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The Long Term Effects of Incest: Clinicians' Perceptions

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The Long Term Effects of Incest: Clinicians' Perceptions THE LONG TERM EFFECTS OF INCEST: CLINICIANS' PERCEPTIONS Janet Olivia Scalzo B.F.A., University of Windsor, 1978 B.A.(~onl, University of Windsor, 1984 k THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in the Department of Psychology @ Janet Olivia Scalzo 1986 SIMON FRASER UNIVERSITY September, 1986 All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without permission of the author. APPROVAL Name: Janet Olivia Scalzo Degree: Master of Arts Title of thesis: The Long Term Effects of Incest: Clinicians' Perceptions Examining Committee: Chairman: Dr. M. Bowman Dr: .M. Kimball ~eni-orSupervisor .' J. Marcia Dr. N. Hyde - External Examiner Director University Counselling Service Simon Fraser University Date Approved: PARTIAL COPYRIGHT LICENSE I hereby grant to Simon Fraser University the right to lend my thesis, project or extended essay (the title of which is shown below) to users of the Simon Fraser University Library, and to make partial or single copies only for such users or in response'to a request from the library of any other university, or other educational institution, on its own behalf or for one of its users. I further agree that permission for multiple copying of this work for scholarly purposes may be granted by me or the Dean of Graduate Studies. It is understood that copying or publication of this work for financial gain shall not be allowed without my written permission. Title of Thesi s/Project/Extended Essay The Long Term Effects of Incest: Clinicians' Perceptions Author:, - ,,,,-, - , 7 V -- (signature) Janet 0. Scal7o ( name 1 (date) ABSTRACT Clinical intervention for incest's immediate and long-term impact has traditionally been accompanied by disbelief or minimization of victims' disclosures. The present study examined clincians' current perceptions in order to illuminate the effects which increasing public and professional awareness may have had on intervention strategies. Questionnaires were mailed to all clinical psychologists and psychiatrists in Vancouver. Questionnaires were received from 45% of those contacted. The data were analyzed for effects of gender, profession, experience, and training in sexual abuse intervention on perceptions of incest survivors. Clinicians' perceptions of incest case incidence, relationship of incest participants, duration, types of coercion, frequency of effects associated with incest among their cases, assessment, diagnostic and intervention practices were elicited. Gender accounted for the most differences on cross tabulations. Relative to male clinicians, female clinicians more frequently estimated a high incidence of incest cases in their practices; reported seeing more victims during the past year; reported an earlier onset of incest; and endorsed more long-term effects. Relative to male clinicians, female clinicians were more likely to endorse the importance of long-term psychotherapy, skills training and incest group therapy and were less likely to endorse the importance of family therapy. iii ~nteractionsamong gender, profession, training and experience were found on estimates of incidence. Affective disorder was most frequently diagnosed. Fewer psychiatrists than psychologists diagnosed borderline personality disorder. Trained clinicians were more likely than untrained clinicians to estimate a high incest incidence; see more victims; endorse some long-term effects and the importance of long-term psychotherapy. Trained clinicians were more willing to ask about incest when clients presented non-sexual problems. Training, or working with many incest victims, both more frequently reported by female clinicians, appears to sensitize clinicians to a possible incest history and a range of long-term effects among their clients. ACKNOWLEDGEMENTS I would like to thank my committee for their valuable guidance in the development and implementation of this research. I am especially grateful to my supervisor, Dr. Meredith Kimball, for her consistent support and encouragement. When the project seemed monumental, her direction brought it back within reachable proportions. Several psychiatrists, physicians and psychologists in Vancouver generously gave their time and assistance in developing the questionnaire. I would especially like to thank Dr. Naida Hyde, Dr. Sue Penfold, Dr. James Schmidt, Dr. Joseph Noone, and Dr. Roy O'Shaughnessy. Dr. Robert Ley's liaison efforts and Dr. Ray Koopman's statistical expertise were also appreciated. The office and technical staff of the Psychology Dept. were also integral to the completion of the research. b There are always people whose names are not found in the reference list of the thesis, yet their impact enhances and sustains the work. My thanks to the following people who continue to sustain me: --to Joyce, for her friendship, support and willingness to listen "just one more timen; --to Carol, for her friendship and encouragement to keep at it. They made a difficult experience worthwhile. --to Candice, Rose and Kim, who persist in keeping me on track. --to the women and men who risk breaking the conspiracy of silence, who teach us all about the impact of incest. DEDICATION To Vera, for her strength TABLE OF CONTENTS Approval .................................................... ii Abstract ................................................... iii ~cknowledgements............................................. v ~edication................................................. vii ~istof Tables ............................................... x I . Review of the Literature ................................ 1 Introduction ............................................ 1 Problems in Researching the Effects of Incest ........... 4 The Prevalence of Incest and Sexual Abuse ............... 7 The Long-Term Effects of Childhood Sexual Abuse and Incest .............................................. 22 The Importance of Familial Relationship to Long-Term Effects ............................................. 48 Diagnostic Issues and Models of Psychopathology ........ 53 Treating the Long-Term ~ffectsof Incest ............... 63 . The Current Study ...................................... 65 I1 . Method ................................................. 70 Subjects ........................................ 70 Measures ............................................... 70 Procedure .............................................. 71 Statistical Analyses Used .............................. 74 I11 . Results ................................................ 77 Response Rate .......................................... 78 Representativeness of Study Sample to Population ....... 79 Demographic Variables .................................. 79 Perceptions of Incidence of Incest in Clinical Practice 86 viii Perceptions of Incest .................................. 94 Perceptions of Assessment and Treatment ............... 101 IV . Discussion ............................................ 121 References ................................................. 142 Appendix A ................................................. 155 Appendix B ................................................. 161 Appendix C ................................................. 164 Appendix D ................................................. 165 Appendix E ................................................. 166 Appendix F ................................................. 167 Appendix G ................................................. 168 LIST OF TABLES Table Page 1 Sample Distribution of ~rofessionsby Gender ........... 79 2 Contingency Table and Summary of Log-linear Analysis of Models of Gender, Profession and Age ................ 82 3 Contingency Table and Summary of Log-Linear Analysis of Gender, Profession and Experience ................... 84 4 Contingency Table and Summary of Log-Linear Analysis of Profession, Gender and Training ..................... 85 5 Contingency Table and Summary of Log-Linear Analysis of Profession, Gender and Incidence Estimates .......... 87 6 Contingency Table and Summary of Log-Linear Analysis of Training, Gender and Incidence Estimates ............ 89 7 Contingency Table and Summary of Log-Linear Analysis of Training, Experience and Incidence Estimates ........ 91 8 Contingency Table and Summary of Log-Linear Analysis of Training, Gender and Victims Seen During Past Year .. 93 9 Summary of Repeated Measures ANOVA on Gender, Profession and Method of Consent .................... 96 10 Clinicians' Rankings of Incest Patterns ................ 98 .11 Summary Table of Repeated Measures ANOVA of Profession, b Gender and Incest Pattern .......................... 100 12 Summary Table of Repeated Measures ANOVA of Profession, Gender and Problem ................................. 102 13 Summary Table of Repeated Measures ANOVA of Training, Gender and Problem ................................. 104 14 Summary Table of Repeated Measures ANOVA of Profession, Gender, Problem and Question ....................... 106 15 Contingency Table and Summary of Log-Linear Analysis of Gender, Victims Seen and Medium Association Items .. 111 16 Contingency Table and Summary of Log-Linear Analysis of Training, Gender and Importance of Improved Coping . 114 17 Primary Diagnosis Given by Psychologists and psychiatrists ...................................... 116 18 Contingency Table and Summary of Log-Linear Analysis of Training, Gender and Long-Term Psychotherapy ....... 119 CHAPTER I REVIEW OF THE LITERATURE Introduction
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