused. Mothers’ belief, in many cases, was not a one-step decision. It was often described as a gradual process o f moving (sometime back and forth) along a continuum from shock and total disbelief to full acceptance o f the content and duration o f the abusive experiences, the identity o f the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 146 offender, the silence o f the abused child, and the consequences for each party involved, including the family as a whole. The day the abuse was officially disclosed, only one fourth o f the mothers were assessed as being capable o f protecting their children from further abuse. Consequently, 73% o f abused children and half o f siblings were detained. Children whose mothers initially disbelieved the allegations were always detained. Additionally, they stayed in foster care significantly longer than those whose mothers initially believed and their mothers stayed in mandatory therapy significantly longer than mothers who believed. None o f the children who stayed with their mothers were reported to experience further abuse; however, detained victims and siblings (20% and 12%, respectively) experienced neglect, and/or sexual, and/or physical abuse while in foster care. In addition, many experienced difficulties in adjusting to foster care, and about one third (34%) were relocated. Following court intervention, 22% o f mothers received their detained children back within less than a month and an additional 25% were returned within less than six months. These data suggest that child protective workers tend to detain more sexually abused children and siblings than is maybe necessary and that this practice endangers the children, creates separation traumas, adjustment difficulties, and delays healing o f both children and mothers. After abuse disclosure, the vast majority o f mothers experienced profound changes in the family structure and in their roles as mothers, wives and workers. Many were left alone following the detention o f children and incarceration/escape of Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 147 offenders. The majority o f these already low-income mothers, suffered loss of income and about one third moved to smaller, cheaper residences. Mothers experienced difficulty in their jobs related to the abuse disclosure and its aftermath and changes in their working situation was often made (60%) to accommodate the children’s needs and the loss o f the offenders’ income. Mothers’ relationships with extended family members almost always changed. Mothers became more guarded and distant when the abuse was kept a secret. Others who shared the disclosure with family, received temporary shelter, assistance in caring for detained children or financial assistance and support. Many, however, reported being criticized and blamed by family members, practices that increased the mothers’ distress and loneliness. Mothers also experienced blame and criticism from non-offenders significant others who placed responsibility for the abuse on them. Their relationships with abused children and siblings became problematic in the vast majority of cases. Mothers reported difficulties in parenting the children because their emotional and behavioral problems increased considerably. Nevertheless, most mothers were consistent in supporting the children. Some became more supportive through therapy, and one fifth remained non-supportive all through therapy. Mothers who believed the allegations expressed intense anger toward all offenders. Relationships with sons-offenders were never terminated. However, relationships with offenders who were other family relatives were almost always terminated. Mothers who were previously unhappy with significant others/offenders terminated the relationships. Those who previously had a good or ambivalent Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 148 relationship with significant others/offenders and viewed offenders as remorseful and as willing to change through therapy considered reunification or reunified. Some who believed the relationship was good before disclosure firmly terminated the relationships after disclosure. Overall, MIAC were profoundly affected by the abuse o f their children. Many experienced devastation and shock, heightened anxieties, and distress. They commonly struggled with anger, helplessness, betrayal, loss, and grief. Some became ill; many experienced depression. One third developed suicide ideation and some carried out suicide attempts. Mothers’ distress was further aggravated and prolonged by the children’s detention and by blame and criticism directed at them both non-directly and directly from CPS workers and therapists as well as their social surroundings. The majority o f MIAC were suffering from stress related symptoms as measured by the psychosomatic symptomatology sub-scale, the PTSD severity sub scale, and the overall LA Symptom Checklist results. In addition, more than half were reported to experience prolonged difficulties in self care, low energy level and/or daily functioning. In terms o f support for the mothers, half o f mothers were reported to lack adequate support from their natural social environment. Mothers were reported to benefit from therapy. They received information about the abuse and its impact. They established new friendships and received support from others in their situation. However, MIAC and therapists were suspicious o f each other. Many therapists tended to believe that most MIAC were not good-enough mothers and that they failed to protect their children from the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 149 abuse. Many therapists believed that most MIAC needed more therapy than the court believed was necessary. Most MIAC reacted to this indirect criticism. They participated in therapy sometimes unwillingly, but consistently, as long as it took them to receive the children back and have their case in DCFS closed. Many did not receive adequate support from therapy, for various reasons including poor attendance, poor adjustment to group therapy and therapists’ focus on roles performance as parents and protectors rather than on the mothers’ own needs and psychological well-being. Figure 1 presents the three major areas in which changes in MIAC’s lives were commonly reported after the child’s sexual abuse disclosure. Changes that were typically experienced as negative are marked as broken arrows, while those that had a potential ofbeing experienced as positive changes, even though they were not experienced as positive for all MIAC, are marked as straight arrows. To the left, the area of social context describes the many different social relationships in which the mothers experienced changes. In most cases, the change in the relationship was experienced as negative. Negative changes could manifest by feelings o f distrust, anger, and blame, difficulty in communication, or complete termination o f the relationships. Relationships with extended family, friends and neighbors were always reported to change either positively or negatively. Newly established relationships with therapists and members o f the support groups were also experienced as negative or positive by the mothers. Accordingly, these relationships are presented as changes that could be either positive or negative. Extended families that provided Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 150 strong affirmation and nonjudgmental support for MIAC encouraged the mothers to develop greater closeness and reliance on extended family members for help. In these cases, MIAC reported that the changes in their relationships with the extended family were positive. Similarly, when therapist were accepting and supportive o f M AC, the mothers reported that they found the relationships to be positive and benefitting. However, many M AC reported that they felt criticized by therapists or members o f the support group. Others reported that they were blamed by their friends and families. In these cases M AC reported that they experienced negative and stressful changes in the relationships. Typically, even those relationships that had a potential to support the mother, were experienced to some degree as challenging. For example, while mothers received help and support from family and friends, they were also exposed to criticism o f their parental performances, or the mate they chose. Supportive relationships with therapists and group members developed over time and were marked by some ambivalence because o f the therapists’ perception o f M AC as non- protective and their control over M A C ’s reunification with the children and termination o f therapy. Not all mothers benefited from the group’s potential to be supportive o f them. Those who did developed trust and support gradually. In Figure 1, to the right, the changes that typically occurred in the physical context of M A C ’s lives are listed. All changes in this area were experienced as negative or as stress inducing. M AC usually moved in with relatives, or to smaller homes in less desired neighborhoods. They had to alter and adapt their vocational situation, their income declined, they were exposed to public scrutiny and were Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 151 perceived as inadequate parents, their children were detained and they were subject to long term court and CPS supervision. These events triggered changed in the intra-personal context. Most MIAC experienced deterioration in their emotional well-being, some became physically ill and many experienced depression and PTSD symptoms. Suicide ideation was experienced by more then a third and some carried out suicide attempts. Mothers’ parental role was changed by the removal o f the children to foster care and/or the departure o f the offender/father from the home. After reunification, mothers experienced an increase in their responsibilities as parents and simultaneously an increase in the children’s emotional needs. MIAC’s self-esteem as parents and most likely as partner was negatively affected, and they suffered from lack of energy/interest in self care. The mapping o f the various areas in which changes typically occur in MIAC’s lives shortly after disclosure may be helpful in comprehending the dramatic turn in these mother’s lives. However, Figure 1 does not tap into the relative importance o f each o f these changes to MIAC or the overall impact o f these various changes on the mother’s well-being or functioning in her social roles. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Figure 1. Changes in the Lives of Non-Offending Mothers Shortly After Child Sexual Abuse Disclosure The Social Context Relations with: • Child’ s Offender • Non Offender Partner • Abused Child • Other Children • Extended Family • Friends and Neighbors • Therapist • Support Group The Intra-Personal Context Depression and/or PTSD Symptoms The Physical Context Mother A ^ Self-Esteem •Self Care ■ •Parental Role Functioning A Negative Change Possibly Positive Change Residence • Vocational Work • Income • Investigations by Police, CPS, Medical Team • Court Involvement • Children’ s Detention 153 Bivariate and Multivariate Analyses Differences in Psychological Well-Being.. Life Change. Relationship Strain and Social Support bv Sub-Groups of MIAC In this section, the results o f a series o f comparisons of different sub-groups o f MIAC are reported. The comparisons attempted to determine whether some subgroups o f MIAC experienced more stress or difficulty in their psychological well being, social relationships, or overall life changes than other MIAC after the child’s sexual abuse disclosure. In many o f the comparisons, t-tests were used to compare the means o f two groups. When the Levene’s test showed no violation of the equal variance assumption, the pooled-variance t-test was used. Otherwise, the separate- variance t-test was used. When the hypotheses tested indicated a direction, one-tail significance level was reported. Otherwise, two-tail significance level was reported. Differences bv History o f Childhood Sexual Abuse The differences in psychological well-being, life change, relationship strain and social support by MIAC’s history o f childhood sexual abuse were examined here. Twenty-one MIAC (34%) reported a history o f childhood sexual abuse and 30 (48%) reported no history o f child sexual abuse. Eleven MIAC were either not asked or did not voluntarily report a history o f child sexual abuse and therefore were excluded from this analysis. First, the hypothesis that MIAC who were sexually abused in childhood experienced significantly more difficulties in their well being in comparison to Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 154 MIAC who were not sexually abused was examined using two t-tests comparing mothers’ overall stress-related symptoms (LA symptoms checklist) and mothers’ PTSD-related symptoms (PTSD 17-item sub-scale) between the two groups of mothers. Table 8 indicates that mothers who were sexually abused in childhood reported experiencing significantly more stress-related symptoms than MIAC’s who were not sexually abused in childhood (t = 1.834, p< .001). More specifically, examination o f the differences per-item revealed that they reported being easily fatigued, depressed and suicidal more than mothers who were not sexually abused in childhood. The results o f PTSD-related symptoms also indicated that MIAC who were sexually abused in childhood experienced significantly more PTSD related symptoms than those who were not sexually abused in childhood (t = 2.716, p< .002). In particular, they reported more vivid memory o f unpleasant prior experiences than mothers who were not sexually abused in childhood. The results indicate that MIAC who were sexually abused in childhood experienced more difficulty in their psychological well being than those who were not abused in childhood in the aftermath o f their children sexual abuse disclosure. Some o f their symptoms may be associated with remembering their own sexual abuse in childhood. Table 8 also presents the groups’ standard deviations which indicate that there were large variations within the groups on the overall stress related symptoms and the PTSD sub-scale. These variations suggest that child sexual abuse history does not affect all mothers’ psychological well-being to the same extent and/or that Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 155 child sexual abuse history is not the only variable that affects the mothers’ well being after their children’s sexual abuse disclosure. Additionally, four t-tests were performed to examine the hypotheses that MIAC who were sexually abused in childhood differ from MIAC who were not sexually abused in childhood in: 1) the amount of difficulty they encountered in social relationships (STRAIN: a variable measuring the number o f relationships reported by the mother to change for the worse after disclosure); 2) the overall number o f life-changes in the mother’s life including family structure, income, vocational and residential changes (LIFECHANG); 3) the overall number of individuals (family and social network) that supported MIAC (FAMSUPPORT); and 4) the overall support (ALLSUPPOR) received from informal (friends, family) and formal support (therapists, group). T-test results, presented in Table 8, indicate that there was no significant difference in the amount o f strain on mothers’ social relationships between MIAC with CSA history and MIAC without CSA history. Further, there was no significant difference between these two groups o f mothers in the number o f changes that occurred in their lives after the child’s sexual abuse disclosure. That is, CSA history, although associated with greater psychological stress, is not associated with increased social strain or greater changes in MIAC’s lives after their child’s sexual abuse disclosure. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 156 Table S Psychological Well Being. Life Change. Relationship Strain and Social Support Among MIAC Who Experienced CSA and MIAC Who did not MIAC with MIAC Without CSA History CSA History (n = 21) (n = 30) M SD M SD Stress- Related Symptoms* 27.2 10.2 17.9 10.7 PT SD -17 Item Scale ** 12.9 4.7 9.2 5.5 Overall Life changes 5.1 2.7 4.3 1.8 Strain 4.1 1.3 4.5 1.2 Informal Support** 1.0 0.8 1.7 1.2 Overall Support 3.8 1.5 4.4 2.0 * p > . 001 ** p > .002 Table 8 also indicates that there is a significant difference (t = -2.559, p <. 002) between MIAC with CSA history and those without it in terms of support received from their social environment. The difference in the means suggests that those without a CSA history were, on average, supported by two family/friends while those with CSA history were usually supported by only one friend/family member. The two groups o f MIAC reported that the therapists and group- therapy members contributed to their support but the difference in the groups’ means on the amount o f overall support received was not significant (p = .19). These data suggest Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 157 that MIAC with CSA history, when offered, do tend to use support through therapy, perhaps to compensate for their lack o f informal support. Differences bv History o f Being a Battered Woman The differences in psychological well-being, life change, relationship strain and social support by MIAC’s history o f being a battered woman are examined in here. There were 23 mothers in this sample who did not have a history o f physical battering by their spouses (37% o f the sample) and 35 mothers who had such history (57%). In four cases it was not reported whether the mother was physically abused or not and these cases were excluded from the analysis. First, the hypothesis that MIAC who were battered women and those who were not differ significantly in their psychological well being was examined using two t-tests comparing mothers’ overall stress-related symptoms (LA symptoms checklist) and mothers’ PTSD- related symptoms between the two groups o f mothers. Table 9 indicates that MIAC who were battered women reported experiencing significantly more stress-related symptoms than MIAC who were not battered (t = -3.764, p < .001) More specifically, examination o f the differences per item revealed that they reported being easily fatigued and depressed more than mothers who were not battered. The results o f PTSD-related symptoms also indicated that MIAC who were battered women experience more PTSD-related symptoms in comparison to those who were not battered. The results were not statistically significant although they did approached significance (p -.072). Taken together, the results indicate that MIAC Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 158 who are battered experience more stress related symptoms and therefore more negative effects o f their child’s sexual abuse on their psychological well being in comparison to non-battered MIAC. Table 9 also indicates that the differences in standard deviations between the groups o f MIAC on the overall LA Checklist of stress relates symptoms and on the 17-items PTSD sub-scale are fairly large suggesting that the within-group differences were large and that a history o f being a battered woman may not be the only variable that affects the mother’s psychological well-being. Next, Table 9 presents the results o f a t-test performed to examine the differences in life changes among battered and non-battered MIAC. The means o f the groups indicate that mothers in both groups tended to experience similar number o f changes after the abuse disclosure and that the difference between the groups was not statistically significant. Three more t-tests were performed to examine differences between battered and non-battered MIAC in terms o f negative changes in social relationships (Strain), informal support, and overall support received after disclosure. The results presented in Table 9 indicate no significant differences between the two groups with regard to experiences o f strain in social relationships, support received from informal network and the overall support received. Therefore, it seems that although battered women are generally characterized by a tendency o f social isolation, in this sample, MIAC who were also battered women were able to increase their sources o f support through therapy and group participation similarly to MIAC who were not battered. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 159 Table 9 Psychological Well-Being. Life Change. Relationship Strain and Social Support among MIAC Who Are Battered Women and Those Who Are Not Battered Women Not Battered Women (n = 35) (a = 23) M SD M SD Stress- Related Symptoms* 24.7 11.6 16.9 9.9 PTSD -17 Item Scale 11.7 5.4 8.5 5.5 Overall Life changes 5.2 2.3 4.7 2.3 Strain 4.4 1.3 4.4 1.5 Family Support 1.4 1.0 1.2 1.2 Overall Support 4.0 1.8 3.8 2.1 *P>.001 Differences by Combined Histories o f CSA and Battered Woman The differences in psychological well-being, life change, relationship strain and social support among MIAC who experienced both sexual abuse in childhood and wife battering, those who experienced either sexual abuse in childhood or wife battering and those who did not experience any o f these abusive events. One-factor ANOVA tests were performed. Three groups o f MIAC were compared: MIAC who experienced both sexual abuse in childhood and physical abuse by a spouse (n = 12), those who experienced only one victimizing event (either child sexual abuse or Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 160 spousal abuse (n=32), and those who did not experience any of these victimizing events (n= 18). Three hypotheses were examined. First, that there is a difference among the three groups o f MIAC with regard to the changes in their well being; second, that there is a group difference with regard to changes in their strained social relations after the child’s sexual abuse disclosure and third, that the three groups differed in the amount o f change experienced in their lives after their child’s sexual abuse disclosure. In all o f the tests, the independent variable was mother's CSA history and physical abuse. The dependent variables were: mother’s overall stress related symptoms (LA Symptom Check List), mothers’ score on the 17-item PTSD scale, number o f negative changes in social relationships (Strain) and overall number o f changes in lives after abuse disclosure (Lifechange). Tests o f homogeneity of variances were non significant for all tests. Table 10 presents the ANOVA results. The results indicate significant differences between at least two o f the groups on the overall stress related symptoms and on PTSD- related symptoms. Table 11 presents the results o f the Tukey Pairwise comparison tests that indicate statistical significant differences between all three groups o f mothers. MIAC with no abusive experiences experienced the least number o f stress-related symptoms and MIAC with both child sexual abuse and battered women history exhibited the greatest number o f stress-related symptoms. Furthermore, the results suggest that being sexually abused in childhood and a battered woman in adulthood has a compounding effect on the mothers’ psychological well being. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 161 Table 10 Analysis o f Variance for Psychological Well-Being. Life Change. Relationship Strain and Social Support among MIAC With CSA and Battered Women History. MIAC With Either CSA Or Battered Women History and MIAC With Non-Abusive History Sum ofSauares df Mean Sauare F Stress-related Symptoms Between 1,946.5 2 973.2 9.20* Within 6,241.7 59 105.7 Total 8,188.2 61 PTSD Between 340.1 2 170.1 6.22** Within 1,622.8 59 27.5 Total 1,962.9 61 STRAIN Between 8.2 2 4.1 2.47 Within 98.2 59 1.6 Total 106.5 61 LIFE CHANG Between 4.1 2 2.0 0.37 Within 320.9 59 5.4 Total 325.0 61 Note. *p > .001 ** p > .004 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 162 Table 1 1 Stress-Related Symptoms Among MIAC With CSA and Battered Women History., MIAC With Either CSA or Battered Women History and MIAC With Non-Abusive History Group By Number o f Abusive Experiences n M Non 18 13.8 One 32 22.3 Two 12 30.3 Note. Differences among all groups were significant at p > .001. Table 12 presents the results o f the Tukey Pairwise comparison tests on mothers’ PTSD stress-relates symptoms. The results indicated statistical significant differences between MIAC who were neither sexually abused in childhood nor physically abused by a spouse and the other two groups o f MIAC. The results indicated that mothers who had no history o f physical or sexual abuse experienced very few PTSD-related symptoms, while those MIAC who had a history of sexual and/or physical abuse tended to exhibit almost double the amount o f PTSD related symptoms as the victimized-free MIAC. Furthermore, the results indicate that being victimized sexually or physically is sufficient for the significant Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 163 Table 12 PTSD Related Symptoms Among MIAC With CSA and Battered Women History. MIAC With Either CSA or Battered Women Historv and MIAC With Non-Abusive History Group By Abusive Experiences n M Non 18 6.5 One 32 11.2 Two 12 12.6 Note. Differences among all groups were significant at p > .004. Table 10 also presents the results o f comparing the three MIAC groups on the amount o f negative changes in their social relationship. The results indicated that the three groups o f MIAC do not exhibit clear statistically significant differences in the amount o f negative change occurring in their social relationships after the abuse disclosure. However, the probability level obtained (p = .093) does approach significance. Examining the mean differences among the groups reveals that those MIAC who had no history o f physical or sexual abuse experienced fewer changes in their social relationships (M=3.75), while those MIAC who had a history o f sexual and/or physical abuse exhibited more negative changes in their social relationships (M= 4.22) and those MIAC who had both a history o f physical and sexual abuse exhibited the most negative changes in their social relationships (M= 4.68). Using a larger sample may help clarify the relationship between a history o f mother’s abuse and the negative changes that occur in her relationships with her social surroundings. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 164 No differences were found on the overall life changes that the mothers experienced after the child sexual abuse disclosure. Differences bv Single/Shared Parenthood In here, the differences in psychological well-being, life change and relationship strain between MIAC who were single parents and those who shared parenting were examined. In this study there were 46 mothers who shared parenting with a male partner (74%) and 16 mothers who were single mothers (26%). First, the hypothesis that MIAC who were single parents differ from those who shared parenting in the difficulties experienced in their well being was examined using two Mann-Whitney tests comparing mothers’ overall stress-related symptoms (LA Symptoms Checklist) and mothers’ PTSD-related symptoms. Non-Parametric statistics were used in here and elsewhere whenever the uneven distributions of subjects in the groups seriously violated the assumption o f equal variance that is underlaying the use o f parametric techniques. The results presented in Table 13 indicate the groups did not differ significantly in overall stress related symptoms (Z = ~.2A,p = .981). The single parents group experienced more PTSD-related symptoms than those who shared parenthood. This difference, however, was not statistically significant, although it does approach significance level (Z = -1.613, p ~ .107). Overall, the results o f these two tests do not support the hypothesis that single parent MIAC experienced more difficulty in their psychological well-being after their children’s sexual abuse Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 165 two tests do not support the hypothesis that single parent MIAC experienced more difficulty in their psychological well-being after disclosure than mothers who shared parenthood, although a larger sample may provide a clearer picture on this issue. Table 13 Psychological Well-Being. Life Change and Relationships Strain among MIAC Who Shared Parenting and Those Who Were Single Parents Group: Single Parents Shared - Parenthood (n = 16) (n = 46) Mean Rank Mean Rank Stress- Related Symptoms 31.6 31.5 PT SD -17 Item Scale 37.8 29.3 Overall Life changes 27.0 33.0 Strain 33.5 30.0 Note. There were no statistically significant differences between the groups. Table 13 also presents the two groups non-significantly different mean ranks on strained social relationships (Z = .569, p = .981) and overall life changes (Z = -1.16, p = .246). Overall, it seems that coping with the sexual abuse o f a child as a single parent creates as many life changes and is as stressful and damaging to the mother’s social relationships as having a partner who is the child’s offender. Differences by MIAC’s relationship with offender In here, the differences in psychological well-being, life change and relationship strain between MIAC whose child’s offender was their male partners Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 166 and those whose child’s offender was another family relative were examined. In this sample, 45 mothers were married to (or co-habitated with) their child’s offender and 17 mothers had other family connections with their child’s offender. First, the hypothesis that these two groups of mothers (MIAC whose partners were the child’s offenders and those whose child’s offenders were other family relatives) differ in their well being was examined using two Mann-Whitney tests comparing mothers’ overall stress-related symptoms (LA Symptoms Checklist) and mothers’ PTSD- related symptoms. The results presented in Table 14 indicate that as a group, those whose child’s offenders were other family members experienced somewhat more symptoms than those whose partners were the child’s offender. However, this difference was not statistically significant (Z = -.663, p = 507). The groups’ mean ranks did differ on PTSD-related symptoms (Z= -1.780, p = .075), However, the results only approached significance. Based on these results, the hypothesis that the two groups o f mothers differ in their well being was not supported. However, a larger sample o f mothers whose children were abused by other family relatives may further clarify if indeed these two groups o f MIAC do not differ in their well being. Two additional Mann-Whitney tests that compared the mean ranks of the MIAC groups with regard to the reported overall number of life changes and number o f strained relationships resulted in no statistically significance differences, although both results did approached significance (Life Change at Z = -1.576, p = .115, and Strain at, t = -1.588, p = .112). The results suggest that while mothers whose partners are offenders tend to experience more changes in their lives, MIAC Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 167 whose children’s offenders are other family relatives may experience more strain in their social relationships and more PTSD related symptoms. The small number of MIAC whose children’s offenders were family members may have limited the analysis. Table 14 Psychological Well-Being. Life Change and Relationships Strain Between MIAC Whose Child’s Offender Was Their Male Partner Or A Family Relative Group Offender was a Family Relative (n = 17) Offender was mother’s Male-Partner (n = 46) Mean Rank Mean Rank Stress- Related Symptoms 34.0 30.6 PTSD -17 Item Scale 38.1 29.0 Overall Life changes 25.6 33.7 Strain 37.3 29.3 Note. There were no statistically significant differences between the groups. Differences by Children’s Detention In here, the differences in psychological well-being, life change and relationships strain between MIAC whose children were detained and MIAC whose children were not detained were examined. In this sample, there were 45 mothers (74%) whose children were detained after disclosure and 17 mothers (26%) whose Reproduced with permission of the copyright owner. Further reproduction prohibited without permission 169 Table 15 Whose Children Were Detained and MIAC Whose Children Remained Home MIAC with: Detained children Non-Detained children O B = 45) (1 = 1 7 ) Mean Rank Mean Rank Stress- Related Symptoms 32.3 29.5 PT SD -17 Item Scale 30.2 34.8 Overall Life changes* 38.7 12.5 Strain 31.6 31.2 * p > .001 It is interesting to note that while the two groups o f MIAC experienced similar overall stress-related symptoms, some MIAC whose children remained at home experienced high PTSD-related symptoms although they experienced much less change in their lives. These results suggest that the daily parenting o f an abused child and the siblings in the home can be as stressful as the removal o f the children and other changes that are associated with that (i.e., changing residency, reduced income). Mothers’ stress in these two groups, however, may be related to different sources. While MIAC whose children remained at home may exhibit stress-related symptoms due to actively assisting their children to heal from the abuse, M LAC whose children were detained were stressed due to the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 170 separation from their children and their need to convince DCFS and the court that they could provide safe and caring parenting to their children. The comparisons among groups that were performed in this section as well as the previous qualitative analysis suggests that mothers’ level o f stress may be affected by several variables including: mothers’ sexual abuse history, mothers’ history o f domestic violence, number o f life changes after disclosure, children’s removal to foster care, negative changes in mothers’ relationship with family and friends, as well as the support provided by mothers’ family and friends. To explore the extent to which these factors impact or predict the mothers’ well being after her child’s sexual abuse disclosure, a multiple regression analysis was performed. Factors Associated With MIAC’s Stress-Related Symptoms: A Multiple Regression Model The multiple regression model examined a group o f variables that in qualitative and/or quantitative analysis performed in this study seemed to influence mothers’ psychological well-being. The qualitative data analysis suggested that the amount o f life changes, strain in relationship, and informal support were important variables that were possibly affecting psychological well being. The qualitative data also suggested that the removal o f the children was associated with mother’s distress. The previously performed statistical tests in this study indicated that a number o f variables were associated with mothers’ stress-related symptoms including MIAC history o f CSA, MIAC history o f spousal abuse and the amount of life changes after disclosure. Other variables, such as the amount o f strain and support in MIAC social relationships were also included in the regression analysis Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 171 because they approached significance in previous statistical analysis and because theoretically they are believed to be associated with mothers’ well being (Antonucci, 1990; Hiebert-Murphy, 1998; Tan et al, 1995). In the multiple regression analysis the dependent variable is mothers’ stress- related symptoms’ level (LA Symptom Checklist); the independent variables are: Mothers’ history o f child sexual abuse (dichotomous), mothers’ history of being a battered woman (dichotomous), the overall number o f life changes that mothers experienced following the child’s sexual abuse disclosure (ratio), children’s removal to foster care after disclosure (dichotomous), number o f friends and family members who supported the mother after disclosure (ratio), and number o f negative changes in the mothers’ relationships with family and friends (ratio). A correlation matrix o f the variables that were included in the regression was performed and revealed no problems o f multi-coliniarity. The regression analysis resulted in an adjusted R square o f .361 indicating that taken together, the independent variables in the model account for 36% o f the variance o f the mother’s overall stress related symptoms’ level as measured by the Los Angeles Symptoms Checklist (F = 5.709;p = .003). Table 16 presents the standardized Beta Coefficients o f the independent variables and their significant levels. Examining the standardized Beta coefficients reveals that in a decreasing order from greatest to least, the variables Mother’s CSA history, Strain in her relationships, Life changes and Mother’s history o f spousal abuse positively and significantly relate to the mothers’ level o f stress symptoms. More specifically, histories o f CSA and spousal abuse were both associated with more stress-related Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 172 symptoms and the greater the number o f strained relationships, and changes in the mother’s life, the greater stress-related symptoms she experienced. The model indicates that Mother’s CSA is an important and strong predictor o f mother’s stress-related symptoms. This is consistent with the study’s previous quantitative and qualitative findings that MIAC with CSA history experienced significantly more stress related symptoms and PTSD related symptoms in comparison to MIAC without CSA history and that they tended to painfully talk about and be saddened by their own abusive experiences. Their distress was even further evident in the therapists’ frequent reports o f their suicide ideation. The fact that many MIAC with CSA history reported receiving no therapeutic assistance associated with their own CSA coupled with their higher stress-related symptoms indicate that traumatic experiences o f CSA remained unresolved and may have been reawakened or exacerbated by their child’s sexual abuse disclosure. Unresolved CSA history has been previously related to PTSD in adults ( Briere & Runtz, 1986) and MIAC with CSA may have been suffering form undiagnosed PTSD. The fact that spousal abuse history was also associated with the mothers’ higher distress is consistent with previous findings about PTSD and stress-related symptoms among battered women (Walker, 2000). Here too, the trauma o f having one’s child sexually abused increased stress-related symptoms that may have been already present due to domestic violence. Since battered women endure substantial damage to their self esteem as a result o f the abuse, and tend to take responsibility for their own abuse, blame themselves for staying in the relationship and for exposing their children to violence (Astin et al, 1995; McCluskey & Hooper, 2000; Walker, 2000), it is possible that their child’s sexual abuse evoked further feelings of shame, guilt, and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 173 helplessness, and increased their distress in comparison to MIAC who were not battered. These results on MIAC with CSA history and with domestic violence history suggest that prior abusive experiences have an important role in shaping ones further encounter with abuse even when it is not directed toward one self. The regression findings indicate that mothers’ CSA and spousal abuse histories can be viewed as risk factors for MIAC high distress and PTSD in the aftermath o f their child’s sexual abused disclosure. In addition, the regression model enriched previous findings by indicating that the variables “Strain” and “life- change”, although not differentiating between various sub-groups o f MIAC, did significantly impact MIAC’s psychological well-being in the aftermath o f the sexual abuse disclosure. These results are congruent with the qualitative data which indicated that mothers varied in the experience o f strain in social relationship and the number o f changes that occurred in their lives after the abuse disclosure and that these variables are related to the mother’s psychological well-being. The findings clarify two important ways in which sexual abuse indirectly yet powerfully affects MIAC’s psychological well being. First, as a result of the child’s sexual abuse the mothers experienced substantial changes in marital status, family structure, and consequently, role change. In addition, they experienced changes in place of residence, economic situation, and work situation following their child’s sexual abuse disclosure. It is conceivable that such changes are associated with stress and that the more changes the mother experience the more stress she will endure. Secondly, the analysis further demonstrated the powerful potential o f child sexual abuse to damage the most close and meaningful social relationships o f the mother: with her children, significant other, extended family and close friends. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 174 Many women and mothers experience relationships with family and friends as a most vital part o f their lives and their identity. The disclosure o f the child’s sexual abuse simultaneously created strain in numerous and various intimate relationships and therefore significantly increased the mothers distress level. The variable children’s removal to foster care was not significantly related to mothers’ level o f stress, indicating that in this sample, mothers’ stress-related symptoms were not aggravated by the children’s detention. This result is surprising because it contradict the qualitative data that clearly indicate that MIAC whose children were removed exhibited great agony and distress. There may be different explanations for this result. First, two less than favorable situations are associated with the statistical analysis o f this dichotomus variable. The variable was unevenly distributed with most MIAC (almost 3/4) having their children detained and a small number o f MIAC (17) whose children remain home. In addition, the group o f MIAC whose children were detained varied greatly with a substantial number of mothers (13) receiving their children back from detention in less then one month and others who were reunified with the children anywhere from 6 to 30 months. These conditions may have obscured an existing association between maternal stress related symptoms and children’s detention. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 175 Table 16 Model Independent Variable Standardized Beta Coefficients t- value Significance level Constant -1.19 .024 Sexual abuse .424 3.43 .001 Domestic violence .224 1.98 .050 Strain .360 3.09 .003 Overall Life changes .352 2.19 .034 Child out o f home -.244 -1.55 .127 Natural Support .006 0.48 .962 Note. n = 62. Alternatively, this result may suggest that dealing with the consequences of the child’s sexual abuse on a daily basis can be at least as stressful as experiencing the detention o f children. In these cases where the children remained with their mothers, the offender always left the home. This change may have also importantly contributed to the overall stress related symptoms o f mothers whose children remained at home. Further research with a larger sample with more even distribution o f the variable o f children’s detention and more accurate measures of distress at different times during the aftermath o f the abuse may clarify the relationship between mothers’ psychological well being and the practice o f children’s detention in cases o f intra familial child sexual abuse. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 176 The variable, natural support (the number o f supportive relationship mothers had with family and friends), was also not significantly related to the mothers’ stress related symptom leveL It may be that while support was important for the mothers’ coping ability, it still was not significant enough to alleviate her stress related symptom level. Alternatively, it may be that a more extended evaluation, preferably by a well-structured and used instrument, o f the number o f supportive relationships as well as the degree o f support obtained from the mothers’ informal and formal network would better clarify the relationship between MIAC’s stress related symptoms and her level o f support. Taken together as a model, 36.1% o f the variance o f mothers’ stress-related symptoms was explained indicating that MIAC’s psychological well-being after a child sexual abuse disclosure can be partially predicted by collecting information on the mother’s own abusive experiences as well as the changes that occurred in her life and her relationships with her social surroundings after the abuse disclosure. This somewhat modest percentage o f variance explained also suggests that there are possibly other variables which may be associated with the mother’s level o f stress related symptoms such as personality or coping skills. Further exploration in this direction may greatly enhance the development o f policies and treatment plans for MIAC and their children. Summary ofBivariate and Multivariate Results The statistical analyses examined various sub-groups o f MIAC in order to better understand the specific difficulties they may have experienced in the aftermath o f their child’s sexual abuse. All variables used for comparing the groups provided Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 177 useful information, however, the variables that were most helpful in differentiating among the groups were the LA Symptoms Checklist and the PTSD-related Symptoms Sub-Seale. Family Support, Life Change, and Strain in social relationship differentiated only among a few groups. The variable “Overall Support” did not differentiate among any o f the groups examined, indicating that overall support from therapy and group members sources were equally available to MIAC from different sub-groups and that these sources o f support supplemented the sometimes limited and uneven support MIAC received from their natural social surroundings. Examination o f different subgroups o f MIAC revealed that MIAC with a CSA history experienced significantly higher levels o f stress-related symptoms and PTSD related symptoms compared to MIAC with no CSA history. They also received significantly less support from their informal support network. Similarly, MIAC who were battered women exhibited significantly more difficulty in their well-being, and somewhat more PTSD related symptoms (although only approaching statistical significance) in comparison to non-battered MIAC. MIAC who experienced a combination o f CSA and battering by a spouse were found to exhibit the highest level o f overall stress-related symptoms and PTSD- related symptoms. This group possibly also experienced more strain in their social relationship (although only approaching statistical significance) in comparison to those who had no history o f either abusive experience. Overall, these results indicate that a history o f CSA and a history o f being a battered woman separately, and more so as a combination, increases the difficulties a mother will experience in her psychological well being in the aftermath o f her Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 178 child's sexual abuse disclosure. In addition, a history o f CSA is associated with less social support and the combination of CSA and being a battered woman may be associated with an increase in strained social relationships. Therefore, these sub groups o f MIAC are at a particularly high risk o f developing PTSD, depression, suicide ideation and suicide attempts in the aftermath o f their child’s sexual abuse disclosure. No significant differences were found between single parent MIAC and those who shared parenting. This is an interesting finding since single parenting is associated with greater parental stress (Down, 1997; Miller, 1996). Further research is needed for determining whether the approaching significant differences obtained on PTSD-related symptoms indicate an increased likelihood o f PTSD among single parenting MIAC after all. No significant differences were found between MIAC whose partners were the child’s offenders and those who were another family relative. The results of number o f life changes and strain approached significance level, with MIAC whose child ’s offender was another family member experiencing fewer changes in their lives, however, more strained relationships. The small number o f MIAC whose children’s offenders were other family members seems to have limited the analysis. Given that mothers whose children were detained voiced great agony and distress as evident in their records, the statistical finding that MIAC whose children remained home exhibited as much stress related symptoms and PTSD-related symptoms although significantly less changes in their lives was unexpected. This result suggests that the daily parenting o f an abused child and the siblings in the home can be as stressful as the children’s detention. It is possible however, that Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 179 while MIAC whose children remained at home exhibited stress due to actively assisting their children to heal from the abuse, MIAC whose children were detained exhibited stress related to the separation and the challenges placed on them to prove themselves as good parents. Hence, while the level o f distress may be similar, it may stem from different sources. The uneven distribution o f MIAC between the offender-partner versus offender-family relative groups, the single-parent versus shared-parenting groups, and the detained versus at-home children groups offered a less than favorable statistical analyses and therefore, a more elaborate examination o f these sub-groups o f MIAC and their experiences in the aftermath o f abuse disclosure may be useful. The multiple regression analysis indicated that 36% o f the variation of mothers’ stress-related symptoms can be explained by mother’s prior abusive experiences o f CSA and spousal abuse, number o f strained relationship, and number o f changes in life. The variables, informal support and children out o f home were not significantly associated with mother’s stress-related symptoms in this research. It may be too early to conclude that they do not contribute to MIAC’s psychological difficulties after disclosure given the findings from the qualitative data analysis and the lack o f prior research in these areas. All in all, the results indicate that while MIAC with CSA, battered women and those with a combination o f CSA and a history o f spousal abuse do have specific clusters o f difficulties, the attempt to relate MIAC’s experiences after the child’s abuse disclosure, with their parental situation (single versus shared parenting), the offender identification (partner versus other family relative), or their child’s detention, was not successful. It seems useful to look at the variables studied as Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. “risk factors” which are associated with higher distress among MIAC. The analyses indicated that MIAC’s CSA history, number o f strained relationships, number of changes in life after disclosure, and a battered woman history are all significantly associated with MIAC’s psychological distress. Therefore, these variables should be considered as risk factors for developing heightened distress and depression, which in turn, may affect MIAC’s functioning in their roles as mothers. Figure 2 outlines these factors which were found to negatively influence maternal well-being. In addition, Figure 2 outlines two other possible factors which were theoretically assumed to influence maternal well-being and which were indicated by the qualitative analysis as influencing maternal well being after the child sexual abuse disclosure, that is, support received from formal and informal sources and the detention o f the children to foster care. However, further exploration o f these specific variables, as well as other variables in relation to maternal well-being is needed. permission of the copyright owner. Further reproduction prohibited without permission. Figure 2. Factors Influencing Maternal Well-Being After Disclosure of Child’s Sexual Abuse Maternal History of Child Sexual Abus© Maternal Physical Abuse in Adulthood Maternal Well - Being Strain In Mother's Social Relationships Children's Detention Following Disclosure Support from Formal and Informal Sources Number of Changes in Mother’ s Life Following Disclosure Possible Factor > Significant Factor 182 CHAPTER 5 DISCUSSION This study o f sixty-two MIAC and their experiences in the aftermath o f their child’s sexual abuse disclosure employed qualitative and quantitative analysis of documents found in therapists’ record files. The thick files contained records of police investigations, DCFS’ assessments, court’s orders and therapists’ documentation o f MIAC progress in therapy at the Sexual Abuse Intervention Unit at the DCFS, the Los Angeles Child Protective Services. The study centered on the description, analysis and interpretation o f MIAC’s experiences o f their child’s sexual abuse disclosure and its aftermath. The files contained rich information on the mothers, their realities and the way they were perceived and assessed by the therapists from the moment o f disclosure until the termination o f therapy (five to 36 months later). This long-time frame allowed for an in-depth examination of MIAC’s on-going experiences and the challenges they faced in the aftermath o f their child’s sexual abuse. The need for this study stems from the growing number o f disclosed child sexual abuse cases, the lack o f basic knowledge on MIAC, and the growing recognition o f the mother’s important role in promoting her child’s recovery in the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 183 aftermath o f sexual abuse disclosure. Every year there are approximately 500,000 new cases o f child sexual abuse in the United States alone, and one out o f three girls and one out o f six boys are believed to experience sexual abuse before reaching 18 years o f age (Finkelhor et al, 1990; Russel, 1983). Therefore, approximately 25-33% of all mothers are parenting, or will be parenting, a sexually abused child. In the past decade, long held notions on MIAC’s pathological personalities and inadequacies as mothers were challenged theoretically and examined empirically in various studies that compared MIAC personality and parental behaviors to that ofMEFAC and community control groups. The comprehensive review o f the accumulative empirical studies, presented in the first chapter o f this study, indicates that the incestuous family model assumptions regarding MIAC are being consistently refuted. However, neither the myths nor their refutation revealed much about MIAC, their experiences, and their needs in the aftermath o f their child sexual abuse disclosure. In addition, no alternative theoretical perspective on MIAC has yet been developed. This study intended to address these gaps in knowledge and to focus on MIAC themselves. It attempted to explore the mothers’ situation and needs, and to identify subgroups o f MIAC who may experience greater difficulties and/or distress in the aftermath o f their child’s sexual abuse disclosure (For a summary of the study’s descriptive, bivariate and multi-variate results please see pages 143-152 and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 184 176-181). In the following section, the results and their implications to policy, practice, and research will be discussed. MIAC’s Experience o f the Child Sexual Abuse Disclosure and Its Aftermath The short-term psychological and emotional effects o f child sexual abuse disclosure on both MEFAC and MIAC were previously described as similarly devastating. Both MIAC and MEFAC were found to experience shock, numbness, shame, and anger toward themselves, the abused child and the offender (Elliot & Carnes, 2001). These reported similarities, overshadowed MIAC’s unique situation resulting from the fact that their child was abused by a close family member. This fact has proved to have major implications for MIAC and their situation both at the abuse disclosure and at its aftermath. The descriptions found in the record files portrayed the official child sexual abuse disclosure as a particularly overwhelming experience for MIAC because it consisted o f several challenging components in an evolving process in which one follows another and the accumulation o f all leaves MIAC shattered. The following short scenario presents MIAC’s common experience in the formal child sexual abuse disclosure: The vast majority o f MIAC became aware o f their child’s sexual abuse either hours before or during the official abuse disclosure. Next, they encounter a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 185 close family member, the alleged offender, who often strongly denies the abuse allegations. Confused they accompany their abused child to the medical exam and to the investigations by police and CPS workers. MIAC find themselves investigated by police and CPS as suspects o f child neglect and/or endangerment. In the vast majority o f cases, they are found to lack in their believe in the abuse allegations, their reactions to disclosure, their protectiveness and support o f the child. Hence, the abused child, and often the siblings, are immediately detained. The alleged offender is incarcerated, bails out o f jail or flees from police. When the formal disclosure concludes, most MIAC return either to the remaining siblings, or to their empty houses. For MIAC, the child’s sexual abuse disclosure consists o f stressful and tragic components: Confrontation with unexpected devastating news about their child’s abuse, the betrayal of a trusted family member, devaluation by powerful authorities, separation from family members and losses o f their taken-for-granted realities, their beliefs about their family members and themselves. The abuse disclosure also has vast and long-term implications on MIAC and their lives. It dramatically and negatively changes almost all aspects o f their realities. In this study, all MIAC lost their independent status as parents and most lost custody o f the child/ren. All were required to participate in a long-term, non-voluntary therapy and many were required to participate in parenting classes as well. The abuse disclosure broke up MIAC’s nuclear family and marked the beginning of a period o f Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 186 continued changes in family structure. MIAC had to adapt and re-adapt as offender left and the children were detained and then reunite, sometimes with offender too. Disclosure has a significant impact on most MIAC’s economic situation. It drove many o f them out o f their homes into relatives’ homes or to smaller apartments in less desired neighborhoods. It decreased their often low-to-begin-with income, forcing reduction in their expenses. Often, it required a change in their work place or in their working capacities. The disclosure resulted in a significant negative impact on the mothers’ social relationships with their partner, the abused child and the rest o f their children. It isolated the majority o f MIAC from their extended family, friends and neighbors due to secrecy, stigma, shame, and criticism associated with intrafamilial sexual abuse. Even those who received support from family and friends often simultaneously experienced criticism or strain in their social relationships. The abuse disclosure seriously damaged most MIAC’s self-esteem, increased self-criticism, self-doubt and self-blame. It shook their belief in their parental skills at a time when they faced increased responsibilities and difficulties in assisting their children to adjust and heal. In terms o f their psychological adjustment, MIAC in this study, as in several previous ones (Davis, 1995; Lewin & Bargin, 2001; Manion et al, 1996), were found to exhibit strong emotional reactions including heightened anxiety, contusion, disorientation, somatic ailments, depression and suicide ideation. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 187 Hence, the findings o f this study indicate that for MIAC, the child sexual abuse disclosure is a life-changing event that carries profound consequences and prolonged challenges at a time when their inner, social and economical resources are being seriously depleted. Taken together, these challenges, depleted resources, and emotional reactions, suggest that many MIAC may experience the child’s sexual abuse disclosure and its aftermath as a major crisis. Crisis has been defined as “A subjective experience in which the individual perceive a hazardous event, or a series o f successive stressful events, as a threat to his/her sense o f autonomy...a loss....a challenge to survival, growth or mastery” (Golan 1978; p.8). It is characterized by a state o f disequihbrium, disorganization and severe emotional upset that can not be resolved by previously used coping methods (Roberts, 1996). A crisis situation is viewed as neither an illness nor as a pathological situation, rather it reflects a realistic struggle in the individual’s life situation. With appropriate, short-term focused intervention an individual can work toward a state of crisis resolution. However, with poor or no intervention some may experience prolonged depression and/or develop PTSD (Hoff, 1995). In spit o f the difficult challenges and the crisis that MIAC encountered, the vast majority have functioned well as mothers to their abused child and the siblings. MIAC have adapted to single parenting and set their priorities on helping the children heal after disclosure. These findings join the growing body o f research that refutes Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 188 the incestuous family model portrait o f MI AC. The findings o f this study indicate that MI AC’s difficulties are related to the crisis that they experience as a result o f the child’s sexual abuse disclosure and are not indicative o f their maternal and personal dysfunction. It has been previously noticed that some MIAC and MEFAC exhibit more emotional distress than others (Newberger et al., 1993; Green et al., 1995; Manion et al., 1996). However, risk factors for MIAC’s heightened distress and PTSD were rarely explored by their therapists. The findings o f this study indicated that MIAC’s CSA history, MIAC’s history o f battered women, MIAC’s number o f strained relationships and the number o f reported changes in their life after disclosure should be considered as risk factors for the development o f greater distress and PTSD among MIAC. Hence, abuse related histories as well as situational stressors may contributes to MIAC’s greater distress. MIAC’s CSA history was previously explored as associated with the development o f greater distress and PTSD with inconclusive results (Lewin & Bergin, 2001). This study supports the now accumulating data that CSA history is indeed associated with greater emotional distress in mothers (Deblinger et al., 1994; Friedrich, 1990). A history o f being battered and its possible consequences o f greater distress among MIAC or MEFAC was not previously studied. However, this study’s results that indicated that MIAC with a history o f being battered exhibit more stress Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 189 and PTSD symptomatology are not surprising given that the multiple and long-term psychological consequences of battering on the victim include PTSD, learned helplessness, social isolation and a tendency toward self criticism and self blame (i.e. Walker, 2000). The finding that these abusive experiences have compounding effects that can be detected when MIAC face their child’s sexual abuse disclosure is interesting because it may indicate an additional long-term consequence of victimization. That is, sexual abuse disclosure o f their child may reactivate previous unresolved abusive experiences and serve as catalyzers in the development of psychological distress and/or PTSD. These results, however, may only reflect the distress and PTSD that these MIAC experienced prior to the child’s sexual abuse disclosure. Therefore, further studies comparing mothers with CSA and BW histories and their distress/ PTSD to MIAC and MEFAC with abusive histories and their distress/PTSD after the child’s disclosure may further clarify these findings. The findings that strained relationships are associated with MIAC’s distress indicate that the quality o f mothers relationship with others is important in understanding MIAC. MIAC, as other women in our culture, are brought up to view harmonious relationships with family members as most important to their well-being. Women invest a great deal in the relationships with others and cherish friendships and intimacy as vital to their existence. Therefore, when MIAC find themselves unsupported, criticized, abandoned, or the target o f anger by people who are most Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 190 important to them, they experience loss, grief and distress. Further exploration o f the various aspects o f strained relationships, and their effects on MIAC may be beneficial in understanding MIAC and their needs. The number of life changes that occurred after the abuse disclosure was also found to serve as a risk factor for increased symptomatology. This finding highlights the fact that abuse disclosure for MIAC implies numerous changes in their lives and that these changes, in turn, aggravate the mothers’ distress. Overall, these results indicate that all MIAC undergo a most difficult time in their lives during and after disclosure. However, MIAC with CSA history and MIAC who are battered women, and more so those who have both histories of abusive experiences, are particularly vulnerable. In addition, those who undergo many changes in their lives post-disclosure and those who experience increased number of strained relationships are more likely to develop distress and PTSD. Studies that examined MIAC’s maternal behaviors in the aftermath o f the child’s sexual abuse disclosure, systematically, although perhaps non-intentionally, decontextualized MIAC’s behaviors from their traumatic situation and experiences during and after disclosure. Maternal belief in the abuse allegation, their protectiveness and support o f the child has been studied, evaluated, and presented as detached from MIAC’s situation during and after disclosure (e.g., Pintello & Zuravin, 2001). This decontextualization, may have contributed to the stigmatization o f MIAC Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 191 by professionals such as CPS workers and therapists by presenting MIAC as non- supportive and unfunctional parents. It also may have reproduced in MIAC, similarly to other clients (Rose, 1990), the feelings o f powerlessness, inadequacy, and incompetence. Contextualizing MIAC’s parental behaviors at disclosure and its aftermath would mean that MIAC’s confusion, disbelief, and disorientation are expected and normal considering the crisis they are facing. Contextualizing additionally suggests that MIAC’s backgrounds are important in understanding their needs and behaviors. In this sample, MIAC were relatively young, low-income women with limited educational and socio-economical resources. These mothers have already experienced several challenging situations including teenage motherhood, immigration, CSA, domestic abuse, separations from partners and/or children, and single parenthood. Most were burdened with parenting 3-4 children in addition to working outside their households, and some already experienced mental health difficulties prior to disclosure. Such backgrounds suggest that many mothers acquired life-experiences, strengths, and abilities that may assist them in successfully meeting the challenges of the child’s sexual abuse disclosure. For example, some may have developed the ability to quickly and successfully adjust to life’s changes. Others, may have been successful at juggling job and parenthood requirements before disclosure. These and Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 192 other strengths o f MIAC were clearly evident in examining their adjustments to the various negative changes after disclosure as well as in their ability to provide on going care and support for their children. Simultaneously, however, MIAC’s limited educational, economical, social, and emotional resources, as well as their CSA and battered women histories, and their distress, depression and PTSD symptomatology in the disclosure aftermath should not be overlooked. These factors are stressors and act as obstacles to their functioning and to a successful resolution o f the child’s sexual abuse disclosure. Contextualizing MIAC in their backgrounds and situation is critical in clarifying their behaviors and needs. MIAC therefore require professionals’ recognition in the child abuse disclosure as a traumatic event that stretches their limited-to-begin-with resources and presents them with extremely challenging demands. Their maternal performance should be viewed in the context o f their various backgrounds, strengths and limitations, and their situation at disclosure. Most important, MIAC’s feelings, behaviors and choices during and after disclosure should be normalized and viewed as reactions to the crisis (Hoff, 1995; Roberts 1996), not as indicative o f pathology or parental dysfunction. MIAC need non- judgmental interventions that recognize their existing strengths and abilities as well as their need for empowerment. Crisis intervention models and strategies suggest that short-time, goal-directed intervention that focuses on the immediate problems, needed Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 193 resources and emotional conflicts can assist the individual to integrate the event into her experiences and move on with her life (Lee, 2001). Professionals in this study did not view MIAC as individuals exhibiting normal reactions under crises. Hesitant, overwhelmed, confused, indecisive, or immobilized mothers had their children removed at time o f disclosure because their behaviors were misunderstood and detached from their complex realities. As such, they were perceived and treated as non-protective mothers. CPS workers and therapists exhibited unrealistic expectations from MIAC in the face o f disclosure such as: the expectations to unequivocably believe, support and provide protection to the abused child and to simultaneously disbelieve and express anger or despise the alleged offender. MIAC were expected to display unconditional maternal support and protection to the child in a time when they were experiencing shock, anxiety and turmoil. Such unrealistic expectations from mothers often stem from a belief in maternal all-powerfullness (Chodorow& Contratto, 1989). MIAC’s inability to live up to these expectations was perceived as maternal unwillingness to perform their duties and therefore was punitively treated by children’s detention and the prolonged therapy for the mothers. Those MIAC, however, who came to the attention o f social institutions, were women who typically experienced several aspects o f powerlessness in their lives such as lack o f education, financial and social resources, experiencing childhood sexual abuse and women battering prior to the child’s sexual abuse Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 194 disclosure. During the abuse disclosure MIAC faced an additional aspect o f their powerlessness, that is, their lack o f control over their children’s safety. Police and CPS investigations were likely to increase MIAC’s sense o f powerlessness and lack o f control. In particular, the children’s detention was a disempowering experience since it carried a clear message o f distrust and failure to MIAC. Moreover, MIAC’s powerless position in regard to the children’s return home from detention damaged MIAC’s position as authority figures and as good parents in the eyes of their children. In fact, it is likely to either create or perpetuate the children’s belief that their mothers are responsible for the abuse, since they are not trusted by authorities and in need for long therapy. Therefore, MIAC’s powerlessness and lack o f control over their lives, and their perceived guilt and inadequacy in the eyes o f their children is perpetuated by the abuse disclosure and more so by CPS interventions. Similarly, the emphasis on long-term therapy for MIAC is likely to increase maternal self-doubts and dependency on professionals. Next, the implications of MIAC’s situation to policy, practice and research are addressed. Recommendations to Policy and Practice Professionals should provide MIAC with a clear and consistent message that they are not at fault in the sexual abuse o f their child. As a group, MIAC should be viewed as caring and functioning mothers who face a life-changing crisis. A child’s Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 195 intrafamilial sexual abuse disclosure and its aftermath should be perceived as a crisis situation not only for the child but for the mothers and siblings as well. MIAC should receive immediate crisis intervention that is focused on their needs as much as on the abused child’s. MIAC’s behaviors and emotional reactions should be considered as resulting from the trauma and shock they endured at disclosure. MIAC’s concerns for their own safety, the offender, as well as for their financial, residential, and familial situation should be perceived as appropriate, rather than selfish and uncaring for the child. Their concerns should be acknowledged and validated. The findings indicate that attention should be given to their mental health status and they should be routinely assessed for the presence and development o f PTSD, depression, and suicide ideation beginning at disclosure. MIAC should receive advocacy services during disclosure and before their investigation by police and CPS. An advocate should provide them with explanations about the purpose, procedures and policies o f police, CPS and the court in the investigation and treatment o f sexually abused children and their parents before the investigations. Given present CPS policy, MIAC should be advised about their position as suspects o f child endangerments and about CPS’s tendencies to detain intrafamilial sexually abused children and their siblings. MIAC should be offered legal advice and information about the courses o f actions that will increase the likelihood of avoiding their children’s detention. For example, in cases where the offender owns, or refuses to leave the house, MIAC and their children should be offered, or advised Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 196 to request, the services o f a shelter. In other cases, MIAC should be advised to ask CPS worker what they can do to avoid the children’s detention and to satisfactory assure their safety at home. An advocate can represent the mother in her crisis and her perception o f her needs to avoid or decrease punitive and judgmental reactions toward her. Ultimately, CPS should revisit policies regarding the frequent detention of intrafamilial sexually abused children. CPS workers and therapists’ need to be informed about current empirical data about MIAC and their parenting skills in comparison to MEFAC and control groups, which indicate that MIAC are not less caring, supporting, or competent as mothers. A non-pathologically based theoretical perspective should be the guiding framework for understanding mothers o f sexually abused children. CPS workers must begin to understand MIAC’s specific reality, in the context o f class, race, gender, and access to resources. Given the findings on the abuse and neglect o f detained sexually abused children at foster care, CPS workers should thoroughly explore various avenues of increasing the safety o f sexually abused children so that they can stay with their non offending parent(s). For example, mothers and children’s involvement in the development o f a protection plan should be considered as an alternative to detention. Those mothers whose children need to be detained, should be given both a written and oral explanations o f the reasons for the children’s detention and needs to be done for returning the children to their mothers’ custody. Overall, CPS workers should be Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 197 encouraged to search and identify MIAC’s strengths and skills as parents. They should strive to empower MIAC by validating their realities and their crisis situation as well as recognize their adaptability and successes in healing themselves and their children. MIAC must be recognized as a valuable and capable partner who has a strong interest in the child’s protection and well-being. CPS workers must recognize MIAC’s important role in supporting the abused child and the siblings to heal. MIAC should be offered various options for fulfilling the court’s requirements of mandatory parental therapy. CPS program should be one o f several different free or low-cost programs available for MIAC. Programs should place MIAC as the primary focus o f attention. The new emerging focus on short-term behavior management training and education for non-offending parents (i.e., Deblinger et al., 2001) is promising. However, it is important not to overlook the situation o f some non-offending mothers, such as in this sample, and their extensive need for services and resources. Short-term assistance should be focused on empowerment and based on recognition o f maternal strengths, adaptability and progress as opposed to maternal deficiencies and dysfunction. Empowerment intervention may be most beneficial for MIAC. Empowerment is “A process through which people become strong enough to participate and share the control o f and influence over events and institutions that are effecting their lives” (Torre, 1985, pl8). The first and foremost important component o f empowerment intervention is validation o f one’s perceptions and experiences (Torre, 1985). It is Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 198 also based on a commitment to an open dialog and on contextualization o f the person’s situation in her life and in the larger societal forces o f race, ethnicity, culture, class and the institutions that influence her life. Empowerment intervention acknowledges the importance o f provision o f knowledge and the development of skills for dealing with conflicts and for gaining access to resources (Parsons, 1991). Support is perceived as mutual aid and achieved through validation and the perception o f commonality among people (Lee, 2001; Torre, 1985). Based on providing clients with control over the intervention process itself, and focusing on their normalcy and competency, empowerment intervention offers a healing experience to the disempowered MIAC. MIAC should be offered information on different federal, state and community resources for shelter, housing, food, emergency money, medical assistance and transportation to and from therapy and child’s visitation. Given their parental responsibilities and their need to work outside the home, they should be offered information on respite, child care and afternoon child enrichment programs available in their community. They should also be provided with information on self-help groups, educational, and employment training opportunities as part o f a concentrated effort to replenish and enrich their resources. MIAC will also benefit from interventions geared toward strengthening their relationships with the children, reestablishing parental authority, building on positive past experiences and their own family traditions. For example, family members Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 199 should be encouraged to identify and then include enjoyable family activities in the aftermath o f disclosure for strengthening family bonds. Mother-child therapy that focuses on improving communication should be offered to MIAC and their children. Further, the children should be encouraged to recognize MIAC’s care for them and to re-establish trust in their mothers. Given the tendency for social isolation due to shame and stigmatization, MIAC should be offered interventions focused on extending and maintaining social network. Interventions in the extended family/friends group after abuse disclosure should be formed with the purpose o f decreasing stigmatization and isolations. For example, family members could be invited and mother could tell them about the abuse and request their support. MIAC who participate in groups should be encouraged to contact other group members between sessions. Group work, however, although economical and beneficial in decreasing MIAC’s social isolation and stigmatization, should be one o f several alternative options, since not all MIAC benefit from group therapy. Mothers should take an active part in planning and prioritizing their goals and should actively assess and redirect the therapy focus according to their needs. Mothers should be encouraged to explore the effect o f the abuse disclosure on their self-esteem, sense o f competence, femininity, sexuality and trust. They need to be taught to attend to their own needs, not only those o f their children. MIAC’s complex and often contradictory feelings toward the offender should be Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 200 acknowledged and addressed. When appropriate, MIAC should also be encouraged to explore their perception of possible common threads between their own CSA and/or WB and their children’s abuse. MIAC with unresolved experiences o f CSA ad WB should be provided with information on programs that help adult survivors of CSA and/or battered women. Therapy plans based on these principles can be empowering for MIAC. Last but not least, MIAC who choose to believe the offender, should be offered support and assistance in the exploration o f their decision and ways of establishing and maintaining child-mother relationships in spite o f the crisis. These mothers who are often condemned and isolated in group sessions seems to be in a most difficult position and their needs o f support and recognition as well as their need to develop positive relationships with their abused child should be addressed. Recommendation for Further Research The qualitative analysis component o f this study contributed significantly to the understanding o f MIAC and their situation in their child’s sexual abused disclosure and its aftermath. However, since the analysis relied on police and CPS’s documents and therapists’ perceptions o f MIAC, mothers’ voices were not directly heard. A longitudinal qualitative study o f MIAC, describing their subjective experiences, as they see them, may add to better understanding o f MIAC and their experiences and needs in the aftermath o f their child’s sexual abuse disclosure. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 201 This study’s fairly modest sample, and the less-than-favorable distributions of different sub-samples of MIAC, limited the statistical analyses o f the differences between some sub-groups o f MIAC and the analysis o f risk factors associated with MIAC’s increased distress, PTSD symptomatology, and social isolation. Further exploration o f the effects o f offender’s relationship to the mothers (for example, non- relative offender, vs. offender-partner vs. offender-family relative) and its effects on the mothers’ well being, strain in relationships, and social isolation should continue. In addition, mothers’ parental situation (single parenthood vs. shared parenthood after disclosure) should be explored further since single parenthood has been previously identified as placing increased difficulties on parents in general, and since this study’s approaching significance results may indicate that single parenthood may indeed present a particularly stress-related situation for MIAC. The effects o f children’s detention on MIAC and their recovery is an extremely important issue given the current practice o f frequent detention o f children who were intrafamilialy abused. Exploration o f the negative, and possibly positive, effects of detention should be conducted. Specifically, the implication of detention on MIAC’s and children’s distress, MIAC’s relationships with the children, and MIAC and children’s healing should be carefully studied. The qualitative analysis in this study indicated that the children’s detention was associated with greater anger, frustration, distress and despair in MIAC. In fact, MIAC ‘s concern for their children in detention sometimes overshadowed their concerns for the consequences o f the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 202 child’s abuse. Since these qualitative findings were not supported by the quantitative analysis that compared stress-related symptoms among MIAC whose children were detained and those whose children remained home, the meanings and effects o f the children’s detention on MIAC deserve further exploration. A better design, in terms o f group size, group uniformity, and evaluation at different points o f time during the abused disclosure aftermath, may allow better understanding o f this important issue. One group o f MIAC consistently did not believe and provided little, if any, support for the abused child. These mothers who provided strong support for their offending partners, were a target for much criticism from professionals. They were therefore characterized by loneliness and non-benefieial participation in group- therapy. These mothers, their realities, perception o f motherhood, relationships with the abused child and the siblings and experiences after the child’s abuse disclosure should be further studied and described. Understanding and assisting them and their children, while respecting their positions with regard to their child’s abuse allegations require further examination. The study o f social strain in MIAC’s and MEFAC’s relationships following child sexual abuse disclosure should be further developed. This study’s identification of the importance o f strain in social relationships on MIAC’s distress, as separate from the issue o f social support, is an important step toward better understanding the effects o f the child’s sexual abuse on the mothers. Since this issue may have implication for theory and practice, a more elaborate exploration o f the severity, Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 203 duration, and number o f strained relationships experienced by MIAC, and their effect on the mothers’ distress should be developed. It may be beneficial to understand which strained relationships mostly affected MIAC’s distress, those with extended family, the abused child, the siblings, or the offenders? It may also be beneficial to know more about different components o f the construct “strain in relationships”. Is it open conflict, anger, distrust or all o f the above that are associated with maternal distress. In addition, information on MIAC and MEFAC informal support networks, their accessability and functioning in the aftermath o f the child sexual abuse disclosure is virtually non-existent. Given the broad and vast effects o f child sexual abuse disclosure on the mothers’ lives, it seems necessary to explore if, how and to what extent social support mediates the specific effects o f the abuse disclosure on the mother. In the absence o f this information, the importance o f the finding that MIAC with CSA history are lacking in their social support, is not clear. Similarly, further exploration o f life changes and their effects on MIAC’s distress, resources and social isolation should continue. In this study, the accumulation o f life changes that occurred after disclosure was found to be significantly related to maternal distress. It is likely, however, that some life-changes are more significantly related to MIAC’s distress than others. Further understanding may assist in better interventions. It is important to continue the explorations o f abuse related histories such as maternal CSA and BW and their association with greater distress, PTSD and social Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 204 isolation in MIAC and MEFAC. It is currently unclear whether these mothers’ greater distress and PTSD symptomatology is a condition which they had prior to the child sexual abuse disclosure or whether the disclosure triggered these reactions. The compounding effects o f multiple abusive histories on the mothers’ distress and PTSD symptomatology after the child’s abuse disclosure, as it was evident in this study, should receive further validation in studies that will directly assess PTSD in mothers. Studies o f mothers’ belief, support and protect o f their abused child should strive to contextualize MIAC’s behavior in their situation. Such contextualization does not necessarily imply the use o f qualitites methodologies. Research questions, designs, discussions o f results and interpretations can explore behavior in context. A few attempts o f contextualizing MIAC’s maternal behaviors were recently documented. These studies illustrate research questions and designs o f studying maternal behavior in context. Regrettably, however, both have focused solely on maternal pathology (inter-generational abandonment and inadequate attachment) as explanations for MIAC’s non-supportive behaviors (Liefer et al., 2001; Lewin & Bergin, 2001). Alternatively, MIAC’s behaviors can be explored in the context o f their socio- economical situation. For example, the exploration o f socio-economical and maternal access to various resources as factors associated with maternal belief and support o f the child. Similarly, evaluation research o f intervention components, such as the effects o f advocacy and support provision to MIAC during the abuse disclosure, on Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 205 their distress, belief and support o f the child, can iftuminate the role o f hostile, punitive social environments on MIAC’s distress, support and protection of their children. Research on CPS policies and workers’ attitudes and interventions with MIAC and their children should continue. Documentation o f the massive detention of children upon disclosure, maternal prolonged therapy, and the abuse and neglect that detained children endured while in foster care was important in understanding the lives o f MIAC and their children after disclosure. Further research on CPS may draw more attention to the need to reexamine CPS’s policies and redefine workers’ interventions. The findings o f this study indicated that MIAC present complex behaviors such that it is impossible to employ simple dichotomies, or easily catagorize MIAC as promoting vs. hindering their child’s recovery. The difficulties result from the fact that “believe”, “support” and “protect” are complex theoretical constructs, which consist o f different dimensions and a variety o f associated behaviors. More attention should be given to the working definitions of these constructs in studies since it is often not clear how they were defined and measured. In addition, frequently MIAC’s belief, support and protection of the child change during the abuse disclosure and more so, in its aftermath. Changes have been documented in both directions: Many MIAC who initially disbelieved or were non- supportive o f the child later believed and became supportive o f the child, while some who initially believed, became more skeptical during the aftermath o f disclosure. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 206 Moreover, mothers did not always exhibit consistency across dimensions o f belief, support, and protectiveness. That is, some mothers disbelieved the abuse allegation yet were protective and supportive o f the child and vise versa. Such processes, changes and inconsistencies in maternal behaviors, few o f which have been documented before (Heriot, 1996; Pintello & Zuravin, 2001), are sadly ignored in terms o f their implications for theory, research, and interventions. Since MIAC’s behaviors have major impact on their children’s detention, court involvement and MIAC’s therapy, it is most important to explore the effects o f these phenomena on child’s recovery. It is also important to identify factors associated with change and inconsistency in maternal behaviors during and after disclosure in order to eliminate unnecessary detention o f children. Finally, evaluation o f interventions with MIAC should be conducted and include pre and post assessments o f various dimensions such as maternal depression, distress and PTSD, maternal access to resources, parental fimctioning, maternal relationships with the abused child and siblings, social support, and the quality o f maternal social relationships pre and post-interventions. Efforts should also be made to study maternal perception o f their power and control over their lives before and after various types o f interventions. In particular, studying the effects of empowerment intervention, as described earlier in this chapter, on MIAC is vital for improving intervention. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Ultimately, these efforts o f contextualizing research questions related to MIAC’s distress and behaviors in their changing realities, and evaluation-based research on maternal self-esteem, resources, and functioning pre- and post interventions, are likely to result in reduction o f MIAC’s stigmatization, and in the development o f empirically testable hypotheses and theoretical frameworks on mothers o f sexually abused children. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 208 BIBLIOGRAPHY Ackerman, R. J., & Pickering, S. E. (1989). Abused no more: Recovery for women from abusive or co-dependent relationships. PA: Blue Ridge Summit. Adams-Tucker, C. (1982). Proximate effects o f sexual abuse in childhood: A report on 28 Children. American Journal o f Psychiatry. 1 3 9 .1252-1256. Alexander, P. (1985). A system theory conceptualization o f incest. Family Process. 24, 79-88. Anderson, M. L. (1993). Thinking about women: Sociological perspectives on sex and gender. New York: Macmillen Publishing Company. Antonucci, T. C. (1990). Attachment, social support, and coping with negative life events in mature adulthood. In E. M. Cummings, A. L. Greene, & K. H. Karraker (Eds.), Life-span developmental psychology: Perspectives on stress and coning, (pp. 261-276). Hillsdale, NJ: Lawrence Erlbaum. Astin, M. C., Lawrence, K. J., & Foy, D. W. (1993). Post-traumatic stress disorder among battered women: Risk and resiliency factors. Violence and Victims. 8. 17-28. Bagley, C., & Ramsay, R. (1986). Disrupted childhood and vulnerability to sexual assault: Long-term sequelae with implications for counseling. Social work and Human Sexuality. 4. 33- 48. Bailey, K. D. (1978). Methods o f Social Research. New York: The Free Press. Baker, C. K., Perilla, J., & Norris, F. H. (2001). Parenting stress and parenting competence among Latino men who batter. Journal o f Interpersonal Violence. 16. 1139-1157. Barrera, M., Jr. (1986). Distinctions between social support concepts, measures, and models. American Journal o f Community Psychology. 14. 413- 445. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 209 Barnett, O. W„, Martinez, T., & Keyson, M. (1996). The relationship between violence, social support and self-blame in battered women. Journal of Interpersonal Violence. 1 0 .221-234. Bell, S. E. (1988). Becoming a political women: The reconstruction and interpretation o f experience through stories. In A. D. Todd, & S. Fisher (Eds.), Gender and discourse: The power of talk (pp. 97-125). Norwood, NJ: Ablex. Beitchman, J., Zucker, K., Hood, J., DaCosta, G., Akman, D., & Cassavia, E. (1992). A review o f the long-term effects o f child sexual abuse. Child Abuse & Neglect. 1 6 .101-117. Berlin, S. (1990). Dichotomus and complex thinking. Social Service Review. 64* 46-59. Berliner, L. & Conte, J. R. (1995). The effect o f disclosure and intervention on sexually abused children. Child Abuse & Neglect .19. 371-384. Berliner, L., & Stevens, D. (1982). Clinical issues in child sexual abuse. In J. Conte & D. Shore (Eds.), Social Work and Child Sexual Abuse (pp. 93-108). New York: Haworth. Bernard, J. (1979). "Afterward". In J. Sherman and E. Beck (Eds.), The prism o f sex: Essays in the sociology o f knowledge, (pp. 44-76). Madison: University o f Wisconsin Press. Bims, B., & Meyer, S. L. (1993). Mothers' role in incest: Dysfunctional women or dysfunctional theories? Journal o f Child Sexual Abuse. 2. 127-135. Blanck, G., & Blanck, R. (1974). Ego psychology: Theory and practice. New York: Columbia University Press. Bograd, M. (1988). Feminist perspectives on wife abuse. In K. Yllo & M. Bograd (Eds.), Feminist perspectives on wife abuse, (pp. 60-77). Newbury Park, CA.: Sage. Bortolaia, Silva, E. (Ed.). (1996). Good enough mothering? Feminist perspectives on lone mothering. London: Routledge. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 210 Bradbury, T. (1998). The developmental course o f marital dysfunction. Cambridge, New York: University Press. Briere, J. (1989). Therapy for adults molested as children: Bevond survival. New York: Springer. Briere, J., & Runtz, M. (1986). Suicidal thoughts and behaviors in former sexual abuse victims. Canadian Journal o f Behavioral Violence. 18, 413-423. Briere, J., & Runtz, M. (1987). Post sexual abuse trauma: Data and implications for clinical practice. Journal o f Interpersonal Violence. 2. 367-379. Briere, J., & Runtz, M. (1988). Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse and Neglect. 12. 51- 59. Brooks, B.(1983). Peoedipal issues in a post-incest daughter. American Journal of Psychotherapy. 37. 129-136. Brown, G. W. Moran, P. M. (1977). Single mothers, poverty and depression. Psychological Medicine. 27 (1), 21-33. Browne, A. (1992). Violence against women: relevance for medical practitioners. Journal o f the American Medical Association 267. 3184-3189. Browning , D. H., & Boatman, B. (1977). Incest: Children at risk. American Journal o f Psychiatry. 134. 69-72. Campbell, J. C. (1995). Prediction o f homicide o f and by battered women. In J. C. Campbell (Ed.), Assessing dangerousness: Violence bv sexual offenders, batterers and child abusers (pp. 96-113). Thousand Oaks, CA: Sage. Caplan, P. J. (1990). Making mother-blaming visible: The emperor's new clothes. Women and Therapy. 10. 61-70. Caplan P. J., & Hall-McCorquodale, I. (1985). Mother-blaming in major clinical journals. American Journal o f Orthopsychiatry. 55. 345-353. Carter, B. (1993). Child sexual abuse: Impact on mothers. AFFILIA. .8. 72- 90. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 211 Cascardi, M., & O'Leary, K. D. (1992). Depressive symptomatology, self- esteem, and self blame in battered women. Journal o f Family Violence. 7, 249-259. Chodorow, N. & Contratto, S., (1989). The fantasy o f the perfect mother. In N. Chodorow (Ed.), Feminism and psychoanalytic theory (pp. 79-97). USA: Yale University Press. Cobb, S. (1976). Social support as a moderator o f life stress. Psychosomatic Medicine. 38. 301-314. Cohen, T. (1983). The incestuous family revisited. Social Casework. 3. 154 -161. Conte, J. R., & Berliner, L. (1988). The impact o f sexual abuse in children: Empirical findings. In L. E. Walker (Ed.), Handbook on sexual abuse o f children (pp. 22-93). New York: Springer. Cook, J. A., & Fonow, M. M. (1990). Knowledge and women's interests: Issues o f epistemology and methodology in feminist sociological research. In J. McCarl Nielsen (Ed.), Feminist research methods: Exemplary readings in the social science (pp. 69-94). Boulder: Westview Press. Crawford, S. L. (1999). Intrafamilial sexual abuse: What we think we know about mothers, and implications for intervention. Journal o f Child Sexual abuse. 7. 55- 72. Dadds, M., Smith, M., Webber, Y., & Robinson, A. (1991). An exploration o f family and individual profiles following Father- Daughter Incest. Child Abuse and Neglect. 15. 575- 586. Davies, J., Lyon, E., & Monti-Catania, D. (1998). Safety Planing with Battered Women. Thousand Oaks, Ca: Sage. Davies, M. G. (1995). Parental distress and ability to cope following disclosure o f extra-familial sexual abuse. Child Abuse and Neglect. 19. 399-40$. Deblinger, E., Stauffer, L. & Landsberg, C. (1994). The impact o f child sexual abuse on maternal response to allegations o f sexual abuse concerning her child. Journal o f Child Sexual Abuse. 3. 67-75. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 212 Deblinger, E., Steer, R., & Lippman, J. (1999). Maternal factors associated with sexually abused children’s psychological adjustment. Child Maltreatment. 4 . 13- 20. Deblinger, E., Stauffer, L., & Steer, R. A. (2001). Comparative efficacies of supportive and cognitive behavioral group therapies for children who have been sexually abused and their nonoffending mothers. Child Maltreatment. 6. 332-343. DeJong, A.R. (1986). Childhood sexual abuse precipitating maternal hospitalization. Child Abuse and Neglect. 10. 551-553. Denzin, N. K. (1984). Toward a phenomenology o f domestic violence. American Journal of Sociology. 90. 485-513. Denzin, N. K., & Lincoln, Y. S. (Eds.). ( 19941 Handbook o f qualitative research. Thousand Oaks, CA : Sage. deYoung, M. (1994). Immediate Maternal reactions to the disclosure or discovery o f incest. Journal of Family Violence. 9. 21-33. Dietz, C. A. & Craft, J. L. (1980). Family dynamics o f incest: A new perspective. Social Casework. 6 1 .602-609. Down, N. E. (1997). In defense o f single parent families. New York: New York University Press. Dutton, M. A. (1992). Empowering and healing the battered woman: A model for assessment and intervention New York: Springer. Edleson, J. L., Eisikovits, Z. C., Guttmann, E. & Sela-Amit, M. (1991). Cognitive styles and socializing attitudes o f men who batter: Where should we intervene? Family Relations. 4. 72-77. Elbow, M. & Mayfield, J. (1991). Mothers o f incest victims: Villains, victims, or protectors? Families in Society: The Journal o f contemporary Human services. 2. 78-85. Elliott, D., & Briere, J. (1994). Forensic sexual abuse evaluations o f older children: Disclosures and symptomatology. Behavioral Sciences and the Law. 12. 261-277. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 213 Elliot, A. N., & Carnes, C. N., (2001). Reactions o f nonoffending parents to the sexual abuse of their child: A review o f the literature. Child Maltreatment. 6. 314 - 331. Ellis, D. (1996). Measuring and negotiating marital conflict. Thousand oaks, CA: Sage Publication. Eisikovits, Z. C., Guttmann, E., Sela-Amit, M., & Edleson, J. L. (1993). Woman battering in Israel: The relative contribution o f interpersonal factors. American Journal o f Orthopsychiatry. 63. 313-317. Erel, O., & Burman, B. (1995). Interrelatedness of marital relations and parent-child relation: A meta-analytic review. Psychological Bulletin, 1 1 8 .108-132. Esparza, D. (1993). Maternal support and stress response in sexually abused girls age 6-12. Issues in Mental Health Nursing. 14. 85-107. Everson, M. D., Hunter, W. M., Runyon, D. K., Edelsohn, G. A., & Coulter, M. L . (1989). Maternal support following disclosure of incest. American Journal of Orthopsychiatry. 5 9 .197-207. Faller, K. C. (1988). The myth o f the "Collusive Mother". Journal of Interpersonal Violence. 3 .190-196. Faller, K. C. (1989). Why sexual abuse? An exploration o f the intregenerationa! hypothesis. Child Abuse and Neglect. 13, 543-548. Follingstad, D. R., Neckerman, A. P. & Vormbrock, J. (1988). Reactions to victimization and coping strategies o f battered women: The ties that bind. Clinical Psychology Review.8. 373-390. Follingstad, D. R , Rutledge, L. L., Berg, B. J., Hause, E. S., & Polek, D. S. (1990). The role o f emotional abuse in physically abusive relationships. Journal o f Family Violence. 5. 107-120. Follingsted, D. R. Brennan, A. F., Hause, E. S., Polek, D. S., & Rutledge, L. L. (1991). Factors moderating physical and psychological symptoms o f battered women. Journal o f Family Violence. 6. 81-95. Finkelhor, D. (1986). Sexual abuse: Beyond the family systems approach. Journal o f Psychotherapy and the family. 2. 53-65. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 214 Finkelhor, D., Hotaling G., Lewis, I. A., Smith, C., (1990). Sexual abuse in a national survey o f adult men and women: Prevalence, characteristics, and risk factors. Child Abuse and Neglect. 1 4 .19-28. Finkelhor, D., & Yllo, K. (1992). Forced sex in marriage: A preliminary research report. Crime and Delinquency. 82. 459- 478. Freud, S. (1961). The Ego and the id. In J. Strachey (Ed. and Trans.), The standard edition o f the complete psychological works o f Sigmund Freud (Vol. 19, pp. 3-66). London: Hogarth Press. (Original work published 1923). Friedrich, W. N. (1991). Mothers o f sexually abused children: An MMPI study. Journal o f Clinical Psychology. 47. 778-783. Gelles, R. J., & Cornell, C. P. (1985). Intimate Violence in Families. Newbuiy Park, CA: Sage. Gellers,!, Foy, D.W., Donahoe, Jr., C.P., & Goldferb, J. (1988). Post- Traumatic stress disorder in Vietnam combat vetems: Effects of traumatic violence exposure and military adjustment. Journal o f Traumatic Stress. 1 .181-192. Giarretto, H. (1982). A comprehensive child sexual abuse treatment program. Child Abuse and Neglect. 6. 263-278. Gilfus, M. E. (1999). The price o f the ticket: A survivor-centered appraisal o f trauma theory. Violence Against Women. 5 . 1238-1257. Gillespie, J. F., & Primavera, J. (2000). Diverse families, competent families: Innovations in research and prevention practice. New York: Haworth Press. Glazer, D. & Frosh, S. (1993). Child sexual abuse. Toronto: University of Toronto Press. Golan, N. (1978). Treatment in crisis situations. New York: Free Press. Goodwin, J., McCarthy, T., & DiVasto, P.(1981). Prior incest in mothers of abused children. Child Abuse and Neglect. 5. 87-95. Gordan, L. (1955). Incest as revenge against the preoedipal mother. The Psychoanalytic Review.42. 284-292. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 215 Graham, D. L.,Rawling, E. & Rimini, N. (1988). Survivors of terror: Battered women, Hostages, and the Stockholm Syndrome. In K. Yello, & M. Bograd (Eds.), Feminist perspectives on wife abuse (pp. 217-233). Beverly Hills, CA: Sage. Green, A. H., Coupe, P., Fernandez, R., & Brooks S. (1995). Incest revisited: Delayed post-traumatic stress disorder in mothers following the sexual abuse o f their children. Child Abuse and Neglect. 19. 1275-1282. Haase, J. E., & Myers, S.T. (1988). Reconciling paradigm assumptions o f qualitative and quantitative research Western Journal o f Nursing Research 1 0 .128- 137. Hanson, R., Saunders, B., & Lipovsky, J. (1992). The relationship between self-reported levels o f distress o f parents and victims in incest families. Journal of Child Sexual Abuse.2.47-58. Heriot, J. (1996). Maternal protectiveness following the disclosure o f intra familial child sexual abuse. Journal o f Interpersonal Violence. 11. 181-194. Herman, J. (1983). Recognition and treatment in incestuous families. International Journal o f Family Therapy. 5. 81-91. Herman, J., & Hirschman, L. (1981). Families at risk for father-daughter incest. American Journal o f Psychiatry. 138. 967-970. Hiebert-Murphy, D. (1998). Emotional distress among mothers whose children have been sexually abused: The role o f a history o f child sexual abuse, social support, and coping. Child Abuse and Neglect. 22. 423-435. Hildebrand, J., & Forbes, C. (1987). Group work with mothers whose children have been sexually abused. British Journal o f Social Work. 1 7 .285-304. Hoff, L.A. (1995). People in Crisis: Understanding and Helping. San Francisco: Jossey-Bass. Hooper, C. (1992). Mothers surviving child sexual abuse. London: Tavistock/ Routledge. Houskamp, B. M., & Foy, D. W. (1991). The assessment o f posttraumatic stress disorder in battered women. Journal o f Interpersonal Violence. 6. 367-375. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 216 Humphreys, C. (1994). Counteracting mother-blaming among child sexual abuse: An Experiential Workshop. Journal o f Feminist Therapy. 6 .49-65. Jaggar, A. M. (1988). Feminist politics and human nature. NJ,: Rowman & Littlefield Inc. James, K. & MacKinnon, L. (1990). The incestuous family" revisited: A critical analysis o f family therapy myths. Journal o f Marital Family Therapy. 16, 71- 88. Joyce, P.A. (1997). Mothers o f sexually abused children and the concept o f collusion: A literature review. Journal o f Child Sexual Abuse. 6, 75-92. Justice, B., & Justice, R. (1979). The broken tabboo: Sex in the family. New York: Human Sciences Press. Kachigan, S. K. (1986). Statistical analysis: An interdisciplinary introduction to univariate and multivariate methods. New York: Radius Press. Kalichman, S. C., Craig, M., & Follingstad, D. (1990). Professionals' adherence to mandatory child abuse reporting laws: Effects o f responsibility attribution, confidence ratings, and situational factors. Child Abuse and Neglect. 14. 69-77. Kelley, S.J. (1990). Parental stress response to sexual abuse and ritualistic abuse of children in day-care centers. Nursing Research. 3 9 .25-29. Kemp, A., Green, B. L., & Hovanitz, C. (1995). Incidence and correlates of posttraumatic stress disorder in battered women: Shelter and community samples. Journal o f Interpersonal Violence. 9. 466- 479. Kemp, A., Rawlings, E. I., & Green, L. B. (1991). Post traumatic stress disorder in battered women: A shelter sample. Journal o f Traumatic Stress. 4. 137- 148. Kempe, S., & Kempe, C. H. (1984). The common secret: Sexual abuse of children and adolescents. New York: Freeman & Company. Kendall-Tackett, K., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis o f recent empirical studies. Psychological Bulletin. 113. 164-180. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 217 King, L. A., King, D.W., Leskin, G., & Foy, D.W. (1995). The Los Angeles symptom checklist: a self report measure o f posttraumatic stress disorder. Assessment. 2 . 1-17. Koch, K., & Jarvis, C. (1987). Symbiotic mother-daughter relationships in incest families. Social Casework. 6 8 .94-101. Krippendorff, K. (1980). Content analysis: An introduction to its methodology. CA: Sage. Lang, R. A., Langevin, R., Van Santen, V., Billingsley, D. & Wright, P. (1990). Marital relation in incest offenders. Journal o f Sex Marital Therapy. 16. 214- 229. Leberg, E. (1997). Understanding child molesters: Taking charge. Thousand Oaks. CA: Sage. LaViolette, A. D. & Barnett O. W. (2000). It could happen to anyone: Why battered women stay. Thousand Oaks, CA.: Sage. Lee, J. A. (2001). The empowerment approach to social work practice: Building the beloved community. New York: Columbia Press. Leifer, M.. Shapiro J. P., & Kassem, L. (1993). The impact o f maternal history and behavior upon foster placement and adjustment in sexually abused girls. Child Abuse and Neglect. 17. 755- 766. Leifer, M.. Shapiro J. P. (1995). Longitudinal study o f the psychological effects o f sexual abuse in African American girls in foster care and those who remain home. Journal o f Child Sexual Abuse. 4 .27-44. Leifer, M. Kilbane, T., & Grossman, G. (2001). A three- generational study comparing the families o f supportive and unsupportive mothers o f sexually abused children. Child Maltreatment. 6. 353-364. Levav, I., Krasnoff L. & Dohrenewend, B. (1981). Israeli Peri Life Event Scale: Rating o f events by a community sample. Israel Journal o f Medical Service. 17. 176-183. Lewin, L.C., & Bergin, C. (2001). Attachment behaviors, depression, and anxiety in non-offending mothers o f child sexual abuse victims. Child Maltreatment. 6. 365-375. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 218 Lincoln, I. S. & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills, CA.: Sage. Lipovsky, J. A., Saunders B.E. & Hanson R. F. (1992). Parent-child relationships o f victims and siblings in incest families. Journal o f Child Sexual Abuse. 14, 35-49. Lovett, B. B. (1995). Child sexual abuse: The female victim's relationship with her nonoffending mother. Child Abuse & Neglect. 19. 729-738. Manion, G., McIntyre, J., Firestone, P., Ligezinska, M., Ensom, R., & Wells, G. (1996). Secondary traumatization in parents o f following the disclosure of extrafamilial child sexual abuse: Initial effects. Child Abuse and Neglect. 2 0 .1095- 1109. Mara, A. & Winton, M. (1990). Sexual abuse intervention: A support group for parents who have a sexually abused child. International Journal o f Group Psychotherapy. 40. 63-77. Margolin, G., Geeberman, L. R., John, D. T. & Ransford, E. (1987, July). Interpersonal factors associated with marital violence. Paper presented at the third Marital Family Violence Conference for researchers, Durham, NH. Martinez, J. (1991). The father-daughter incest in Spanish speaking and Angelo families. Unpublished doctoral dissertation. University o f California Los Angeles, Los Angeles. Massat, C. R., & Lundy, M. (1998). “Reporting costs” To non-offending parents in cases of intrafamilial child sexual abuse. Child Welfare. LXXVII. 371-388. McCluskey,. J., & Hooper C. A. (2000). Psvchodvnamic perspective on abuse: The cost of fear. Philadelphia: Kingsley. McIntyre, K. (1981). Role o f mothers in father-daughter incest: A feminist analysis. Social Work. 26. 462- 466. Meiselman, K.C. (1978). Incest: A psychological study o f causes and effects with treatment recommendations. San Francisco: Jossey-Bass. Meyer, B. D., Sullivan, J. X. (2001). The effects o f welfare and tax reform: The material well-being o f single mothers in the 1980s and 1990s. Cambridge, MA: National Bureau o f Economic Research. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 219 Miller, D. T., & Porter, C.A. (1983). Self-blame in victims o f violence. Journal o f Social Issues. 39. 139-152. Miller, J. (1996). Mothers, workers, wives: comparing policy approaches to supporting lone mothers. In Bortolaia, Silva, E. (Ed). Good enough mothering? Feminist perspectives on lone mothering (11- 97). Routledge: London. Mills, T. (1985). The assault on the self: Stages in coping with battering husbands. Qualitative Sociology. 8, 103-123. Morrison, N. C., & Clavenna-V alleroy, J. (1998). Perceptions o f maternal support as related to self-concept and self-report o f depression in sexually abused female adolescents. Journal o f Child Sexual Abuse. 7. 23- 40. Myer, H. Margaret. (1985). A new look at mothers o f incest victims. Journal o f social work and Human Sexuality, 347-358. Muram, D., Rosenthal, T., & Beck, K. (1994). Personality profiles of mothers o f sexual abuse victims and their daughters. Child Abuse and Neglect. 18. 419-423. Murphy, C. M., & Cascardi, M. (1993). Psychological aggression and abuse in marriage. In R. Hampton, T. Gullotta, G. Adams, E. Potter, & R. Weissberg (Eds.), Family violence: prevention and treatment. Newbury Park, CA.: Sage. Nakhle Tamraz, D. (1996). Nonoffending mothers o f sexually abused children: Comparison o f opinion and research. Journal o f Child Sexual Abuse. 5. 75- 103. Newberger, M. C., Gremy, I. M., Watemaux, C.A., & Newberger, E. H. (1993). Mothers o f sexually abused children: Trauma and repair in longitudinal perspective. American Journal o f Orthopsychiatry. 63. 92-102. Neumann, A. D. (1994). Long-term correlates o f childhood sexual abuse in adult survivors. In Briere, J. (Ed). Assessing and treating victims o f violence: New directions for mental health services, (pp. 64-78). New York: Jossey-Bass Inc. Neumann, D. A.., Houskamp, B. M., Pollock, V. E., & Briere, J. (1996). The Long-term sequelae o f childhood sexual abuse in women: A meta-analytic review. Child Maltreatment. 1. 6-16. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 220 O’Neill, M., & Kerig, P. K. (2000). Attributions o f self-blame and perceived control as moderators o f adjustment in battered women. Journal o f Interpersonal Violence. 1 5 .1036-1049. Padgett, D. K., (1998). Qualitative methods in social work research: Challenges and rewords. Thousand Oaks, C A .: Sage. Parsons, R. J. (1991). Empowerment: Purpose and practice principle in social work. Social Work with Groups. 14. 7- 21. Pedhazur, E. J., & Pedhazur, L. S. (1991). Measurement, design, and analysis: An integrated approach. New York: Lawrence Erlbaum Associates. Pellegrin, A. & Wagner, W. (1990). Child sexual abuse: Factors affecting victims' removal from home. Child Abuse and Neglect. 14. 53-60. Pelletier, G., & Handy, L. (1986). Family dysfunction: The psychological impact o f child sexual abuse. Canadian Journal o f Psychiatry. 3 1 .407-412. Peterson, R. F., Basta, S. M., & Dykstra, T. A. (1993). Mothers o f Molested children: Some comparisons o f personality characteristics. Child Abuse and Neglect. 17* 409-418. Pierce, G. R., Sarason, B.R., & Sarason, I. G. (1990). Integrating social support perspectives: Working models, personal relationships, and situational factors. In S. Duck & R. C. Silver (Eds.), Personal relationships and social support (pp. 173- 189). Newbury Park, CA: Sage. Pintello, D. & Zuravin, S. (2001). Intrafamilial child sexual abuse: Predictors o f post disclosure maternal belief and protective action. Child Maltreatment. 6. 344- 352. Reinharz, S. (1992). Feminist methods in social research. New York: Oxford University Press. Regehr, C. (1990). Parental responses to extrafamilial child sexual assault. Child Abuse & Neglect. 1 4 .113-120. Reimer, S. A. (1940). A research note on incest. Journal o f Sociology. 45. 566-575. Renwick, T. J. (1998). Poverty and single parent families: A study of minimal subsistence household budgets. New York: Garland. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 221 Ringwalt, C., & Earp, J. (1988). Attributing responsibility in cases o f father- daughter sexual abuse. Child Abuse and Neglect. 12. 273-281. Rist, K. (1979). Incest: Theoretical and clinical views. American Journal of Orthopsychiatry. 49. 680-691. Roberts A. R. (1996). Crisis management and brief treatment: Theory, technique and applications. Chicago: Nelson Hall. Rose, S. M. (1990). Advocacy/empowerment: An approach to clinical practice for social work. Journal o f Sociology & Social Welfare. 17. 41-51. Rozenboom, W. W. (1966). Foundations o f the theory prediction. Homewood, IL.: Dorsey Press. Russell, D. (1983). The incidence and prevalence o f intra familial and extrafkmilial sexual abuse o f female children. Child Abuse and Neglect. 7. 133-146. Russell, D. (1984). Sexual exploitation: Rape, child sexual abuse, and workplace harassment. Beverly Hills, CA.: Sage. Russell, D. (1986). The secret trauma : Incest in the lives o f girls and women. New York: Basic books. Sagatun, I. J. (1990). Differences in self-report among incest family members. Child and Family Behavior Therapy. 12. 49-64. Salt, P., Meyer, M., Coleman, L., & Sauzier, M. (1990). The myth o f the mother as “accomplice” to child sexual abuse. In B. Gomes-Schwartz, J. M. Horowitz, & A. P. Cardarelli (Eds.), Child sexual abuse: The initial effects ( pp. 109- 131). Newbury park, CA.: Sage. Saunders, D. G. (1994). Posttraumatic stress symptoms profiles o f battered women: A comparison o f survivors in two setting. Violence and Victims. 9. 31- 44. Sounders, D. G. (1995). Prediction o f wife assault. In J. Campbell (Ed.) Assessing Dangemess: Violence by sexual offenders, batterers and child abusers (pp 68-95). Thousand Oaks, CA: Sage. Schmitz, C. L., & Steiger, S. (1999). Diversity in single-parent families: Working from strength. Milwaukee, WI: Families International. Schuman, H., & Presser, S. (1981). Questions and answers in attitude surveys: Experiments on question form, and context. New York: Academic Press. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 222 Scott, R. L., & Stone, D. A. (1986). MMPI profile constellations in incest families. Journal o f Consulting and Clinical Psychology. 54, 364-368. Sirles E. A. & Franke, P. (1989). Factors influencing mothers' reactions to intrafamily sexual abuse. Child Abuse and Neglect. 13. 131-139. Smart, C. ( 1996). Deconstracting motherhood. In: Bortolaia, Silva, E. (Ed). Good Enough Mothering? Feminist perspectives on lone mothering (37-58). Routledge: London. 37-58. Smith, D. W. & Saunders, B. E. (1995). Personality characteristics of father/perpetrators and nonoffending mothers in incest families: Individual and dynamic analyses. Child Abuse and Neglect. 19. 607-617. Springs, F. E. & Friedrich, W. N. (1992). Health risk behaviors and medical sequelae o f childhood sexual abuse. Mayo Clinic Proceedings. 67. 527-532. Star, B. (1980). Patterns in family violence. Social Casework. 61, 339-346. Stauffer, L. B. & Deblinger, E. (1996). Cognitive behavioral groups for nonoffending mothers and their young sexually abused children: A preliminary treatment outcome study. Child Maltreatment. 1. 65-76. Steel, B. R. & Pollock, C. B. (1968). A Psychiatric study o f parents who abuse infants and small children. In R. E. Heifer & C.H. Kempe (Eds.), The Battered Child (pp.103-147). Chicago: University o f Chicago Press. Stets, S. E. (1990). Verbal and physical aggression in marriage. Journal of Marriage and The Family, 52. 501-514. Strauss, A. (1987). Qualitative analysis for social scientists. Cambridge: Cambridge University Press. Strube, M.. J. (1988). The decision to leave an abusive relationship. In G. T. Hotaling (Ed.), Coning with Family Violence: Research and Policy Perspectives. Newbury Park.: Sage. Tan, C., Basta, J., Sullivan, C. M,, & Davidson, W. S. (1995). The role o f social support in the lives o f women exiting domestic violence shelters: An experimental study. Journal o f Interpersonal Violence. 4 .437- 451. Taubman, S. (1984). Incest in context. Social Work. 27. 35-40. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 223 Taylor, S. J. & Bogdan, R. (1984). Introduction to qualitative research methods (2nd ed.). New York: Wiley & Sons. Thome-Finch, R. (19921. Ending the silence: The origins and treatment of male violence against women. Toronto: University of Toronto Press. Tolman, R. M. (1992). Psychological abuse o f woman. In R. T. Ammerman and M. Herson (Eds.), Assessment o f family violence: A clinical and legal sourcebook. New York: Wiley. Torre, D. (1985). Empowerment: Structured conceptualization and instrument development. Unpublished Doctoral Dissertation, Cornell University, New York. Tremblay, C., Herbert, M., & Piche, C. (1999). Coping strategies and social support as mediators o f consequences in child sexual abuse victims. Child Abuse & Neglect. 23. 929-945. Turner, R. J. (1992). Measuring social support: Issues o f concept and method. In H. O. F. Veiel & U. Baumann (Eds.), The meaning and measurement of social support (pp. 217-231). New York: Hampisphere. Vaux, A. (1988). Social Support: Theory, research, and intervention. New York: Praeger. Vivian, D., & O'Leary, K. D. (1987, January). Communication patterns in physically aggressive engaged couples. Paper presented at the third Marital Family Violence Conference for researchers, Durham, N.H. Wagner, W. G. (1991). Depression in mothers o f sexually abused vs. mothers o f nonabused children. Child Abuse & Neglect. 15. 99-104. Walker, L. (2000). The battered women svndrom. New York: Springer. Walker, L. E. (1991). Post-traumatic stress disorder in women: Diagnosis and treatment o f battered women syndrome. Psychotherapy. 28. 21-29. Waterman, J., MacFarlane, K., Conerly, S., Damon, L., Durfee, M., & Long, S. (1986). Challenges for the future. In K. MacFarlane, K., & J. Waterman, (Eds.), Sexual abuse ofvoung children (pp. 315-332). New York: Wiley. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 224 Wattenberg, E. (1985). In a different light: A feminist perspective on the role o f mothers in father-daughter incest. Child Welfare. 69. 203-211. Wilson, M. (1995). A preliminary report on Ego Development an nonoffending mothers o f sexually abused children. Child Abuse & Neglect. 19. 511- 518. Winton, M. (1990). An evaluation o f a support group for parents who have a sexually abused child. Child Abuse & Neglect. 14. 397-405. Wyatt, G.E., Guthrie, D., & Notgrass, C. M. (1992). Differential effects of women's child sexual abuse and subsequent sexual victimization. Journal of Consulting and Clinical Psychology. 6 0 .167-173. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 225 APPENDIX 1 Tablel: Mothers o f Sexually Abused Children: Personality. Childhood Background, Marital Relationship and Responses to the Child’s Abuse Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Study Sample size <n=) Type of Sexual abuse Sample source Informants Sexual abuse definition Measurements used Mothers’ personality Mothers’ relationship w/ parents M others’ childhood sexual abuse M others’ marital and sexual satisfaction Mothers’ physical abuse in marriage M other’s beliefs and protective actions Mother support of child Dietz & Craft, 1980 200 Incest; definition not provided. Child Protective W orkers from Department o f Social Services Estimations of Child Protection Workers based on their experience in agencies NA* Questionnaire, demographic and descriptive information on incest families 41% evaluated mothers as submissive; 67% as having low self-image and 49% as depressed NA NA M arital relationship estimated as “poor” 78% evaluated the mothers as being abused NA NA Goodwin etal., 1981 34 incest; 66 physical abuse; 500 Control Incest: fathers; stepfathers; father figure; other relatives 34 mothers of incest; 66 physical abuse (clinical samples) 500 control community The mothers and control women ‘Any upsetting sexual event in childhood’ Psychiatric interview, Sexual Stress Questionnaire (self-report) NA NA Incest group: 20% CSA** to clinicians, 29% CSA on self- report. Physically abused group no sig. dif.; control rig. less CSA NA NA NA NA Myer, 1985 43 Incest; biofathers; stepfather and mother’s boyfriend Treatment center Mother’s self-report; clinicians’ evaluation NA M ilton clinical muldaxial inventory; questionnaire on historical data and mother’s attitudes Personality type: 18% dependent; 11% Narcissists 9% borderline 44% poor relationship with parents 65% suffered incest; data on extra-familial abuse not provided NA “Many” (p. 54) 56% believed allegation. Mothers Protected by forcing abuser to leave home 56% showed empathy; 9% little concern; 35% hostile to child Scott & Stone, 1986 44 Incest, 44 Control Incest: fathers; stepfathers Therapy groups, control from community The mothers All fathers convicted. Abuse from fondling 42% to intercourse 37% Group form o f MMPI; demographic questionnaire Normal, no pathology, Yet Sig. dif. from control on 12 scales. Dissociative profile in 18% NA NA NA NA NA NA 226 Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Faller, 1988 171 m others in 3 groups: biofather/ husband; biofather/ divorced; stepfather m other’s boyfriend Incest: step and biofathers, m other’s boy-friend Referred to child abuse project from Child Protective units; law and mental health agencies. Case records; interviews with fam ilies All cases were validated as sexual abuse Likert scales developed: m other’s protective actions; relations with victim; NA NA N A NA N A Sig. dif.; divorced mothers protected best; m others m arried to biofather protected least Sig. dif in warm th to child: Divorced m others were sig warmer than others Everson et al,, 1989 84 m others Incest: Step and biofather; m other’s boyfriend; other relatives Social service agencies in 11 counties Interviews with mothers, social w orkers and case records Validated cases o f sexual abuse D eveloped the Parental Reaction to Incest Disclosure Scale. PRIDS NA NA NA N A N A NA Support: 44% consistent; 32% not consistent; rest not supportive. Divorced m others sig. more supportive Faller, 1989 154 Incest: biofather, father figure Same as in Faller, 1988 Same as in Faller, 1988 Non- contact behaviors such as exposure w ere excluded Inform ants w ere asked if CSA occurred in family o f origin: Yes/ N o answers. NA NA 42% o f 154 m others w ere direct victim s o f CSA N A N A N A NA Sirles & Frank, 1989 193 Incest: fathers, stepfathers, live in friends and family relatives Child Sexual Abuse Treatm ent Program Interview s with m others and victims Sexual contact betw een an adult relative and a child Questionnaire developed for study on m other’s believe NA NA NA NA N A 78% believed. B elief was effected by factors related to offender; victim ; nature o f abuse N A Salt et al., 1990 156: com pared incest vs. extra- familial Both. Incest: fathers; father figures. N o n related offenders C hildren and fam ilies referred to Family Crisis Program The m others and clinicians Confirm ed cases o f contact betw een a child and adult when child is used for sexual stimulation M ilton clinical m ultiaxial inventory. Questionnaire on historical data; relations w / spouse and m other’s protect and support N o sig. emotional problems. N o sig. dif. betw een incest and extra/ fam ilial on depression 45% Poor relationship w ith mother; 39% with father. N o dif. between incest and extra- familial groups 41% CSA N o dif. betw een Incest and extra - fam ilial groups N A 39% abused by husbands or lovers 82% took protective actions. W hen abuser is step/f or boyfriend m other least protective 90% expressed concern for child. N o sig. differences between groups so N 5 - 4 Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Study Sample size (n~) Type o f Sexual abuse Sam ple source Inform ants Sexual abuse definition M easurem ents used M others’ personality M others’ relationship w/ parents M others’ childhood sexual abuse M others’ marital and sexual satisfaction M others’ physical abuse in m arriage M other’s beliefs and protective actions M other’s support o f child Lang et al., 1990 Incest 92, control 40 Incest: biofathers, stepfathers, other relatives From law enforcem ent agency control: not reported Sentenced offenders; pretrail offenders; control NA. How ever, 87% o f offenders admitted abuse S elf report: Clarke M arital R elation Questionnaire; Sexual B ehavior and M arital Satisfaction NA NA NA S ig .less marital satisfaction than control. No. Sig. dif. in sexual satisfaction N A NA NA Pellegrin & W agner, 1990 58 Both. 53% Incest, 47% extra- familial Child Protective Services Case records V alidated cases: from fondling to penetration Collected inform ation on m other’s beliefs, em ploym ent and treatm ent com pliance N A NA NA NA 65% totally believed only 3% totally disbelieved N A Saga tun, 1990 36 families: offenders, spouses and victims Incest: 33 fathers and stepfathers; 3 grand fathers M em bers o f ‘Parents U nited’: A self help group Offenders, spouses and victims Ail offenders had been prosecuted Self adm inistered questionnaire on family background NA N A 42% o f spouses reported being sexually abused by their fathers 50% wives and 64% offenders reported sexual withdrawal. 56% wives 78% mates emotional withdrawal NA 33% m others said they reported to police. Offenders said same; victim s said only 8% o f m other reported NA Dadds et al., 1991 Incest; 46 fathers; 47 mothers; 36 control couples Incest: fathers and stepfathers Clients in a sexual abuse treatm ent program. Control from comm unity Offenders, mothers, control fathers and mothers Confirm ed cases by Departm ent o f Fam ily Services Lock-W allace Marital Adjustm ent Scale No sig. dif. between groups on m other’s self esteem NA NA N o sig. difference between groups in marital adjustm ent NA NA NA E lbow & M ayfield, 1991 24 Incest; fathers County Protective Services Unit Case records Validated sexual abuse Reviewed records N A NA NA N A NA 83 % believed allegation. 29% protect by report to agenci es NA N > o o Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Friedrich, 1991 37 abuse; 43 out patients; 76 control Both, 21 incest; rest non related offenders M others o f abused and nonabused children in treatm ent; control Sexual abuse at least genital contact MM PI profile M M PI sig. elevated in com parison to control. However, within normal limits NA 75% o f abused group had CSA in two other groups. CSA m others sig. more depression and alienation NA NA NA NA NA M artin ez, 1991 102 Incest; 55 biofathers and 47 father figures Referred to program s for incest fam ilies by Child Protective Services Father- offenders and m others Cases o f father- daughter incest from Child Protective Services H udson’s Indexes o f m arital and sexual satisfaction NA NA NA L ow er marriage and sexual satisfaction com pared to norms. N o dif. In partners’ perception: NA NA NA W agner, 1991 104 in 3 groups; 32 incest; 26 extra- fam ilial; 46 control (clinical) Both; Incest; father, family m em bers Children who came to university outpatient clinic for evaluation The mothers V alidated cases o f sexual abuse Beck Depression Inventory (BDI) M oderate depression, 50% incest; 69% extra/f and 50% control No Sig. group dif. Na NA NA NA NA NA Carter, 1993 24 mothers Both: 10 fathers, 6 relatives, 12 trusted friends or neighbors 9 from support groups; 8 welfare agencies; 7 ad. In paper The mothers and case records Children sexually violated according to Canadian laws In-depth interviews with mothers and review o f agency’s case records NA NA 71% indicated history o f CSA NA NA 95% m others initially believed child NA Esparza, 1993 19 abuse; 50 control pairs o f mother- daughter Both however, offender is not a parent and do not live with m other and child Four clinical agencies serving abused children and families. Control from comm unity The m others and children About half sample reported penetration Fam ily Peer Relationship Questionnaire, Stress Response Scale. The Child Life Event Inventory (CLEI) NA NA NA NA NA NA No Sig. dif. in support between groups as perceived by both m others and girls when CLEI in controlled VO Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Study Sam ple size («*) Type o f Sexual abuse Sam ple source Inform ants Sexual abuse definition M easurem ents used M others’ personality M others’ relationship w/ parents M others’ childhood sexual abuse M others’ m arital and sexual satisfaction M others’ physical abuse in m arriage M other’s beliefs and protective actions M other support o f child Leifer et a)., 1993 68 Both Incest, friends; relatives, no stranger 73% offenders lived w ith child From child protective services, exam ined at children’s hospital, 68 fem ale victim s and their biological or foster m others Genital touching; offender at least 5 years older than victim M aternal interview developed for study: history, functioning and attitudes tow ards victim N A 52% had poor relationship with parents 53% CSA definition o f m others’ sexual abuse identical to that o f ch ild ’s sexual abuse N A NA 71% believed child; 58% took actions to protect 49% supported. N o sig. Relationship betw een support and m other’s CSA or relationship w / parents Peterson et al., 1993 40 in 3 groups: 13 Incest (F); 15 teacher m olested (T ) and 12 control (C) Incest: fathers; stepfathers; family relatives. Extra- familial: Teacher Incest; S elf help groups, teacher m olested and control from 2 day care centers The m others T able o f abusive acts: from fondling to penetration Clinical Analysis Questionnaire 16 Personality Q uestionnaire N o Sig. dif. in norm al personality T low er than F on Sensitivity and IQ. F and T: greater distress than C. NA NA N A NA NA NA D eblinger et al 1994 183 in 2 groups; 83 m others with CSA history and 100 w ithout CSA Both incest and extrafam ilial sexual abuse M others o f children referred by Family Services or prosecutor’s office to forensic m edical exam ination in hospital The mothers Suspected victim s o f child sexual abuse Sym ptom s Checklist 90 revised (SCL- 9 0 -R )an d a structured clinical review Sig. d if betw een groups: M others w ith CSA higher distress & feeling o f loneliness NA 45% reported history o f CSA N A 61% w ith and 56% without CSA history reported abuse. No sig. dif betw een groups 80% w ith and 76% without CSA history believed in allegation No sig. dif. between groups 67% with and 60% w ithout CSA history supported. N o sig. dif. betw een groups de Y oung, 1994 20 Incest; bi ofathers and stepfathers Fam ilies m andated therapy by court at Incest Treatm ent Program The m others A busive act varied from fondling to vaginal/anal penetration In-depth life hi story interview, recorded and analyzed N A NA NA N A N A 65% believed Sig, m ore believed child than other who told. 60% protection NA 230 Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission. Study Sam ple size (n=) Type o f Sexual abuse Sample source Inform ants Sexual abuse definition M easurem ents used M others’ personality M others’ relationship w/ parents M others’ childhood sexual abuse M others’ m arital and sexual satisfaction M others’ physical abuse in m arriage M other’s beliefs and protective actions M other support o f child M uram et al., 1994 65 victim ’s m others; 65 control Both incest and extrafamilial sexual abuse Department o f human services Control from a medical clinic The m others Validated sexually abused chil dren Eysenek Personality Questionnaire, Leisure Interest Checklist N o display o f and Sig. pathology. Sig less on sociability and less on impulsivity. Sig, more contriced NA NA NA NA NA N A Lovett, 1995 60 abused girls age 7- 12 Both; 38% blood relatives and 62 other offenders 2 outpatient medical clinics and a treatm ent clinic The abused girls Table o f abusive act; yes/no, percents Parental Acceptance/ Rejection Questionnaire and Profile Analysis (Rohner, 1991) NA NA NA NA NA 72% perceived m other as believing child 91% perceived m other as w arm and accepting Sm ith & Saunders, 1995 94 fathers and 65 mothers Incest. Biofathers; stepfathers; father figure 2/3 from comm unity agencies; 1/3 from Navy facilities; all referred for evaluation The m others and the father/ offenders Confirm ed child Sexual abuse involving physical contact 16 Personality Factor Questionnaire and Profile Analysis (Krug, 1981) M others within nonclinical range. Variety o f personality profiles; “normal” is the common. Tendency to social isolation NA 34% at least one instance o fC S A No passive- dominant pairing found. M others associated with partners with alike personality NA NA NA W ilson, 1995 21 non offending mothers Both: 71% incest; husbands, exhusband and boy friends Group therapy program for fam ilies o f sexually abused children The m others Identified sexually abused children Ego Development M easurement (Levinger and W essier, 1 9 7 0 )and demographics M ost had relatively integrated levels o f ego developm ent NA 67% history o fC S A seem s to be no relationship between CSA history and m other protectiveness NA NA 62% believed; 27% ambivalent; 66% acted to stop abuse NA to 232 6 8 % were supportive. L ess protect associated w iih severe abuse. 62% supportive. Support is related to inter- generational attachment NA S • ° ? * - « te J2 ^ *- ^ 3 S -§ J? -2 1 § J 3 « s ! i a g 4 1 % both believed & protect, 3 1 % did n o t 28% ambivalent. Protect related to maternal a n d child’s predictors 04 2 g g NA NR i g NR g g NA Troubled attachment with mothas is related to maternal support NA i NA NA Questionnaire developed by i reporters Parental reaction to C S A scale, a n d semi structured intsview Developed questioner cm protectiveness a n d 20 predictors Substantiate cases of C P S reports S o m e form o f genital touching had occurred i * 4 j j j *9 8 £ 8 i Intake D ata and workers’ CSA report forms 1 . S I I I 11 Case Records & computer Database files Child Protective , Services Child Protective Services and others professional sources Child Protective Services Incest: anyone related to d ie child’s fam ily or mother Incest: Established member of th e family system. Intrafamilial sexual abuse 1 1 8 non offending mothers 9 9 non offending mothas 4 3 5 mothers 1 I Heriot, 1996 Leifer e t al., 2001 Pintello & Zuravin, 2001 8 I l l •i J - s i $ Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX 2 Approval o f Study Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3MSBERS OF TOE PBESHSUIG JUDGE : 3S ANGELES JOTEMXLE OO0RT - - 3mund D. Edelaan Children's Court 01 Centre Plaza Drive, ■ Suite 3 • onterey Part, California 91754-2158 (213) 526-6668 SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES JUVENILE COURT m behalf of; laura O'Keefe, Ph.D. SPECIAL ORDER RE; MEDIA ACCESS, WAIVER OF SMKDfflTiaEIW OR RESEARCH PROPOSAL Petitioner Pursuant to a written petition and letter dated Kay 16, 1997, Maura O'Keefe, Ph.D., Associate Professor at BSC School of Social Wort ("Petitioner") requests a waiver of confidentiality to conduct research involving victims of sexual abuse. (Copies attached.) Good Cause Appearing, the Juvenile Court hereby issues the following Order pursuant to Welfare and Institutions Code section 827 and California Rules of Court, Rule 1423: This order grants to Petitioner a Halted waiver of confidentiality to analyze closed DCFS files of children treated by the sexual abuse unit between the years 1985 - 1997. Petitioner agrees to the following limitations: 1. Petitioner agrees to pay all costs incidental to the research. These costs will be established prior to initiation of the project. 2. Petitioner agrees to abide fay all case confidentiality policies and procedures of the Department of Children and Family Services and the Los Angeles County Superior Court Local Rules. Strict confidentiality shall be maintained as to any identifying information regarding each minor whose file is used in the study. The information obtained shall be used for the sole purpose outlined in the attached petition. 3. Petitioner will ensure that no unauthorized persons or agencies have access to the confidential information released to Petitioner. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 4. Accept the Department of Children and Family Services8 acisions on scheduling regarding access to the requested files. 5. Petitioner will not use the names or identifying nformation of any minor published documents (i.e. reports, -valuations) . 6. v The research pursuant to this order must be completed by 'anuary. 1, 1998. 7. A copy of the research findings shall be submitted to the (epartment of Children and Family Services. Presiding Judge Juvenile Court Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. NITA M. BOCK D i r e c t o r COUNTY O F LOS ANGELES DEPARTMENT OF CHILDREN AND FAMILY SERVICES ® SS&®asi% ii®-LasAag«te!(C S O ) 3 S l - S « stM W December 21,1999 GLORIA MOLINA YVONNE BKATHWAITE BURKE ZEV YAROSLAVSKY DON KNABE MICHAEL D. ANTONOVICH D r. Maura O ’ Keefe do Michal Seia-Amit . 847 S. Sherboume D r., Apt 5 Los Angeles, CA 90035 Dear Ms. Sela-Amit The Department of Children and Family Services (DCFS) and the Juvenile Court has approved your extension request to conduct research. I f you have any questions regarding the above, please call me at (213) 351-5741. truly yours. NO:no Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. w m rnM m m m xm tm m m m G tixm m m A t . w m b w w n u i M O O E S t I R s^ u m i " B ie " i SSa D * % i » 9f/SSS rtm m om m m : G6tB»i£tVt 01 8*96 £g£ S33infflS J j« 5 3 - r n r ad 9£«S1 68©? 60 (M X* H D U 19 1999 1USS ■ DEC SI 1999 15:40 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 238 APPENDIX 3 The Case Extraction Form and the Los Angeles Symptom Checklist Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 239 The Experience and Effects o f Intra-F240240239amilial Child Sexual Abuse on the Non-Offending Mothers as Recorded by Helping Professionals Date: Subject Number: Date o f Opening Case Date o f Treatment Termination: A. Mother’s Socio-Demographic Information 1. Age o f the mother when abuse was disclosed? 2. Mother's ethnicity? 3. If mother immigrated to the U.S.A., when? 4. Mother's marital status? ( Single never married, Married, Separated, Divorced, Widowed, Live-in boy-friend, Remarried) 5. Mother's number o f children? 6. Mother's level o f education? 7. Mother's occupation? 8. Did mother work outside the household before the abuse disclosure? 9. Level o f income for the household before disclosure? 10. Main source o f income before disclosure? 11. Mother's physical health before disclosure? 12. Mother's psychological health before disclosure? 13. Mother's substance abuse before disclosure? (Drug\ Alcohol) 14. Mother’s age when first child was bom? B. Facts About the Sexually Abused Child 1. The child's sex? Female\ Male. 2. The child's age at time o f onset o f sexual abuse? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 240 3. The child's age at time o f disclosure o f abuse? 4. History o f physical abuse o f the child? No\ Yes, by mother\Yes, by father\ Yes. 5. History o f neglect o f the child? No\Y es. 6. History o f living away from mother’s care? C. Facts About the Sexual Abuse 1. Type (severity) o f abuse? (List all: Fondling, rape, intercourse...) 2. Duration of abuse: (In years from first incidence to last one) 3. Frequency o f abuse: (The number o f incidences reported) 4. Where was mother when abuse incidents happened? 5. The offender's relation to the abused child: (Father, stepfather, brother ...) 6. The offender's relation to the child's mother: (Husband, ex-husband, live-in boy friend...) 7. Did offender confirm/ deny sexual abuse allegations? Confirm\ deny 8. Were the allegations o f abuse supported by witness? No\Yes. 9. Were the allegations o f abuse supported by a medical examination? No\Yes. 10. Were charges filed against offender? No\ Yes. 11. Was offender found guilty? No\Yes. D. Facts about the Child Sexual Abuse Disclosure 1. What were the circumstances o f abuse disclosure for the mother? 2. Who reported the child's sexual abuse to the police or the Child Welfare Agency? 3. Who reported the child's sexual abuse to the mother? 4. Did the mother believe the sexual abuse allegation when she first learned about it 5. Was the mother consistent regarding her position on the issue o f believing the child? If not, indicate the direction, what is known about the reasons or circumstances for the changes in mother's position? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 241 F- Changes of the Mother’s Life Circumstances After Disclosure 1. Did family move into a different house after disclosure? More than once? To where? 2. Did offender leave the mother's house after disclosure? 3. Did the abused child leave mother's house immediately after disclosure? Why? To where? 4. Did other children leave the mother's house after disclosure? 5. Was the mother's role as a parent change after disclosure? Did Mother became a single parent? Children came from foster care, specify..when... why? 6. Did mother report experiencing difficulty in parenting the sexually abuse child after the disclosure? (specify the nature o f all difficulties....). 7. Did mother report experiencing difficulty in parenting the siblings of the abused child after the disclosure? (specify the nature o f difficultyies: school, insomnia... 8. Did mother have an open case in DCFS after abuse disclosure? Reasons? 9. Was mother instructed by law to participate in parenting group? No\Yes. Did she go? 10. Is mother responsible for the participation o f other family members in therapy? No\Yes. 11. If the children were placed in out-of-home care, how frequently did mother visit them? Called and had them over for visitation? 12. Did mother change work place after abuse disclosure? No\Yes. Why? 13. Did mother change the number o f working hours per week after disclosure? No\Yes, more hours\ Yes, less hours. What were the reasons? 14. Did mother reported difficulty in working outside the household? 15. Was there a change in the income level o f the family after disclosure? No\Yes, less income\ Yes, more income. Why? 16. What were the reasons for the change in income level? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 242 F. Changes in the M others Intimate and Social Relationships After Abuse Disclosure 1. List all known mother's emotional reactions toward the sexually abused child after disclosure such as: Anger, hostility, pity, over-protection, support, other: 2. Was there a change in the relationship between the abused child and the mother after disclosure and during treatment? NoYYes. Direction o f change, how did relationships changer during the aftermath? 3. To what extent was mother described by therapist as supportive o f her sexually abused child? 4. In cases where offender is not the mother's significant other, describe any changes in the mother-offender relationship. 5. Was there a change in the relationship between mother and the non-offender significant other after the abuse disclosure? NoYYes, specify: more\ less supportive, conflictual, alienation, 6. In cases where offender is the mother’s significant other describe any change in relationships. 7. Was the mother physically abused after the sexual abuse disclosure of her child? NoYYes. 8. Were there threats toward the mother or the abused child after disclosure? NoYYes. Specify: 9. Was there a change in the relationship between mother and her other children after disclosure? No\Yes. Specify: 10. Were there changes in the relationship between the mother and members o f the extended family after the abuse disclosure? NoYYes. Direction of change: rejection, supportive. .Reasons for change which ? 11. How many relationships changed after disclosure? Which ones? 12. What were there changes in the overall support mother received after the abuse disclosure? No\Yes, mother received more support\ Yes, mother received less support\ Other- Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 243 13. Were there changes in the mother's support system after abuse disclosure? No\Yes 14. List all known sources o f mother's support: Religious affiliation, support group, friends.... G. Changes in the Mother's Well-Being After the Abuse Disclosure 1. What was the therapist’s evaluation o f the mother's mental and emotional well being at the intake interview? 2a. Fill out all the LA Symptom checklist. 2b. List all o f mother's recorded reactions which are not included in the LA symptom checklist to the sexual abuse disclosure and the number o f times each reaction is mentioned by the therapists during all therapies Modula: Shame, anger, self blame, sadness, lack of satisfaction with herself, sense o f failure, guilt feeling, self-hate, social withdrawal, other.. 3. List all o f mother's recorded psychosomatic symptoms after the abuse disclosure and the number o f times mentioned for each one o f them (Insomnia, lack of energy, lack o f appetite, anxiety, numbness, indecisiveness, other...) 4. Did the mother experienced any physical illness ( how many times) after the abuse disclosure? NoYYes. 5. Substance abuse o f the mother after abuse disclosure? NoYYes, Alcohol\ Yes, Drugs. 6. Did the mother experience self-destructive thinking or behaviors after abuse disclosure? No\Yes. List number o f times mentioned for each one. Wish to die, self-mutilation, self-loathing, suicide attempts, other... 7. Unresolved issues that were evoked in the mother as a result o f the child sexual abuse disclosure? NoYYes. (Specify: CSA history, other victimization, traumatic loss, other..) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 244 8. What are the recorded effects o f separation on the mother in the cases where the children were taken out o f the mothers' home following the abuse disclosure? 9. What are the recorded effects o f separation on the mother in the cases where significant other left the mother's home following the abuse disclosure? 10. Total number o f areas in which disturbance in the mother’s well being has been reported ( each area is counted only once. 11. Total number o f disturbance symptoms reported ( if mother is said to be depressed three times, count as three symptoms. 12. Did mother self perception changed? How? H. Mother's sexual abuse in childhood I. Did mother reported being sexually abused before she was 18 years old? NoYYes 2. Who was the offender(s)? 3. What is known abut the severity and the duration o f mother's CSA (child sexual abuse)? 4. Did mother disclose sexual abuse when young? NoYYes 5. Did mother receive therapy for CSA? No\ Yes, during childhood\ Yes, during adulthood. I. Mother's Patterns of M arital. Sexual and Familial Relationships Before Disclosure 1. What is known about the quality o f relationships between the mother and her significant other prior to disclosure? 2. Infidelity in the relationships (whom)? No\ Yes, mother \ Yes, significant other\ Yes, both. 3. Where there times o f separation between mother and significant other ? 4. Was there physical abuse o f mother by significant other before disclosure? 5. Was there a threat to mother or the children's lives before disclosure? 6. Was a weapon ever used while threatening? Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 245 7. Did mother ever leave home as a result o f domestic violence? 8. Where did mother go? Shelter\ Friends\ Family\ Other 9. Did mother ever get a restraining order against significant other? 10. What is known about the relationships between mother and her abused child prior to disclosure? J. Descriptive Information About the Mother's Therapy 1. Did mother participate in Non-Offending Parents (NOP) therapy following court order? 2. Forms o f therapy for the mother? (list all: Individual, Group, Family, Victim- Mother Group). 3. How many hours o f therapy did the mother received overall? 4. How many months was mother in therapy from day of intake until treatment termination? Or how many Modula did the mother attend? 5. Was mother’ s attendance in therapy assessed as reliable? Reliable\ Unreliable. 6. According to the therapist, were therapy goals for the mother met? Met, Partially met, Unmet. 7. What were the reasons documented on file for the termination o f treatment with mother? (Treatment goals met, DCFS case closed, Treatment rejected, Unable to contact, Poor attendance, Downsizing, Other: explain). 8. According to the therapist, did the mother benefit from the therapy? NoYYes. Specify how... 9. What else helped mother to adjust and overcome? 10. How did mom helped her self, the abused child and the siblings to heal? 11. How does mother sees her self at the end o f treatment? Terms: NA: Not Applicable. NR: Not Reported. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 246 —The LA Symptom Checklist— Adult version: Rate each item on a scale from 0 to 4 according to how much o f a problem that item is: o = not a problem, 1 = a slight problem, 2 = a moderate problem, 3 = a serious problem and 4 = an extreme problem. 1. Difficulty falling asleep. 23. Vivid memories o f unpleasant prior experience. 2. Abusive drinking 3. Severe headaches 4. Restlessness. 5. Nightmares 6. Difficulty finding a job 7.difficulty holding a job 8. Irritability 9.Pervasive disgust 24. Excessive eating. 25.Difficulty concentrating. 26. Dizziness/ fainting 27. Sexual problems 28. Waking during the night 29. Difficulty with memory 30.Marked self -consciousness 31. Depression 10. Momentary blackouts friends 11. Abdominal discomfort friends. 12. Management of money. 13. Trapped in an unsatisfying job. morning. 14. Physical disabilities or medical problems explain..................... 15. Hostility/ violence 16. Marital problems 17.Easily fatigued. 32. Inability to make and keep same sex 33.Inability to make and keep opposite sex 34. Excessive jumpiness. 35. Waking early in the 36. Loss o f weight/ appetite 37. Heart palpitations 38. Panic attacks Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 247 18. Drag abuse __40. Avid activities that remind you of prior unpleasant experiences 19.1nability to express feelings. __41. Trouble trusting others. 20. Tension and anxiety __42. Loss o f interest in usual activities. 21. No leisure activities __43. Feeling emotionally numb. 22. Suicidal thoughts Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 248 APPENDIX 4 Table 2: The Effects of Child Sexual Abuse on Non-Offending Mothers: Research Hypotheses Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 249 Table 2 The Effects o f Sexually Abuse on Non-Offending Mothers: Research Hypotheses The Research Question The Hypothesis Test & level o f Significance 3a. Do MIAC who were sexually abused in childhood experience more difficulty in their well being than MIAC who were not sexually abused in childhood? * Ho: r 1 = r 2 H I: MIAC who were sexually abused in childhood experience significantly more difficulty in their well being in comparison to MIAC who were not sexually abused. t-test. (1-tail test) alpha = .10 3b. Do MIAC who are battered women experience different amount o f change in their lives than MIAC who were not battered women? Ho: r 1 = r 2 HI: These two groups o f MIAC differ significantly with regards to the amount of change in their lives after the child’s abuse disclosure. t-test. (2- tailed test) alpha = .10 3b. Do MIAC who were battered women differ from those who were not with regards to their well being after the abuse disclosure? Ho: r 1 = r 2 HI: The two groups o f MIAC differ significantly with regards to their well being after the abuse disclosure. t-test. (2- tailed test) alpha = .10 3d. Do single parent MIAC differ from MIAC who share parenting in experiencing change in their well being after the abuse disclosure? Ho: r 1 = r 2 H I: The two groups o f MIAC differ significantly with regards to their well being after the abuse disclosure. t-test. (2- tailed test) alpha = .10 3d. Do single parent MIAC differ from MIAC who share parenting in the change that occurred in their lives? Ho: r 1 = r 2 HI: The two groups o f MIAC differ significantly with regards to the change that occurred in their lives. t-test. (2- tailed test) alpha = .10 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 250 3e. Do MIAC who are married to the child’s offender differ than MIAC who are not in the change that occurred in their well being ? Ho: r 1 = r 2 HI: The two groups o f MIAC experience significantly different amount o f change in their well being. t-test. (2- tailed test) alpha - .10 3e. Do MIAC who are married to child’s offender differ than MIAC who are not in the amount o f change in their social relationships? Ho: r 1 = r 2 H I: The two groups o f MIAC differ significantly in the changes that occurred in their social relationships. t-test. (2- tailed test) alpha = .10 3e. Do MLAC who are married to the child’s offender differ than MIAC who are not in the amount o f change that occurred in their lives? Ho: r 1 = r 2 HI: These Two groups o f MIAC differ significantly in the amount o f change that occurred in their lives. t-test. (2- tailed test) alpha = .10 3f. Do MIAC whose children were placed in supervised care differ from MIAC whose children stayed home in the changes experienced in their well being? Ho: r 1 = r 2 H I: The two groups o f MIAC experience significantly different amount o f change in their well being. t-test. (1- tailed test) alpha - .10 3f. Do MIAC whose children were placed in supervised care differ from MIAC whose children stayed home in the changes experienced in their social relationships? Ho: r 1 = r 2 HI: The two groups o f MIAC differ significantly in the changes that occurred in their social relationships. t-test. (2- tailed test) alpha — .10 3f. Do MIAC whose children were placed in supervised care differ from MIAC whose children stayed home in the changes experienced in their lives? Ho: r 1 = r 2 HI: The two groups o f MIAC differ significantly with regards to changes in their life after their child sexual abuse disclosure. t-test. (1- tailed test) alpha = .10 Note. The table starts with question 3 since previous questions do not involve hypotheses testing. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Hostile family environments and children's perceptions of social support

PDF

Exploration of the relationships between child and family characteristics, pre -adoptive risk history, and adoption services utilization

PDF

A comparative study of the family processes of youth of Mexican descent who have dropped out of high school and those who have remained in school

PDF

Interviews with children: how they perceive psychotherapy

PDF

Academic performance and persistence of Asian American students in the Los Angeles Community College District

PDF

Emancipated foster youth: A study of outcomes of emancipated foster youth in a transitional housing program

PDF

Effects of parenting style and ethnic identity on European American and Asian Indian adolescents' academic competence and self esteem

PDF

Comparative analysis of the stress process in AIDS caregivers: Gay male partners, Anglo women, and Latinas

PDF

"Self" in self -worth protection: The relationship of possible selves to achievement motives and self -worth protective strategies

PDF

Interfaith family process and the negotiation of identity and difference

PDF

Gender, learning, and trafficking: Helping vulnerable Thai women through NGO and government non -formal education programs

PDF

Braving the streets of Brazil: Children, their rights, and the roles of local NGOs in northeast Brazil

PDF

Affection and conflict in family relationships

PDF

Family functioning, intergenerational conflict, and psychological symptomology of Asian American college students

PDF

Determining competent/resilient outcomes across multiple domains in sexually abused and nonabused females

PDF

An adolescent -parent conflict resolution skills training program for ethnically diverse families: A program evaluation study

PDF

Emotion regulation as a mediator between family-of-origin aggression and marital aggression

PDF

Development of a family risk-factor measure that predicts imminent risk of placement and appropriateness for family-based, wrap -around services

PDF

Aggression and victimization as predictors of drug use in early adolescence

PDF

Chinese immigrants united for self -empowerment: Case study of a weekend Chinese school

Asset Metadata

Creator Sela-Amit, Michal (author)

Core Title Intra-familial child sexual abuse: The experience and effects on non-offending mothers

School Graduate School

Degree Doctor of Philosophy

Degree Program Social Work

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,psychology, developmental,Social Work,sociology, individual and family studies,sociology, public and social welfare

Language English

Contributor Digitized by ProQuest (provenance)

Advisor O'Keefe, Maura (committee chair), Mor Barak, Michalle (committee member), Stromquist, Nelly (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-549897

Unique identifier UC11339356

Identifier 3094401.pdf (filename),usctheses-c16-549897 (legacy record id)

Legacy Identifier 3094401.pdf

Dmrecord 549897

Document Type Dissertation

Rights Sela-Amit, Michal

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA