Hungarian Workshop

Seminar on Child Sexual Abuse

Ralph C. Underwager
and
Hollida Wakefield

Hungary
October, 1996

Introduction

As Western civilization has developed from the beginnings in Athens over 2500 years ago, there has been a movement toward greater freedom and individual responsibility. Part of that movement is to seek to reduce the violence done and to build a peaceful world. In pursuit of that goal, decreasing the frequency of the abuse of children has moved to a central focus in many places. There are many, many decisions made by the institutions charged with carrying out the policies which are intended to protect children from harm by adults. The accuracy of those decisions is of greatest importance. No one can dispute that everyone, child, parents, families, and the society, all benefit from making the most accurate decisions possible. This is what we hope to foster in these workshops. Sharing the experience of the United States can contribute meaningfully to those who wish to make the best decisions possible at any stage or any level of the process. We also hope for learning from others willing to share their wisdom and knowledge with us so that we can also progress toward more accuracy in decision making.

I. History and Scope of the Problem

A. Children have been abused by adults throughout history (Bakan, 1971; Wakefield & Underwager, 1988).

B. Beginning with the passage of the initial British child labor laws in the mid-nineteenth century, care and concern for children began to be addressed through government institutions and policies. The concept of a protected childhood in the home took hold in American and Western European culture. The history of the development of the system responding to child abuse demonstrates the scope and limitations of social change policies in a democratic society (Nelson, 1984).

1. Orphanages and institutions were built, adoption services, foster care systems, reformatories, and juvenile courts were established and compulsory education laws were passed.

2. In the United States, following the passage of the Child Abuse Prevention and Treatment Act (CAPTA) in 1974, laws mandating reporting suspected child abuse were passed in all fifty states by 1976.

3. These laws made child abuse in the United States a national issue beginning in 1972 and focused federal intervention on the goal of assuring every child an abuse free life (Nelson, 1984).

4. The result in the United States was that there was a twenty-fold increase in the number of reports of all forms of child abuse and neglect.

a. In 1993 there were approximately three million reports of child abuse and neglect compared to 1963 when 150,000 cases were reported (Besharov & Laumann, 1996).

b. Of these total reports, nearly half were for sexual abuse (Lamb, 1994).

c. As a result of the reporting laws, child abuse and neglect deaths have fallen from 3000 to 5000 a year to about 1100 a year (Besharov & Laumann, 1996).

d. Much child abuse still goes unreported in the United States.

e. But there has also been a significant increase in the number of reports that are unfounded. In the United States the rate of unfounded reports is now between 60% and 65%. In 1974, the unfounded rate was 45% (Besharov & Laumann, 1996).

f. This dramatic increase in unfounded reports overloads the system and prevents help from reaching children who actually are being abused. The protective service agencies are making mistakes on both sides.

5. Most of the other Western industrialized nations have also witnessed substantial increases in the number of reported incidents of child abuse.

C. How common is child sexual abuse?

1. Incidence and prevalence

a. Incidence is the rate of new cases occurring during a prescribed period of time for a given population.

b. Prevalence is defined as the ratio of all active cases present in a specific population at a particular point in time.

c. Reported incidence rates are generally lower than prevalence rates.

d. Both reported incidence rates and prevalence rates of child sexual abuse are very inconsistent.

e. The incidence rate for 1992 in the United States was 0.7 and is lower in other countries (Lamb, 1994).

2. Estimates for prevalence range from 62% for women and 30% for males to 5% for females and 3% for males (Wakefield & Underwager, 1988).

3. The discrepancy in estimates is due to differences in methodology and definitions between studies. Studies differ on the ages of the victim and perpetrator, whether the study included noncontact experiences, the characteristics of the samples, and the method of data gathering.

4. A study with good methodology and a community sample of 3132 found a lower prevalence rate: 5.3% (6.8% for females and 3.8% for males) (Siegel, et al., 1987).

5. Studies in other countries have reported prevalence rates ranging from 7% to 36% for women and 3% to 29% for men (Finkelhor, 1994).

II. False Allegations of Child Sexual Abuse

A. How many allegations are false?

1. There has been a continuing dispute about the proportion of sexual abuse allegations that are false, with some professionals claiming they are extremely rare and others maintaining false allegations have become a serious problem. No one knows how many there actually are.

2. The unsubstantiated rate is approximately 60% to 65%.

3. Problems in definition

a. Unsubstantiated does not mean false and substantiated does not mean true.

b. Some writers define false allegation as all allegations that are not true; others limit the term to deliberate fabrications. Deliberate false allegations are relatively infrequent.

4. Following the initial extensive screening of reports, at any one time around 400,000 families across the country are under the supervision of child protection. However, a study conducted for the U.S. National Center of Child Abuse and Neglect found that in about half of these cases, the parents never actually maltreated their children (Besharov, 1985).

5. In an effort to detect all cases of child sexual abuse the absence of highly accurate evaluation procedures will inevitably result in an increase in the number of false allegations. The more we try to reduce the number of sexually abused children that are missed, the more we will misidentify children as sexually abused when they are not.

B. Immediate effects of the accusation

1. Once an accusation is made, often the accused parent is not allowed to see his child. Sometimes the accused parent is not allowed to see his child for months even though no determination of guilt has been made by the justice system.

2. The child is often immediately placed in therapy where a therapist, who believes that abuse occurred, does sexual abuse therapy and solidifies the story in the mind of the child. This process may also create an account of abuse that never happened.

3. A criminal indictment often, but not always, follows the accusation.

C. Divorce and custody disputes

1. Many professionals believe that the largest percentage of false allegations are in divorce and custody disputes.

2. False allegations are usually not deliberate fabrications made for advantage in a custody dispute.

a. Instead, an angry spouse in a custody dispute is ready to believe the worst about her spouse and overinterprets or misinterprets a behavior or comment from the child.

b. Most false accusations are made as a result of questioning by an adult, usually the mother.

c. Deliberate false allegations have been estimated to occur around 15% of the time (Wakefield & Underwager, 1991b, Theonnnes & Pearson, 1988).

2. There is there is disagreement over just how often this happens, although most estimates range between 20% and 80% (Wakefield & Underwager, 1991b; 1994a).

3. Some professionals have speculated about possible reasons for a true abuse disclosure in a divorce and custody dispute.

a. The nonoffending parent finds out about the sexual abuse and decides to divorce the offending parent,

b. Long-standing sexual abuse is only revealed in the context of divorce.

i. A child who has been threatened with the breakup of the family may tell once this has already happened.

ii. It is more difficult for the abusing parent to persuade the child to keep the secret once he or she is not living with the child.

iii. A child may become genuinely terrified at the prospect of spending time alone with the abuser and therefore tell in order to avoid a visit.

c. The father may begin sexually abusing his child because of the stress and emotional devastation of the divorce.

4. Behavior changes resulting from the stress of a divorce situation may make children more vulnerable to influence from the accusing parent and others who interview them. The behavior changes observed in children whose parents are divorcing may be used as evidence that a child is abused.

5. Courts in the United States have held that when a parent is involved in the fabrication of a false sexual abuse accusation against the other parent, custody is to be given to the falsely accused parent. A false allegation of abuse is sufficient grounds to transfer custody and, in some instances, terminate parental rights of the falsely accusing parent.

D. Allegations by adolescents and older children

1. This is most likely to happen with a stepfather. The motives for such actions include anger, the attention the accusation gets, and/or a desire to move to a different home where the child believes there will be more freedom.

2. For years it was believed that it was extremely rare for a child to fabricate sexual abuse. But this is no longer the case.

3. Some factors related to false accusations by older children include the discussions in the media and the schools about good touch and bad touch, incest, and the ready availability of X-rated videos and cable television, dial-a-porn, etc.

4. When a false allegation is attended to by adults and authority figures, reinforced, and then repeated several times in telling it to different people, the initially fabricated event may become subjectively real for the person telling it.

5. Even if the tale is later recanted, the recanted testimony may not be believed because of the widespread (unfounded and erroneous) belief that a child would not make a false accusation about sexual abuse.

E. Accusations against teachers, camp counselors, day care workers and others involved with the care of youngsters.

1. Several cases have been very well publicized. When accusations are widely covered by the media, there has been a surge in reporting sexual abuse in other facilities.

2. In such cases there is often a predictable evolution of the stories into wilder and more fanciful accusations.

3. This common progression suggests that repeated interviews tap into an ever deeper layer of the kind of fantasies children are known to have.

F. Allegations of ritualistic and satanic abuse

1. The allegations of ritual abuse come from two sources

a. Accounts of "survivors" who uncover memories of bizarre satanic ritual abuse ceremonies during the course of therapy. The alleged abuse is not remembered until the adult goes into therapy with a therapist skilled in special techniques of recovered memory therapy, such as survivors' groups and hypnotherapy.

b. Accounts of children who have allegedly been ritualistically abused at day care centers and other cases involving allegations of multiple perpetrators and many children.

c. These sources have affected one another.

2. Such highly publicized cases have occurred not only throughout the United States, but around the world, including the Netherlands, Great Britain, Canada, Scotland, New Zealand, and Australia.

3. Despite hundreds of investigations by the FBI and police, there is no independent evidence of ritual abuse, animal and human sacrifice, murder, and cannibalism of hundreds of children by a conspiracy of apparently normal adults who are functional and organized enough to leave no trace of their activities. There is no corroborating evidence for a conspiracy of satanic ritual abusers who prey on day care centers and abuse children (see Bottoms, Shaver, & Goodman, 1996; Rossen, 1989; Victor, 1993; Richardson, Best, & Bromley, 1991; Lanning, 1992; Hicks, 1991; Nathan & Snedeker, 1995; Wakefield & Underwager, 1994b).

G. Several highly publicized cases in the United States have recently been overturned on appeal as authorities and the legal system realize that the allegations were the result of flawed investigations and coercive interviews of the children.

III. Investigating Child Sexual Abuse Allegations

A. Serious harm to children and adults can occur with both types of errors-failing to identify an abused child and misidentifying abuse when it has not occurred.

B. Secondary victimization

1. The massive effort to protect abused children has resulted in damage to innocent people and nonabused children.

2. The sexual abuse investigation itself can be devastating to families and children whether or not the allegations is ultimately determined to be false (Wakefield & Underwager, 1994a; Prosser, 1996a, 1996b; Tyler & Brassard, 1984).

3. In a study of 8058 sexual abuse victims in Lower Saxony, Baurmann (1983) found that for one-fifth of his sample, the main cause of the injury was judged by the victims to be the behavior of relatives, friends, or the police.

4. Jones (1991) describes nine possible components of iatrogenic (doctor induced) harm by the system when children have been actually been abused. They are 1) overzealous professional intervention, 2) repeated interviewing, 3) repeated physical examinations, 4) decline in living standards, 5) defensive decision making, 6) attendance at court, 7) withholding treatment, 8) overtreatment, and 9) foster care.
5. Minimizing secondary victimization

a. Minimize the risk of identifying a nonabused child as abused. Make the most accurate decision possible.

b. Do not remove the child from home unless absolutely necessary.

i. Gomes-Schwartz et al. (1990) found that children who were removed from home were more distressed than those who remained.

ii. Instead of removing the child, either place an observer in the home to offer security for the child and family or have the alleged perpetrator removed.

c. Do not interview the child in school.

d. Do a careful assessment of the child before placing the child in sexual abuse therapy.

e. Do not exaggerate and overstate the consequences of child sexual abuse.

IV. Interviewing children who are suspected of being sexually abused

A. The child witness

1. Young children are capable of providing accurate and useful information.

2. Jones and Krugman (1986) give an example of a three-year-old child who accurately described her abduction, sexual abuse, and attempted murder.

3. The problem is that adults do not know how to let children produce the most reliable information they can (Garbarino & Stott, 1989).

B. The memory of young children

1. The free recall of children, particularly if they are questioned soon after an event, can be accurate. However, young children do not produce much in the free recall situation.

2. Because of the phenomena of infant amnesia, adults and older children do not usually remember specific incidents from their lives that happen prior to age three to four, although they do have script memories.

3. Young children are more suggestible than older children and adults (Ceci & Bruck, 1993, 1995).

4. Young children are likely to make "source monitoring" errors (Ceci, Loftus, Leitchman, & Bruck, 1994; Johnson, Hashtroudi, & Lindsay, 1993).

a. A source monitoring error is when people mistake events they have thought about, dreamed about, or been questioned about for memories of real events that have happened.

b. Preschoolers appear to be vulnerable to source attribution errors when they are repeatedly encouraged to think about or talk about events that never occurred.

5. Very young children cannot use one object as a representation for another (DeLoache, 1995).

6. Several facts concerning child witnesses can be said to be generally accepted in the scientific community (Ceci & Bruck, 1993)

a. There appear to be significant age differences in suggestibility, with preschool children being more vulnerable to suggestion that either school-aged children or adults.

b. Children can be led to make false or inaccurate reports about very crucial, personally experienced central events.

c. Children sometimes lie when the motivational structure is tilted towards lying.

d. Extreme statements (e.g., children never lie vs. children are incapable of getting it right) are not supported by credible and reliable scientific data.

e. Even preschoolers are capable of recalling much that is forensically relevant.

C. General principles of the investigatory interview

1. The goal of the interview of a child suspected of being sexually abused is to obtain uncontaminated data.

2. The problem is not that children cannot give reliable information but rather that adults do not know how to enable them to produce the information they are capable of providing.

3. The free recall of children may be fairly accurate, but they recall less than do adults. The less information the child gives in free recall, the sooner the interviewer may become frustrated and then may turn to using leading questions and coercive procedures.

4. Contamination can occur when the child's recollections become altered through poor interview techniques (Ceci & Bruck, 1995; Underwager & Wakefield, 1990; Wakefield & Underwager, 1988, 1994a).

5. The child's memory of an actual experience may be significantly altered by the questioning about the incident and the child may even develop a subjectively believed memory for events that never happened (Ceci & Bruck, 1995; Ceci, et al., 1994; Loftus & Ketcham, 1991; Underwager & Wakefield, 1990). There is little or no correlation between subjective confidence and the accuracy of an account of a past event (Brainerd, Reyna, & Brandse, 1995).

6. The primary issue is not whether or not the child is lying. The issue is the level, nature, extent, and effects of adult social influence upon young children.

7. Although repeated and/or suggestive interviews and flawed investigations do not mean that a child has not been abused, they make it very difficult, if not impossible, to sort out what, if anything, may have happened.

8. The issue is the level, nature, extent, and effects of adult social influence upon young children. It is through adult social influence that a child can make statements of sexual abuse that may not be true. The child is unlikely to be an active participant when a fabricated allegation is developed.

9. Poorly conducted interviews make it very difficult, if not impossible, to sort out what, if anything, may have happened.

10. Example of a bad interview from the McMartin case

Q Do you think, do maybe-I'll tell you what. Maybe you could show me with this, with this doll (putting hand on two anatomical dolls, one naked, one dressed) how the kids danced for the naked movie star.

A They didn't really dance. It was just like, a song.

Q Well, what did they do when they sang the song?

A They just, went around singing the song.

Q They just went around and sang the song?

A (Nods head up and down.)

Q And they didn't take their clothes off?

A (Shakes head negative)

Q I heard that, I heard from, several kids, that they took their clothes off. I think that (classmate's name) told me that. I know that (second classmate's name) told me. I know that (third classmate's name) told me. (Fourth classmate's name) and (fifth classmate's name) all told me that. That's kind of a hard secret, it's kind of a yucky secret to talk, of-but, maybe, we could see if we could find-

A Not that I remember.

Q -another puppet. This is my favorite puppet right here. (Reaching, picking up and putting on the bird puppet.)

A I get to be that puppet.

Q You wanna be this puppet? Okay. Then I get to be Detective Dog.

A (Makes a sound.)

Q Okay, let's see if we can figure this. Let's see.

A (Grabs the dog puppet's nose that the interviewer is wearing, using bird puppet's beak.)

Q Yeah. Let's be friends. Let's (unintelligible). I know that we're gonna figure this out-all this stuff out right now. Okay, when that tricky part about touching the kids was going on, could you (reaching for marker from can on the table, handing it to girl) could take a pointer in your mouth and point, on the, on the doll over here, on either one of these dolls, where, where the kids were touched? Could you do that?

A I don't know.

Q I know that the kids were touched. Let's see if we can figure that out.

A I don't know.

Q You don't know where they were touched?

A Huh-uh. (Slight of head, negative.)

Q (Unintelligible.) Well, I (unintelligible) some of the kids told me that they were touched sometimes. They said that it was, it kinda sometimes it kinda hurt. And sometimes it felt pretty good. Do you remember that touching game that went on?

A No.

Q Okay, let me see if we can try something else and-

A Weeeeee. (Spinning the bird puppet on right hand above her head.)

Q Come on bird, get down here and help us out here.

A No.

Q (Girl's name) is having a hard time talking. I don't wanna hear any more "no's." No, no, Detective Dog and we're gonna figure this out.

A No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no. (To musical cadence, spinning bird puppet over head.)

Q Do you wanna not play with the puppets? Would you rather talk to me directly? Is that easier for ya?

A No.

Q Okay. How can I help you?

A (Makes sound.) gosh.

Q (Girl's name), look at me! (Putting puppeted hand on bird puppet.) How can I help you get rid of those yucky secrets? How can we help you to tell them, so they can go away and not bother you any more? What would be the best way that we could help you do that? I don't think the puppets are working really well. And I think that you're real scared to tell. And I understand why you're scared. 'Cause I heard all about the threats and all the tricks that he tried to make the kids be scared so they wouldn't talk. Those were all tricks, they were lies. They weren't true. None of those things happened to anybody. And none of that stuff that happened at school were the kids' fault. That was all the it, Ray's fault, it wasn't the kids fault. And I know the kids are scared to talk about it, but I need you to tell me. How can I help you get rid of those yucky secrets? What's the best way for me to help you do that?

A (Looks upward with pointer dangling from mouth.) (Cody, 1989, p. 28.)

D. Specific problems in interviews

1. The interviewer is convinced about what happened before the interview begins. The interviewer who expects to find abuse is apt to ask questions in a way to confirm his or her hypothesis (Ceci & Bruck, 1995).

2. The interviewer ignores the pressure felt by the child to conform to what the child believes the interviewer wants. The pressure to give some form of answer may result in demand characteristics to which children have little resistance.

3. The interviewer reinforces selected responses of the child.

a. A child is told that she is brave and that "Mommy will be so proud of you for telling the scary secret" or a child is told that he can play with a special toy or go for a treat after he tells about the abuse.

b. Children have been promised or given candy, food, beverages, and toys if they cooperate and answer the questions.

4. The interviewer does not make it clear to the child that it is all right not to answer a question if the child does not know the answer.

a. Children will give answers to bizarre, unanswerable questions. In a study by Hughes and Grieve (1980), 5- and 7-year-old children gave answers to very bizarre questions, such as "Is red wider than yellow?"

b. The pressure to give some form of answer and to discourage "don't know" responses may result in demand characteristics to which children have little resistance.

5. The interviewer ignores responses that don't fit the interviewer's preconceptions.

6. The interviewer encourages a child who does not say anything in response to questions to "pretend" with puppets or dolls.

7. The interviewer begins the interview with good touch/bad touch questions and drawings where the child identifies body parts. This tells the child what will be expected to be discussed in the interview.

8. The interview is not videotaped or audiotaped. A videotape is the only means whereby the procedures and data obtained during the interview can be fully documented (Lamb, 1994; McGough, 1995; Myers, 1994; Raskin & Yuille, 1989; Underwager & Wakefield, 1990; Wakefield & Underwager, 1988, 1994a)

9. Procedures with doubtful or nonexistent reliability and validity are used in the interview. These unsupported procedures include drawings, projective tests, and anatomical dolls.

a. Neither the anatomical dolls nor their use are standardized or accompanied by normative data.

b. The use of the dolls can provide a modeling effect and, as they are often used, can encourage the child to engage in fantasy.

c. Very young children cannot use one object as a representation for another (DeLoache, 1995). These studies falsify the use of the dolls as demonstrative aids.

d. There are no data supporting a differential behavior of abused and nonabused children when the dolls are used to assess sexual abuse. The studies that claim to show differences have major methodological shortcomings (Ceci & Bruck, 1993, 1995; Skinner & Berry, 1993; Underwager & Wakefield, 1990, 1995; Wakefield & Underwager, 1994a; Wolfner, Faust, & Dawes, 1993).

e. We recommend that the dolls not be used. They are controversial and they are not generally accepted in the scientific community.

f. There are similar problems with books and drawings.

10. Disclosure-based play therapy is used to draw conclusions about abuse.

a. There is no scientific evidence showing any efficacy or utility for play therapy with sexual abuse victims (Campbell, 1992a, 1992b).

b. The sessions may focus on reenactments and discussions of the abuse and the behavior of the child in the play therapy sessions is used to form conclusions about abuse. Play therapy may encourage false allegations (Campbell, 1992b).

c. A major difficulty is the unexamined assumption that play reflects reality whereas for children play is fantasy (Bretherton, 1984).

d. The therapist providing the therapy may confuse the therapy and investigator roles.

E. General guidelines for appropriate interviewing

1. Be aware of your own biases and try to explore all possible hypotheses about what may have happened rather than focusing on just one. Debiasing procedures have been recommended by a number of decision theory researchers (Arkes, 1991)

2. Conduct the interview in a comfortable room which does not look like a business office or doctor's office. Keep distracting toys out of sight.

3. Do not sit on the floor with the child. Sit in a chair and ask the child to sit in a chair. Children know adults are adults and if an adult suddenly begins behaving in strange ways the child may perceive it as coercive.

4. Interview the child alone. The presence of another person may induce bias, distortions or omissions in the child's account. The error can be in either direction.

5. Begin by establishing the relationship with the child, getting an impression of the child's level of development and capacities, and establishing the child's expectations for what is going to happen in the evaluation. Ask neutral questions regarding age, school and friends before discussing the events surrounding the alleged abuse.

6. Make it clear to the child that it is all right not to answer a question if the child does not know the answer. Tell the child to say "I don't know" and "I don't remember" rather than trying to say what he thinks the interviewer might want to hear. It may help to practice with a question such as "Did the doctor who delivered you wear glasses or not?

7. When the child is comfortable, ask open-ended nonleading questions (i.e., "Tell me about your father"). It may take longer to get useful information but the information obtained is much less likely to be contaminated.

8. Aim toward encouraging the child to provide a free narrative account by asking open-ended questions. The free recall of a child is as accurate as that of an adult; the trick therefore is elicit it and not to alter it through suggestive, leading questions. Open-ended questions can be repeated a number of times.

9. Do not interrupt the child's narrative with questions.

10. If closed questions must be asked, only ask them at the end after first attempting to get a narrative from the child through open questions.

11. Avoid repeating questions other than open-ended. When an answer is ignored and a direct question is repeated again and again, the child learns what he is expected to answer.
12. Proceed from the most general aspects to the more specific. Explore specific areas after the child has mentioned them first.

13. Do not encourage make-believe by saying things such as "let's pretend you are in your bedroom . . ." or "let's pretend this doll is you . . ."

14. If the child has difficulty providing specific details, try using nonleading mnemonic devices. For example, ask the child to view the alleged incident from the eyes of a camera.

15. Use invitational statements in order to get more details from the child such as, "And then what happened?" or "Would you please tell me everything you remember about that?"

16. Throughout the interview, be alert to the cognitive developmental level of the child.

17. Throughout the interview, test for alternative hypotheses.

18. Do not ask the child to remember what he said to others-parent, social worker, or police-a couple of days ago. This request means that you are confusing the child between a prior conversation and the reality of a prior event of abuse.

19. Minimize cues given to a child about what he is supposed to say. Requests for details should be about events already disclosed by the child.

20. Use a neutral, friendly tone throughout and avoid pressure or coercion to give a desired response and selective reinforcement of certain types of responses. A frequent subtle cue to a child as to what the interviewer wants is the repetition of a question when the child has already answered but not in the desired direction.

21. Be aware of your own tolerance for ambiguity and frustration level. Remain calm and don't show irritation when the child is not responding as desired.

22. Conduct the interview in a way that does not contribute to the emotional trauma of the child. Know when to stop interviewing. Grilling, coercion, repeated questioning when a child gives a negative response or says "I don't know" tells the child that he is not producing what the adult in authority wants.

23. At some point in the interviews, inquire about possible influences upon the child that may have taken place prior to the interview. This is important both in the case of a child who relates sexual abuse and with a child who recants an earlier story of abuse.

24. At the end of the interview, explore the child's susceptibility to suggestion.

25. Videotape or audiotape all interviews from the beginning. This provides for fully documented interviews and an accurate account of who said what can be transcribed. Videotape also permits examination of some of the nonverbal cues that may be present.

26. Minimize the number of interviews. (However, take the time needed to do a thorough and reliable assessment.)

27. If there is time pressure, as there may be if a choice about the safety of the child must be made, get as much reliable information as you can, and make the choice.

28. A promising technique, Cognitive Interviewing, has produced a number of research studies suggesting that it improves the accuracy of information (NIJ, 1992; Powell & Thomson, 1994). Those techniques that appear helpful are given below.

a. Give four instructions to prepare the child. Practice these answers by asking questions about an event that occurred in the waiting room or one that you both participated in or observed.

i. It is all right to say you do not know an answer but do not guess or make anything up.

ii. If you do not want to answer a question, that is all right. Just tell me.

iii. If you do not know what I mean, please tell me.

iv. If I ask a question more than once, you do not have to change your answer. Just tell me what you remember the best you can.

b. Reconstruct the circumstances. You may use pictures, favorite toys, and familiar objects to assist a child to picture the circumstances, persons, and feelings surrounding the alleged event(s) you are seeking information about. Then seek a free narrative recall with the instruction just to tell you everything that happened, including even little things.

c. For children who are old enough, backward order recall appears to be more effective in allowing for accurate information to be produced. Recall the events in backward order beginning with the end, then the middle, and then the beginning. After each response, ask "What happened right before that?"

d. Also for children who are old enough to understand this instruction, ask the child to describe the incident from a different perspective, that is, as if someone else were watching, what they would have seen.

V. Criteria for judging an allegation

A. A spontaneous disclosure made by a young child without evident adult influence is more likely to be true.

B. The probability of the behaviors alleged

1. If the alleged behaviors are extremely improbable, then it is less likely that the allegation is true.

2. A study of two samples of false allegations found many allegations of abuse that were much more unusual, intrusive, and deviant than has been found in cases of verified abuse (Wakefield & Underwager, 1994b).

3. It is crucial to think very realistically and practically about what would actually have to happen in order for the alleged behavior to have actually taken place

4. Tollison and Adams (1979) describe the general behaviors engaged in by the pedophile:

Pedophiliac behavior may involve caressing a child's body, manipulating a child's genitals, or inducing a child to manipulate an adult's genitals. Occasionally, the behaviors also include penile penetration (partial or complete--vaginal or anal), oral sex, and any practice utilizing the sexual parts or organs of a child so as to bring the person in contact with the child's body in any sexual manner. Pedophiliac acts may be homosexual or heterosexual in nature and may include touching, caressing, masturbation, oral-genital contact, and intercourse, as well as pedophilic exhibitionism, voyeurism, rape, sadism, and masochism....Physical violence to the child occurs in only 2 percent of instances... (page 326).

5. In homosexual pedophilia, the most common contact is masturbation-done to rather than by, the boy. This is followed by fellatio. Anal intercourse is less common.

6. Vaginal and anal penetration is rare in young children and is extremely painful. It results in injuries and laceration, not stretching of the involved organ. The molester must have a strategy for muffling the child's screams (Erickson, Walbek, & Seely, 1988).

7. Vaginal penetration is more likely with an older child and is more common in clinical samples compared to community samples (Wakefield & Underwager, 1994b).

8. The original Kinsey report on the sexual behavior of females (Kinsey, et al., 1953) provides information about the preadolescent sexual contacts their sample had with adult males.

Nature of Contact Percent

Approach only 9
Exhibition, male genitalia 52
Exhibition, female genitalia 1
Fondling, no genital contact 31
Manipulation of female genitalia 22
Manipulation of male genitalia 5
Oral contact, female genitalia 9
Oral contact, male genitalia 1
Coitus 3

9. Bribery is more common than threat. Threatening a child is the way to assure the quickest disclosure when the threatening agent is not present.

10. Aggression and violence are not usually part of the behavior. Sadistic, bizarre, or homicidal forms of abuse occur but are extremely rare.

11. There is no evidence for satanic ritual abuse conspiracies.

12. In incest, a grooming process is often involved.

13. In false cases, the allegations may initially be very vague and not easily amenable to being verified or refuted.

14. Female child sexual abusers (Wakefield & Underwager, 1991a).

a. Sexual abusers are primarily male.

b. There are widely different circumstances in which females may engage in behavior that is defined as "child sexual abuse" and the circumstances that lead women to sexually abuse children can often be differentiated from those causing men to do so.

C. Characteristics of the child's statement

1. Valid accounts of abuse will have appropriate details given the child's age, especially affective and contextual details, and the child's affect will be appropriate to the report.

2. If there is strong hatred expressed toward the accused that is based upon trivial and vague reasons, this may be the result of learning from the accusing parent rather than from actual abuse.

3. A child who is very eager to talk about the abuse may have learned that adults reward such talk.

4. Significant contradiction and variation in the story across time, especially when the account shows that the child has no visual image but is responding to verbal cues, supports the possibility of the child learning the story from adults.

5. However, Ceci and Bruck (1995) found that professionals were unable to differentiate between videotapes of children describing real events and children describing events they had learned about through suggestive questioning. Adult judgments or opinions about the accuracy of children's accounts may be no better than chance.

D. Recantation is not a good criterion for judging whether an allegation is true or false since children who have been abused as well as children who have fabricated an allegation may retract once they see the consequences of the allegation. Nevertheless, recantations must be taken seriously and evaluated in the context of all information about the specific allegations.

E. Personality characteristics of the persons involved

1. In divorce and custody cases, a personality disorder in the person making the accusation may increase the possibility of an allegation being false (Wakefield & Underwager, 1990).

2. The personality of the person accused

a. If it cannot be demonstrated that an accused person has the pathology associated with most child sexual abusers, the likelihood of a false accusation increases.

b. However, a "normal" personality based on an MMPI or other assessment techniques does not mean that the individual could not be a sexual abuser. A significant minority of child sexual abusers have normal MMPIs and appear relatively normal.

c. The presence of psychological problems does not prove that the abuse is real.

d. Consideration of the personality characteristics of the accused is particularly important when the allegations are of highly deviant behaviors.

e. Unusual or infrequent sexual behaviors in the life of the accused does not necessarily increase the likelihood of being a child molester. An example is transvestite behaviors which do not increase the probability of being a child abuser.

f. Minimization and rationalization are common in child sexual abusers.

F. Behavioral indicators

1. Various behaviors and behavior changes are often cited as signs of sexual abuse in children and adolescents. For example, The Journal of the American Medical Association in 1985 (JAMA, 1985, p. 798) includes the following as behavioral signs of sexual abuse:

a. Become withdrawn and daydream excessively
b. Evidence poor peer relationships
c. Experience poor self-esteem
d. Seem frightened or phobic, especially of adults
e. Experience deterioration of body image
f. Express general feelings of shame or guilt
g. Exhibit a sudden deterioration in academic performance
h. Show pseudomature personality development
i. Attempt suicide
j. Exhibit a positive relationship toward the offender
k. Display regressive behavior
l. Display enuresis and/or encopresis
m. Engage in excessive masturbation
n. Engage in highly sexualized play
o. Become sexually promiscuous

2. Such lists were widely disseminated through the media, pamphlets, popular articles, seminars and workshop aimed at training or consciousness raising.

a. In 1892 Kellogg proposed a list of behaviors to determine if a child was masturbating. If so parents were urged to take severe remedial steps, including clitoridectomies and restraints.

b. The 1892 list is identical with current lists used as indicators of sexual abuse. Those who do not know history are doomed to repeat the errors of the past (Legrand, Wakefield, & Underwager, 1989).

3. Behavioral indicators result from stress in general and are not specific to the stress of sexual abuse.

4. The base rates of the presence of many such behaviors in normal children, in troubled children, in non-abused children, and as part of the developmental process for all children is so high that any attempt to use them as indicating abuse will result in a high rate of error.

5. Not all sexually abused children are symptomatic subsequent to sexual abuse so the absence of behavioral symptoms cannot be used to rule out sexual abuse.

6. It is now generally accepted that such behavior changes cannot be used to conclude that the child has been abused (Lamb, 1994).

7. Sexual behavior in children

a. This is often claimed to be a better behavioral indicator.

b. But nonabused children exhibit many sexual behaviors. Friedrich, et al. (1991) report that their normal, nonabused sample of children showed a wide variety of sexual behaviors at relatively high frequencies.

c. However, Friedrich et al. also found that behaviors more imitative of adult sexual behavior were unusual. Therefore, if a child is found engaging in explicitly sexual behavior, such as oral-genital contact, this should be carefully checked out.

d. But even this does not prove that the child was sexually abused by an adult. Peer sexual play, inadvertently seeing adults having intercourse, or access to x-rated video might account for it.

G. Medical evidence

1. Many parents, social workers, investigators, prosecutors, defense attorneys, therapists, etc. erroneously assume that an abused child will show physical signs of the abuse.

2. In most reported cases of child sexual abuse, however, there is no physical or medical evidence that a child has been sexually abused (Adams et al., 1994).

a. Inasmuch as a considerable portion of sexual abuse involves exhibitionism, breast and/or genital fondling, and masturbation of the perpetrator, this finding is not surprising.

b. Therefore, a normal physical exam cannot rule out sexual abuse.

3. A medical examination ought be done whenever it may contribute helpful information if a report is not immediately dismissed as unfounded. It is particularly important when the allegations are of abusive behaviors that are likely to result in physical sequelae (i.e., penile penetration of a young child).

4. The results of medical examinations for sexual abuse are frequently ambiguous and must be carefully interpreted.

a. Base rate studies of nonabused children indicate that many of the findings often used to support a conclusion of abuse are found in nonabused children (McCann et al., 1989, 1990).

b. Some reported findings, such as lax sphincter tone and the anal dilatation reflex, are controversial and rejected by many medical authorities.

5. However, there are now enough data on normal and nonabused children to classify many findings as normal or nonspecific and others as lying on a continuum of certainty that sexual abuse has occurred (Adams, 1995; Bays & Chadwick, 1993; Heger & Emans, 1992).

6. The only specific and unambiguous physical findings demonstrating sexual contact are pregnancy or sperm in the vagina or anus (Krugman, 1989).

VI. Effects and Treatment of Victims

A. Effects of sexual abuse

1. Sexually abused children vary widely as to how the abuse affects them. Some children are relatively unaffected, some show short-term effects, some are more seriously affected.

2. Research on the effects of sexual abuse generally use clinical samples which cannot be generalized to the entire population of sexually abused children.

3. Contrary to what most people believe, the long-term effects of sexual abuse are not nearly as severe as is often assumed (Levitt & Pinnell, 1995; Rind & Harrington, undated).

a. The effects of physical abuse and neglect are likely to be more serious and generate more long-term damage (Ney, Fung, & Wickett, 1994).

b. When family dysfunction is controlled, the effects of sexual abuse wash out. This is because both extrafamilial and intrafamilial sexual abuse are closely associated with families that are dysfunctional and pathological (Alexander & Lupfer, 1987, Beitchman et al., 1991, Levitt & Pinnell, 1995; Nash et al., 1993).

3. Some factors seem to be associated with greater harm.

a. Because of the difficulties mentioned above, this does not in any way establish a direct cause and effect link (Nash, Zivney, & Hulsey , 1993).

b. Also, there is no contributing factor that all studies agree on as being consistently associated with greater harm.

c. Many studies report greater harm with use of force, genital as opposed to other types of contact, sex with the father or stepfather, and long duration of repeated abuse.

d. Studies assessing the effect of age of onset have contradictory results.

4. A supportive environment, including a supportive, functional family, is associated with less harm.

B. Treatment for sexually abused children

1. Role of the therapist vs. role of the evaluator

a. The professional conducting the evaluation as to whether abuse happened should not be the professional who provides treatment for sexual abuse. The roles are different and are contradictory in many respects.

b. Therapy should never be used to make a determination as to whether, in fact, abuse happened.

c. A child should not be given therapy for sex abuse until there is a determination that abuse has occurred (Ceci, 1994; Gardner, 1992; Wakefield & Underwager, 1988). If the child needs treatment before a judicial determination, any treatment should address whatever behavioral problems the child is having, but not focus on sexual abuse.

d. If a child is in therapy prior to such a determination, the child may ask questions or talk about sexual abuse. Give careful responses that will not contaminate the child's memory and answer questions honestly. Remember that the goal of therapy is to restore the child to normal developmental growth as quickly as possible. This can be done without focusing on abuse.

2. Begin with a careful individual and family assessment.

a. Children react to abuse differently. There are no typical symptoms of the sexually abused child. Some children may need only reassurance and support, but not long-term therapy. There is no such thing as a child sexual abuse syndrome that is diagnostic of children who have been sexually abused.

b. The assessment should include some assessment of the child's developmental level, descriptions from the parents as to problem behaviors, and information about the nature of the abuse.

c. Emphasize measurable, objectively described behaviors and not hypothesized internal states.
d. Evaluate the extent to which the child's problems are the result of the investigation process and the child's family's reactions to the disclosure. This includes interviews by law enforcement and social services, foster home placement, genital examinations, publicity about the case in the media which results in the child's peers knowing about the abuse, foster home placement, and termination of contact with a parent.

e. In intrafamilial abuse, assess the degree of danger for future abuse. In the United States, this is not likely to be a problem since either the perpetrator or the child will be removed from home.

f. Assess the family system and the strengths and problems. This can be done through behavioral observation of the family in interaction as well as through individual assessments of all members of the family. Stress and rely upon valid and reliable statistical and actuarial methods as much as possible. These measures may include personality, intellectual functioning, and strengths and resources.

3. Include standardized measures of the child's problems.

a. For example, the Child Behavior Checklist (Achenbach & Edelbrock), the Louisville Behavior Checklist (Miller), and the Personality Inventory for Children (Wirt, et al). These are parent-report checklists that differentiate between children with psychopathology from children in the general population and provide descriptive information of the child's assets and problems.

b. Do not use drawings for anything other than interview aids and conversation starters. There is no evidence that the symbolic sign approach to children's drawings is reliable or valid.

4. Do not convey to the parents or the child that the child is likely to be seriously and perhaps permanently damaged by the abuse.

a. The exaggerated emphasis on the harmful effects of abuse can leave the family hopeless, fearful, and anxious. This can become a self-fulfilling prophecy.

b. If long-term, intensive therapy is given to a child who does not need it, a relatively brief, although unpleasant event, in the child's perception, may be blown up into a major catastrophic event. Misguided therapy may teach a child to be a lifelong victim.

5. If a careful assessment indicates no problems, do not give the child long-term intensive therapy. Reassure the child and be in a monitoring role with the child and parents. If problems appear later, they can be addressed.

6. Family involvement is essential.

a. With incest, treatment of the child must be coordinated with treatment for the offending and nonoffending parent.

b. In extrafamilial abuse, the parents and other family members should be actively involved whenever possible. Do not treat the child apart from the parents.

c. With younger children, the focus should be on helping the parents learn effective ways of responding to the child's problem behaviors.

d. Parents may attend to problem behaviors that they believe were caused by the abuse. This often has the effect of increasing the frequency of the behaviors. Therefore, it is important to work with the parents on effective ways to respond to problem behaviors.

7. The type of therapy for children which has demonstrated efficacy is cognitive-behavioral (Casey & Berman, 1985; Weitz et al., 1987, 1995; Weitz & Weiss, 1993).

a. Specific problems are targeted and strategies are developed for working on them.

b. The treatment strategies will involve step-by-step, daily activities that help the child and the parents address the child's problems.

8. Child therapy as is practiced in most clinics in the United States is not effective according to the outcome research (Weitz et al., 1992; Weisz, Donenberg et al., 1995; Weitz & Weiss, 1993)

9. Play therapy

a. This is the most frequent approach used in the United States. Sometimes, it is termed "disclosure-based, play therapy."

b. Children are encouraged to express their feelings and act out the abuse in play sessions. The therapists may use drawings, dolls, puppets, and sand tables. Their play, in turn, is interpreted as reflecting actual things that have happened to them.

c. There is no research on play therapy that supports its use with sexually abused children (Campbell, 1992a; White & Allers, 1994).

10. View the child as an active participant in solving her problems and help the child modify her behavior.

a. Do not treat the child as a passive victim.

b. Give the child the message that, although she is not responsible for the abuse, she is responsible for knowing right from wrong and for getting help if she is abused again.

c. The child can learn more effective ways of dealing with whatever problems she now has.

10. Cognitive-behaviorally focused group therapy can be helpful with older children, since meeting other children who have been abused can be helpful.

11. Children may show opposition and resistance to therapy (Haugaard, 1992). This should be handled by exploring and then gently challenging false beliefs about therapy that the child may have. These false beliefs include:

a. The child may think she was brought to therapy because of a personal defect or illness she has that caused the abuse.

b. The child may see therapy as a type of punishment. "Why must I come here when it was my father who did everything wrong."

c. The child may believe he must go to therapy because people think he will become a child abuser himself later in life.

12. Family therapy is recommended

a. This was the first approach used to respond to sexual abuse.

b. The Child Sexual Abuse Treatment Program (CSATP) was developed by Giarretto (1980) in Santa Clara County, California beginning in 1971. It succeeded admirably. 90% of the children were returned home within the first month and 95% eventually. There was no recidivism reported in more than 250 families.

c. Unfortunately, as the emphasis in the United States shifted to prosecution and demonization of alleged perpetrators, this established and demonstrated program dropped out of use. It combined individual treatment, family therapy, and marriage therapy and emphasized the positive contributions strengths can make to growth.

d. This was the approach Dr. Underwager first used in 1953 when he encountered a case of incest. We also used this approach with the cooperation of the authorities until about 1977 when it became difficult to pursue family therapy and reunification of families.

e. The advent of a systematized child protection system and the emergence of a corps of protection workers moved treatment n a different direction.

13. Major premises of family therapy

a. The family is viewed as an organic system. Family members assume behavior patterns to maintain system balance (family homeostasis).

b. A distorted family homeostasis is evidenced by psychological/physiological symptoms in family members.

c. Incestuous behavior is one of the many symptoms possible in troubled families.

d. The marital relationship is a key factor in family organic balance and development.

e. Incestuous behavior is not likely to occur when parents enjoy mutually beneficial relations.

f. A high self-concept in each of the mates is a prerequisite for a healthy marital relationship.

g. High self-concepts in parents help to engender high self-concepts in children.

h. Individuals with high self concepts are not apt to engage others in hostile-aggressive behavior. In particular, they do not undermine the self-concept of their mates or children through incestuous behavior.

i. Individuals with low self-concepts are usually angry, disillusioned, and feel they have little to lose. They are thus primed for behavior that is destructive to others and to themselves.

j. When such individuals are punished in the depersonalized manner of institutions, the low self concept/high destructive energy syndrome is enforced. Even when punishment serves to frustrate one type of hostile conduct, the destructive energy is diverted to another outlet or turned inward.

14. Overall the continuing research shows that family dysfunction is the major issue in causation of abuse, physical, emotional or sexual, and any long-term negative effects. Children growing up in intact, functional and supportive nuclear families are significantly less likely to report any form of abuse (Gaudin et al., 1990; Mullen et al., 1996)

VII. Treatment for Perpetrators

A. Psychological characteristics of child sexual abusers

1. Child sexual offenders must be differentiated from pedophiles.

a. A child sexual offender has committed a criminal act. He may or may or may not be a pedophile. It is adult/child sexual contact that is against the law.

b. A pedophile has an anomalous sexual preference. If a pedophile never acts on his impulses, he is not a sex offender.

c. Pedophiles are an heterogeneous group and many do not fit the stereotype of the dirty old man lusting after little \children.

2. There is no single child sexual offender personality type, although there are some characteristics that many child sexual abusers have.

3. It is often claimed that abusers were themselves abused as children.

a. However, most of the studies of this suffer from problems with control groups and no really good study with appropriate controls has yet been done. With the current knowledge it is a mistake to think that an abuser must have been abused in the past or that an abused child will grow up to be an abuser.

b. Even if it could be established that many abusers were abused themselves, this does not mean that most persons who were abused as children will later become abusers. Most abused children do not become abuse perpetrators in later life (Widom, 1989).

4. Some characteristics of sexual offenders that are often reported include:

a. Inadequate and immature with low self-esteem and poor social skills.

b. Poor impulse control.

c. Hostile, aggressive, psychopathic.

d. Manipulative and lacking in empathy.

e. Many rationalizations and cognitive distortions.

5. Child sexual abusers generally do not have normal MMPIs.

a. The pathology is most likely to be seen in the elevation of the scales which reflect poor impulse control, antisocial behavior, poor judgment, a history of acting out, lack of self-esteem, feelings of inadequacy, a schizoid social adjustment, much time spent in fantasies, and/or thought disorders and confusion. Scale 4 in various combinations is the usual pattern.

b. However, Erickson, Luxenberg, Walbek, and Seeley (1987) report that 19% of their convicted sex offenders had within normal limits profiles.

c. The more aberrant the behavior of the abuser, the more likely it is that he will have a pathological MMPI.

6. Female child sexual abusers (see Wakefield & Underwager, 1991a).

a. Although awareness about female sexual abusers has greatly increased in recent years, most sexual abusers are males.

b. Female child sexual abusers are less likely than men to fit the psychiatric definition of "pedophile."

c. There are widely different circumstances in which females may engage in behavior that is defined as "child sexual abuse" and the circumstances that lead women to sexually abuse children can often be differentiated from those causing men to do so. One example of this is sexual abuse which occurs in conjunction with a dominant male and in which the woman plays a secondary role. Another is found by the retrospective surveys of college men in which many of the boys reported that they had engaged in the incidents voluntarily and did not feel victimized.

d. Many studies depict women who sexually abuse children as being loners, socially isolated, alienated, likely to have had abusive childhoods, and apt to have emotional problems. However, most are not psychotic.

B. Assessment of child sexual abusers

1. Perform a clinical interview, which includes a careful social and sexual history along with details of the offense.

2. Include detailed information about the offenders' sexuality and sexual fantasies. Knight, Prentky, & Cerce (1994) report that sexual offenders have more sexual preoccupation, deviance, compulsiveness, and inadequacy than is evident in their clinical files.

3. Include standardized tests, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Millon Clinical Multiaxial Inventory-II (MCMI-II), and the California Psychological Inventory (CPI) for personality. Get some measure of general intelligence. Use other tests as indicated.

4. Penile plethysmograph

a. The penile plethysmograph assesses physiological arousal in response to different sexual stimuli.

b. It is widely used to assess male sexual arousal and preference for various sexual stimuli.

c. There are problems with it however, and its use is controversial.

d. It cannot be used to assess whether an individual who denies the offense has, in fact, sexually abused a child.

5. Multiphasic Sex Inventory (Nichols & Molinder, 1984)

a. This a test developed for assessing sexual offenders and developing treatment strategies.

b. It cannot be used on a person who denies the offense.

6. On the basis of the assessment, develop an individualized treatment plan.

C. Three general types of treatment approaches

1. Organic, biological approach

2. Psychotherapeutic approach (individual, group, and family counseling)

3. Cognitive-behavioral

D. Treatment and Recidivism

1. There has been controversy over the effectiveness of treatment for sex offenders.

a. Some reviewers have concluded that there is little evidence that treatment reduces recidivism (Furby, Weinrott, & Blackshaw, 1989; Quinsey et al., 1993).

b. More recent reviews have reported positive effects when the treatment is cognitive-behavioral (Lösel, 1995; Nagayama Hall, 1995).

c. Marshall et al. (1991) concludes that comprehensive cognitive-behavioral programs (for child molesters, incest offenders and exhibitionists, but not for rapists) are most likely to be effective.

2. Treatment must include attending to the cognitive distortions, be comprehensive, and be individually designed to meet individual needs (Marshall & Pithers, 1994; Marshall, Eccles, & Barbaree, 1993; O'Donahue & Letourneau, 1993).

3. A June 1996 report by the United States General Accounting Office sees the research as inconclusive but concludes that cognitive behavioral treatments are the most promising (U. S. GAO, 1996). This is based on an analysis of 22 review articles on sexual offender treatment.

4. The clinician cannot wait for the research to produce definitive answers. There is sufficient support now to conclude that cognitive behavioral procedures are the treatment of choice.

5. Sexual offender recidivism is lowest for incest offenders.

E. Traditional offenders programs

1. In the past, the most common treatment approach in the United States was group therapy that relies heavily upon punitive and hostile confrontation and a nonsystematic blend of psychoanalytic concepts and traditional talking therapy.

2. Most required a threshold requirement of admission of guilt before being admitted into the program. All in prison treatment programs that we are aware of still require an admission of guilt for successful completion. When probation or parole are dependent upon completing a program, this creates great difficulty for the many innocent persons who have been wrongfully convicted.

3. The expression of feelings is absolutely required in the traditional psychotherapeutic approach. Common treatment goals include bringing the perpetrator to the point where he admits all of his abusive behaviors, expresses guilt and remorse for them, and is willing to admit and apologize to the victim.

4. There is no evidence for the effectiveness of this type of treatment to cure sexual abuse and prevent recidivism.

F. Biological treatment

1. This includes surgical castration, hormonal/pharmacological, and psychosurgery. The rationale is that if the sex drive is reduced, sexual offenses will be prevented.

2. The United States General Accounting Office (1996) states that no program in the United States reports using these methods alone as the basis for treatment.

3. Some researchers report that there is some effectiveness with hormonal treatments, but there is no consensus about a particular drug being most effective or about the duration of positive effects (United States General Accounting Office, 1996).

4. Surgical castration in widely used in Europe (United States General Accounting Office, 1996). Over 10,000 men were castrated in Zurich alone in the years between 1910 and 1961 according to one report (Quinsey & Marshall, 1983).

5. Quinsey and Marshall (1983) report that there is no research supporting the efficacy of castration on sexual misbehavior and state that sexual potency is not reduced in many castrated men who continue to engage in some form of sexual behavior.

6. Nagayama Hall (1995), however, reports on a study in Germany were castration was reported to lower recidivism.

G. Treatment directions with research support.

1. Treatment should be cognitive-behavioral and include relapse prevention (Maletzky, 1996a, 1996b; Marques et al., 1994; Miner et al., 1990).

a. Cognitive behavioral treatment seeks to change the offenders' distorted sexual cognitions and perceptions, reduce deviant sexual arousal, and increase arousal to appropriate behaviors or partners.

b. The goal is to get offenders to understand and take responsibility for their actions and to learn skills to help control their deviant behaviors.

c. Cognitive-behavioral treatment includes a wide variety of treatment methods and combines behavior control techniques with some type of individual, group, and/or family therapy.

d. This approach is now used by most treatment programs in the United States.

2. Treatment should be individually-tailored and include careful assessment of the situation along with the capacities, personality, and behaviors of the individual and a therapy program that uses a broad mix of learning theory-based treatment techniques. Different treatment interventions must be planned for different types of child molesters.

3. Treatment should address the level of self-confidence. Low self-esteem both may be a major factor in causing the sexual behavior and an obstacle to any behavior change. To change, persons must believe they are capable of change (Marshall, 1996).

4. Treatment should address social skills and intimacy deficits.

5. Behavioral techniques for strengthening the person's arousal pattern to appropriate behaviors or partners while weakening the deviant arousal pattern may include aversion therapy, covert sensitization, satiation, and directed masturbation.
6. Cognitive-behavioral techniques such as aversive conditioning, cognitive restructuring, thought stopping, covert sensitization, satiation, contracts, covert reinforcement, modeling, role playing, social skills training, and relaxation training may be used.

7. With pedophiles, it may not be possible to change the arousal pattern. Langevin and Lang (1985) maintain that "sexual preference is a powerful and persistent feature of human behavior and there is no evidence that therapy in any form can change it" (p. 409).

a. Therefore the goal of therapy for a pedophile must be to help the pedophile manage his urges for sexual contact with children.

b. A key factor in the success in any treatment of pedophiles will be motivating them to change; most pedophiles are resistant to giving up a sexual behavior pattern which they perceive as positive and rewarding.

8. Treatment should involve material and homework assignments that respond to what has been learned about the individual.

a. Use didactic materials, bibliotherapy, structured assignments, and individualized therapy sessions that are aimed at reattribution and cognitive restructuring.

b. Wherever possible, use behavioral homework assignments that are part of ongoing interpersonal relationships or will guide the individual through the development of new interpersonal relationships.

8. Group treatment should be cognitive-behavioral rather than confrontational.

9. Treatment should help the person understand the potential harm done to children by reinforcing and teaching a genitalized view of sexuality.

10. When a satisfactory level of response to the initial cognitive restructuring has been reached, move to a relapse prevention approach.

a. Relapse prevention is a self-control program designed to teach individuals who are trying to change their behavior how to anticipate and cope with the problem of relapse. It is based on social learning theory and combines behavioral and cognitive interventions. There is an emphasis on self-management. It is not an isolated treatment; relapse prevention was developed as a maintenance strategy and is intended to preserve gains in whatever treatment preceded it (Laws, 1989; Maletzky, 1996b).

b. The relapse prevention program is individually developed following a careful assessment of the individual. Offenders learn to identify and anticipate high risk situations, control their urges, develop more effective coping skills, maintain a more balanced lifestyle and gain a sense of control and self-efficacy. Through this process, it is hoped that they will be less apt to relapse and recommit a sexual offense.

c. Offenders learn that there offense is the result of a chain of events involving cognitions and emotions that trigger a sequence of behaviors that end with the commission of the sex offense. In relapse prevention, they learn skills that avoid or interrupt the behavior chain.

H. Court-ordered sex offender treatment.

1. Probation with mandated treatment and perhaps some jail time is a common disposition in the United States. Also, a person accused of sexual abuse may be offered a choice of therapy in place of punishment as part of a plea bargain.

2. There may be a negative effect on therapy when it is court-ordered. The therapist must make regular reports to parole officers, judges, and child protection workers and information given by the sex offender about other victims or offenses must be reported. Langevin and Lang (1985) comment that a therapist who serves both as helper-therapist and as informer for the law becomes a "double agent."

3. However, few sex offenders voluntarily seek treatment.

I. Treatment for deniers.

1.The requirement of a threshold admission of guilt may prevent both actual perpetrators and innocent people from being able to progress in resolution of their individual situations.

2. An indeterminate number of people found by the family or criminal courts to be child sexual abusers are, in fact, innocent.

3. When an accused person who is actually innocent enters treatment with the hope of eventually having a relationship with his children or of benefiting from therapy, it can be disastrous.

4. Failure to admit abuse can result in termination of parental rights in the United States.

5. Therefore, it is important to find a way to provide treatment to individuals who deny.

6. Maletzky (1996a) developed a cognitive-behavioral group and individual program for deniers.

a. Just over 60% who entered treatment completely denying admitted something by the end of their program.

b. Group was more effective at producing this verbal change than was individual.

c. The men who made this verbal change were somewhat more successful in treatment than those who did not.

d. Men who admitted crimes at entry into treatment were more successful than those who denied.

e. The vast majority of men who did not admit, yet completed the program were successful at not relapsing.

f. Men in total denial who completed the program were overwhelmingly safer to be at large than those who admitted but did not complete treatment.

Conclusion

The experience of the United States in pursuing the noble goal of reducing the frequency of adults savaging little children can be of assistance to other nations. The flaws and mistakes in the system developed in the US can be avoided and the strengths demonstrated can be expanded and increased.

References

Achenbach, T. M., & Edelbrock, C. E. (undated). Child Behavior Checklist. Department of Psychiatry, University of Vermont, Burlington, VT.

Adams, J. A. (1995). The role of the medical evaluation in suspected child sexual abuse. In T. Ney (Ed.), True and False Allegations of Child Sexual Abuse: Assessment and Case Management (pp. 231 241.). New York: Brunner/Mazel.

Adams, J. A., Harper, K., Knudson, S., & Revilla, J. (1994). Examination findings in legally confirmed child sexual abuse: It's normal to be normal. Pediatrics, 94(3), 310 317.

Alexander, P. C., & Lupfer, S. L. (1987). Family characteristics and long-term consequences associated with sexual abuse. Archives of Sexual Behavior, 16(3), 235-245.

Arkes, H. R. (1991). Costs and benefits of judgment errors: Implications for debiasing. Psychological Bulletin, 110(3), 486 498.

Bakan, D. (1971). Slaughter of the Innocents. San Francisco: Jossey-Bass.

Baurmann, M. (1983). Sexualitat, Gewalt und psychische Folgen. Ein Langsschnittuntersuchung bei opfern sexueller gewalt und sexuellen Normverletaungen anhand von angezeigten Sexualkontakten. Wiesbaden: Bundeskriminalamt.

Bays, J., & Chadwick, D. (1993). Medical diagnosis of the sexually abused child. Child Abuse & Neglect, 17(1), 91-110.

Besharov, D. J. (1985, Spring). Right versus rights: The dilemma of child protection. Public Welfare, 19-27.

Besharov, D. J. (1990, Spring). Gaining control over child abuse reports. Public Welfare, 34-41.

Besharov, D. J., & Laumann, L. A. (1996). Child abuse reporting. Social Science and Modern Society, 33(4), 40 46.

Beitchman, J. H., Zucker, K. J., Hood, J. E., daCosta, G. A., & Akman, D. (1991). A review of the short-term effects of child sexual abuse. Child Abuse & Neglect, 15(4), 537 556.

Bottoms, B. L., Shaver, P. R., & Goodman, G. S. (1996). An analysis of ritualistic and religion-related child abuse allegations. Law and Human Behavior, 20(1), 1 34.

Brainerd, C. J., Reyna, V. F., & Brandse, E. (1995). Are children's false memories more persistent than their true memories? Psychological Science, 6(6), 359 364.

Bretherton, I. (1984). Representing the social world in symbolic play: Reality and fantasy. In Bretherton, I. (Ed.), The Development of Social Understanding (pp. 3-41). New York: Academic Press.

Campbell, T. W. (1992a). Promoting play therapy: Marketing dream or empirical nightmare? Issues in Child Abuse Accusations, 4(3), 111-117.

Campbell, T. W. (1992b). False allegations of sexual abuse and the persuasiveness of play therapy. Issues in Child Abuse Accusations, 4(3), 118-124.

Casey, R. J., & Berman, J. S. (1985). The outcome of psychotherapy with children. Psychological Bulletin, 98(2). 388-400.

Ceci, S. J. (1994). Cognitive and social factors in children's testimony. In B. D. Sales, & G. R. VandenBos (Eds.), Psychology in Litigation and Legislation (pp. 11 54). Washington, DC: American Psychological Association.

Ceci, S. J., & Bruck, M. (1993). The suggestibility of the child witness: A historical review and synthesis. Psychological Bulletin, 113(3), 403-439.

Ceci, S. J., & Bruck, M. (1995). Jeopardy in the Courtroom: A Scientific Analysis of Children's Testimony. Washington, DC: American Psychological Association.

Ceci, S. J., Loftus, E. F., Leichtman, M. D., & Bruck, M. (1994). The possible role of source misattributions in the creation of false beliefs among preschoolers. International Journal of Clinical and Experimental Hypnosis, 42(4), 304 320.

DeLoache, J. S. (1995). The use of dolls in interviewing young children. In M.S. Zaragoza, J. R. Graham, G. C. N. Hall, R. Hirschman, & Y. S. Ben-Porath, Improving Children's Testimony (pp. 160 178). Thousand Oaks, CA: Sage.

Erickson, W. D., Walbek, N. H. & Seely, R. K. (1988). Behavior patterns of child molesters. Archives of Sexual Behavior, 17(1), 77-86.

Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18(5), 409 417.

Fisher, C. B., & Whiting, K. A. (1996). The [mis]use of posttraumatic stress disorder to validate child sexual abuse. Register Report, 22(1), 8 10.

Friedrich, W. N., Grambsch, P., Broughton, D., Kuiper, J., & Beike, R. L. (1991). Normative sexual behavior in children. Pediatrics, 88(3), 456-464.

Furby, L., Weinrott, M. R. & Blackshaw, L. (1989). Sex offender recidivism: A review. Psychological Bulletin, 105(1), 3-30.

Garbarino, J., & Stott, F. M. (1989). What Children Can Tell Us. San Francisco, CA: Jossey-Bass Inc., Publishers.

Gardner, R. A. (1992). True and False Accusations of Child Sex Abuse. New Jersey: Creative Therapeutics.

Gaudin, J. M., Wodarski, J. S., Arkinson, M. K., & Avery, L. S. (1990). Remedying Child Neglect: Effectiveness of Social Network Interventions. Paper supported by Grant No.90 CA from U.S. Department of Health and Human Services, Office of Human Development, National Center On Child Abuse and Neglect.

Giarretto, H. (1980). Humanistic treatment of father-daughter incest. In L. G. Schultz (Ed.), The Sexual Victimology of Youth (pp. 140-162). Springfield, IL: Charles C. Thomas.

Gomes-Schwartz, B., Horowitz, J. M., & Cardarelli, A. P. (1990). Child Sexual Abuse: The Initial Effects. Newbury Park, CA: Sage.

Haugaard, J. J. (1992). Sexually abused children's opposition to psychotherapy. Journal of Child Sexual Abuse, 1(2), 1-16.

Hicks, R. D. (1991). In Pursuit of Satan. Buffalo, NY: Prometheus Books.

Heger, A., & Emans, S. J. (1992). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas. New York: Oxford University Press.

Hughes, M. & Grieve, R. (1983). On asking children bizarre questions. In M. Donaldson, R. Grieve & C. Pratt (Eds.), Early Childhood Development and Education: Readings in Psychology (pp. 105-114). New York, NY: The Guilford Press.

Johnson, M. K., Hashtroudi, S., Lindsay, D. S. (1993). Source monitoring. Psychological Bulletin, 114(1), 3-28.

Jones, D. P. H. (1991). Professional and clinical challenges to protection of children. Child Abuse & Neglect, 15(Sup. 1), 57-66.

Jones, D. P., & Krugman, R. D. (1986). Can a three-year-old child bear witness to her sexual assault and attempted murder? Child Abuse & Neglect, 10(2), 253-258.

Knight, R. A., Prentky, R. A., & Cerce, D. D. (1994). The development, reliability, and validity of an inventory for the multidimensional assessment of sex and aggression. Criminal Justice and Behavior, 21(1), 72-94.

Krugman, R. D. (1989). The more we learn, the less we know "With reasonable medical certainty"? Child Abuse & Neglect, 13(2), 165-166.

Lamb, M. E. (1994). The investigation of child sexual abuse: An interdisciplinary consensus statement. Child Abuse & Neglect, 18(12), 1021 1028.

Langevin, R. & Lang, R. (1985). Psychological treatment of pedophiles. Behavioral Sciences and the Law, 3(4), 403-417.

Lanning, K. V. (1992). Investigator's Guide to Allegations of "Ritual" Child Abuse. National Center for the Analysis of Violent Crime: Quantico, VA.

Laws, D. R. (Ed.), Relapse Prevention with Sex Offenders (1989). New York: The Guilford Press.

Legrand, R., Wakefield, H., & Underwager, R. (1989). Alleged behavioral indicators of sexual abuse. Issues in Child Abuse Accusations, 1(2) 1-5.

Levitt, E. E., & Pinnell, C. M. (1995). Some additional light on the childhood sexual abuse-psychopathology axis. International Journal of Clinical and Experimental Hypnosis, 43(2), 145 162.

Loftus, E., & Ketcham, K. (1991). Witness for the Defense: The Accused, the Eyewitness, and the Expert who puts Memory on Trial. New York: St. Martin's Press.

Lösel, F. (1995). Increasing consensus in the evaluation of offender rehabilitation? Lessons from recent research synthesis. Psychology, Crime & Law, 2(1), 19 39.

Maletzky, B. M. (1996a). Denial of treatment or treatment of denial? Sexual Abuse: A Journal of Research and Treatment, 8(1), 1 5.

Maletzky, B. M. (Ed.). (1996b). Special issue on relapse prevention. Criminal Justice and Behavior, 23(1), 162 199.

Marques, J. K., Day, D. M., Nelson, C., & West, M. A. (1994). Effects of cognitive behavioral treatment on sex offender recidivism: Preliminary results of a longitudinal study. Criminal Justice and Behavior, 21(1), 28-54.

Marshall, W. L., Eccles, A., & Barbaree, H. E. (1993). A three tiered approach to the rehabilitation of incarcerated sex offenders. Behavioral Sciences and the Law, 11(4), 441-455.

Marshall, W. L., Jones, R., Ward, T., Johnson, P., & Barbaree, H. E. (1991). Treatment outcome with sex offenders. Clinical Psychology Review, 11(4), 465 485.

Marshall, W. L., & Pithers, W. D. (1994). A reconsideration of treatment outcome with sex offenders. Criminal Justice and Behavior, 21(1), 10-27.

McCann, J., Voris, J., Simon, M., & Wells, R. (1989). Perianal findings in prepubertal children selected for nonabuse: A descriptive study. Child Abuse & Neglect, 13(2), 179-193.

McCann, J., Voris, J., Simon, M., & Wells, R. (1990). Comparison of genital examination techniques in prepubertal girls. Pediatrics, 85(2), 182-187.

McCann, J., Wells, R., Simon, & Voris, J. (1990). Genital findings in prepubertal girls selected for nonabuse: A descriptive study. Pediatrics, 86(3), 428-439.

McGough, L. S. (1995). For the record: Videotaping investigative interviews. Psychology, Public Policy, and Law, 1(2), 370 386.

Miller, L. C. Louisville Behavior Checklist-Revised. Los Angeles, California: Western Psychological Services.

Miner, M. H., Marques, J. K., Day, D. M., & Nelson, C. (1990). Impact of relapse prevention in treating sex offenders: Preliminary findings. Annals of Sex Research, 3(2), 165 185.

Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1996). The long-term impact of the physical, emotional, and sexual abuse of children: A community study. Child Abuse & Neglect, 20(1), 7 21.

Myers, J. E. B. (1994, July). Child Victim Witness Investigative Pilot Projects: Research and Evaluation Final Report. Sacramento, CA: California Department of Justice.

Nagayama Hall, G. C. (1995). Sexual offender recidivism revisited: A meta-analysis of recent treatment studies. Journal of Consulting and Clinical Psychology, 63(5), 802 809.

Nash, M. R., Hulsey, T. L., Sexton, M. C., Harralson, T. L., & Lambert, W. (1993). Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation. Journal of Consulting and Clinical Psychology, 61(2), 276-283.

Nash, M. R., Zivney, O. A., & Hulsey, T. (1993). Characteristics of sexual abuse associated with greater psychological impairment among children. Child Abuse & Neglect, 17(3), 401-408.

Nathan, D., & Snedeker, M. (1995). Satan's Silence: Ritual Abuse and the Making of a Modern American Witch Hunt. New York: Basic Books.

Nelson, B. J. (1984). Making an Issue of Child Abuse: Political Agenda Setting for Social Problems. Chicago: The University of Chicago Press.

Ney, P. G., Fung, T., & Wickett, A. R. (1994). The worst combinations of child abuse and neglect. Child Abuse & Neglect, 18(9), 705 714.

NIJ. (1992). New Approach to Interviewing Children: A Test of its Effectiveness (1992, May). National Institute of Justice, Research in Brief, pp. 1-6. Washington, D. C. 20531

O'Donohue, W., & Letourneau, E. (1993). A brief group treatment for the modification of denial in child sexual abusers: outcome and follow-up. Child Abuse & Neglect, 17(2), 299-304.

Powell, M. B., & Thomson, D. M. (1994, April). Children's eyewitness-memory research: Implications for practice. Families in Society: The Journal of Contemporary Human Services, pp. 204 216.

Prosser, J. (1996a). An ethnographic case study approach to studying the process of child abuse investigation in the United Kingdom. Issues In Child Abuse Accusations, 7(3), 146 154.

Prosser, J. (1996b). A case study of a UK family wrongly accused of child abuse. Issues In Child Abuse Accusations, 7(3), 155 163.

Quinsey, V. L., & Marshall, W. L. (1983). Procedures for reducing inappropriate sexual arousal: An evaluation review. In J. G. Greer, & I. R. Stuart (Eds.), The Sexual Aggressor: Current Perspectives on Treatment (pp. 257 289. New York: Van Nostrand Reinhold Company.

Quinsey, V. L., Harris, G. T., Rice, M. E., & Lalumiere, M. L. (1993). Assessing treatment efficacy in outcome studies of sex offenders. Journal of Interpersonal Violence, 8(4), 512-523.

Raskin, D. C. & Yuille, J. C. (1989). Problems in evaluating interviews of children in sexual abuse cases. In S. J. Ceci, D. F. Ross, & M. P. Toglia (Eds.), Perspectives on Children's Testimony (pp. 184-207). New York: Springer-Verlag.

Rind, B., & Harrington, E. (undated). A Critical Examination of the Role of Child Sexual Abuse in Causing Psychological Maladjustment: A Review of the Literature. Manuscript under consideration for publication.

Richardson, J. T., Best, J., & Bromley, D. G. (Eds.). (1991). The Satanism Scare. New York: Aldine De Gruyter.

Rossen, B. (1989). Zedenangst: Het verhaal van Oude Pekela. Lisse: Swets & Zeitlinger. English translation, 1990.

Siegel, J. M., Sorenson, S. B., Golding, J. M., Burman, M. A., & Stein, J. A. (1987). The prevalence of childhood sexual assault: The Los Angeles Epidemiologic Catchment Area Project. American Journal of Epidemiology, 126(6), 1141-1153.

Skinner, L. J., & Berry, K. K. (1993). Anatomically detailed dolls and the evaluation of child sexual abuse allegations: Psychometric considerations. Law and Human Behavior, 17(4), 399-421.

Thoennes, N., & Pearson, J. (1988). Summary of recommendations from the sexual abuse allegations project. In E. B. Nicholson, & J. Bulkley (Eds.), Sexual Abuse Allegations in Custody and Visitation Cases (pp. 279-286). Washington, DC: The American Bar Association.

Tollison, C.D., & Adams, H. E. (1979). Sexual Disorders: Treatment, Theory, and Research. New York: Gardner.

Tyler, A. H., & Brassard, M. R. (1984). Abuse in the investigation and treatment of intrafamilial child sexual abuse. Child Abuse & Neglect, 8, 47-53.

Underwager, R., & Wakefield, H. (1990). The Real World of Child Interrogations. Springfield, IL: C. C. Thomas.

Underwager, R., & Wakefield, H. (1995). Special problems with sexual abuse cases. In J. Ziskin, Coping with Psychiatric and Psychological Testimony (pp. 1313-1370).

United States General Accounting Office (1996). Sex Offender Treatment Research Results. GAO: GGD-96-137. Washington, D. C. 20548.

Victor, J. S. (1993). Satanic Panic: The Creation of a Contemporary Legend. Chicago, IL: Open Court Publishers.

Wakefield, H, & Underwager, R. (1990). Personality characteristics of parents making false accusations of sexual abuse in custody disputes. Issues In Child Abuse Accusations, 2(3), 121 136.

Wakefield, H., & Underwager, R. (1988). Accusations of Child Sexual Abuse. Springfield, IL: CC Thomas.

Wakefield, H., & Underwager, R. (1991a). Female child sexual abusers: A critical review of the literature. American Journal of Forensic Psychology, 9(4), 43-69.

Wakefield, H., & Underwager, R. (1991b). Sexual abuse allegations in divorce and custody disputes. Behavioral Sciences and the Law, 9, 451 468.

Wakefield, H., & Underwager, R. (1991c). Sex offender treatment. Issues In Child Abuse Accusations, 3(1), 7-13.

Wakefield, H., & Underwager, R. (1994a). The alleged child victim and real victims of sexual misuse. In J. J. Krivacska & John Money, The Handbook of Forensic Sexology (pp. 223-264). Amherst, NY: Prometheus Books.

Wakefield, H., & Underwager, R. (1994b). Return of the Furies: An Investigation into Recovered Memory Therapy. Chicago: Open Court.

Ward, T., Louden, K., Hudson, S. M., Marshall, W. L. (1995). A descriptive model of the offense chain for child molesters. Journal of Interpersonal Violence, 10(4), 452 472.

Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63(5), 688 701.

Weisz, J. R., & Weiss, B. (1993). Effects of Psychotherapy with Children and Adolescents. Newbury Park: Sage.

Weisz, J. R., Weiss, B., Alicke, M. D., & Klotz, M. L. (1987). Effectiveness of psychotherapy with children and adolescents: A meta-analysis for clinicians. Journal of Consulting and Clinical Psychology, 55(4), 542-549.

Weisz, J. R., Weiss, B., & Donenberg, G. R. (1992). The lab versus the clinic. American Psychologist, 47(12), 1578-1585.

Weisz, J. R., Weiss, B., Han, S. S., Granger, D. A., & Morton, T. (1995). Effects of psychotherapy with children and adolescents revisited: A meta-analysis of treatment outcome studies. Psychological Bulletin, 117(3), 450 468.

White, J., & Allers, C. T. (1994). Play therapy with abused children: A review of the literature. Journal of Counseling and Development, 72, 390 394.

Wirt, R. D., Lachar, D., Klinedinst, J. E., Seat, P. D., & Broen, W. E. Personality Inventory for Children. Los Angeles, CA: Western Psychological Services.

Wolf, T. L., & Campbell, T. W. (1994). Effective treatment for children in cases of extrafamilial sexual abuse. Issues In Child Abuse Accusations, 6(4), 207 213.

Wolfner, G., Faust, D., & Dawes, R. M. (1993). The use of anatomically detailed dolls in sexual abuse evaluations: The state of the science. Applied & Preventive Psychology, 2, 1-11.

The views and opinions expressed in this page are strictly those of the page author.
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The views and opinions expressed in this page are strictly those of the page author.The contents of this page have not been reviewed or approved by the University of Minnesota.

The views and opinions expressed in this page are strictly those of the page author.
The contents of this page have not been reviewed or approved by the University of Minnesota.