THE CONCEPT OF INNER CHILD AS EXPERIENCED BY ADULT SURVIVORS OF CHILD SEX ABUSE by KELLEY A. RILEY, B.A., M.A.
A DISSERTATION IN HUMAN DEVELOPMENT AND FAMILY STUDIES Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY Approved
December, 1993 I)c ••> ^ /* '.
T\ ij ACKNOWLEDGEMENTS ; ^ '--1 -•
^ o • ^- I would like to express my sincere gratitude to Dr. Judith Fischer, who has acted as my scholastic advisor for the past four years and as
the chair of my dissertation endeavor for the past two and one-half
years. Her support and guidance, both academically and personally,
have truly helped me persist in completing my academic goal. I would
like to thank Dr. Karen Wampler, Dr. Ed Glenn, Dr. Virginia
Felstenhausen, and Dr. Beth Shapiro, members of my dissertation committee,
for their academic and editorial input. Finally, I would like to thank
Kevin Lyness for his statistical, computer, and editorial advice, as
well as his strong emotional support, which played a major role in the
completion of this dissertation.
n TABLE OF CONTENTS
ACKNOWLEDGEMENTS ii ABSTRACT , v
LIST OF TABLES v
LIST OF FIGURES vi
CHAPTER
I . CHILDHOOD SEX ABUSE 1 II. LITERATURE REVIEW 16 III . METHODS 82 IV, RESULTS 103 V. DISCUSSION 119 REFERENCES 134 APPENDIX A, QUTSTIONNAIRE 140
I 1 I ABSTRACT
Using symbolic interaction theory as a guide, t .h i ?
study provides a definition of inner child that expands
and clarifies popular writings on the topic. This stu further empirically examines aspects of severity of abuse, perceptions of inner child, and lack of adult adjustment. The sample was comprised of 34 women survivors of chili.lhood sexual abuse who were in therapy at the time of thf^ study, or had. been in therapy with a therapist who introduced inner child work. A multivariate analysis of variance was conducted to examine rl i f f ert^ncf^s between self-concept of wounded and idt^al inner rhilci^en. Wounded inner child self-concept was 'Significantly lower than that of ideal inner children. No "Significant correlations were found between difference scores and scores on any of the three outcome measures (BDI. BAI, RSES). A path analysis using Linear Structural Equations (7) (LISPED was also conducted. Severity of abuse was not significantly related to wounded inner child self-concept, difference scores between wounded and ideal inner child IV LIST OF TABLES 2-1 Applications of Symbolic Interaction Theory A'^sumnt ions About Self to the Concepts of the Wouded Inner Child and the Ideal Inner Child 7 8 3-1 Percent of Respondents Reporrmg Background Inf orm.at ion 98 3-2 Percentage of Respondents Report: mg Abuse Issues 100 4-1 Intercorreiations of Dependent Variables 114 4-2 Correlations of Aspects of Abuse with Sever 11 y 1 1.5 4-3 Background Information Correlated with Sea I ed Scores 116 4-4 Covariance Matrix \nalvzed. , 117 LIST OF FIGURES 2-1 Model to be Tested 81 4-1 Results of Model Testing I 1>^ VI CHAPTER I CHILDHOOD SEXUAL ABUSE Although childhood sexual abuse in the home, particularly incest, has been described in both ancient and modern literature, large gaps are evident. For example, the reported incidence of childhood sex abuse varies from study to study (Hodson & Skeen, 1987). The sparse documentation of the incidence of childhood sexual abuse, especially incest, is not surprising in view of strong societal and familial taboos against the discussion of any sexual issue, especially sexual problems and incest. Bagley and Ramsay (198.5) suggested that the confusion and bias previously surrounding the topic of child sexual abuse, such as the notion that sexual exploitation in family contexts was rare and harmless, is disappearing based on information provided by longitudinal and clinical studies. Increased media attention around the topic of child sexual abuse has heightened public knowledge and awareness of the problem and has contributed to an increase in the reporting of cases. Adults who survived child sexual abuse are often referred to as "survivors." emphasizing the strength and creativity individuals use to overcome the trauma of chiId sex abuse. Efforts at researr-h on the topic of survivor'^ are faced with a number of problems. Some of these prnblf^ms include (a) estimating prevalence, (b) reaching a consensus on a definition, (c) the repression into adulthood of childhood experiences, and (d) differing methodologies used by researchers. For example, determining a true figure of the prevalence of child sexual abuse of the population of females in the United States is problematic. Different research methodologies such as interviews as opposed to questionnaires may result in different figures when examining prevalence. The Murphy et al. (1988) prevalence figure of 32% identified in their face-to-face interview study falls between the figures of 54%-62% previously obtained in interview studies, and 15%-20% obtained in a study u^^ing a self-administered questionnaire method. Following a review of the literature, Bagley and Ramsay (1985) estimated that between 18 and 30 percent of women surveyed had experienced serious, unwanted sexual contact, involving anything from manual fondling of the genital area through completed intercourse, prior to their eighteenth birthday. At least half of the assaults were at the hands of family members or trusted family fr iends. Another factor contributing to the difficulty nf conducting research comparable across studies, as well as obtaining a prevalence figure, is a lack of clarity regarding a definition of child incest and sexual abuse. Sexual abuse of a child reported m the literature represents a broad range of definitions: (a) exposure to abuse on a single occasion, (b) multiple instances of sexual intercourse (Einbender & Friedrich, 1989), (c) some form of nonconsenting sexual experience with an older person during childhood (Murphy et al., 1988)., (d) intrafami 1ial sexual abuse involving molestation of a daughter by her father or male guardian (Brunngraber, 1986), or (e) a broad definition of incest accepted in the psychological literature, any sexual contact involving a child in the sexual stimulation of a parental figure or a significant other in the child's intrafami1ial system (Morrow & Sorell, 1989). Mo^t definitions of child sexual abuse and incest are broad enough to include male and female perpetrators who ma>' be inside or outside of the family, and male and female child victims. Most literature reported in this paper, however, described female child victims and adult male perpetrators. Without a clear definition of childhood sexual abuse it is difficult to discern who should be included in studies. It also makes it difficult to r^le^rly establish control groups for comparison purposes. The wide range in definitions reported in the researr^h reviewed makes comparison across studies inaccurate. For example, studies indicate that severity of abuse is related to number and extent of negative outcomes in survivors (Bagley & Ramsay, 1985; Bryer: Nelson. Miller, & Krol, 1987; Morrow & Sorell, 1989). It is possible that studies using less stringent definitions of sex abuse may find different adult adjustment than studies defining abuse in more severe terms. All forms of sexual abuse deserve study, but a clear definition should be agreed upon so that comparisons across studies will be more accurate. Another factor which makes it difficult to get a true prevalence figure and to locate samples ^^r empirical research is the fact that memory of the abuse may be repressed, even though fear and anxiety associated with it persist (Einbender & Friedrich, 1989). Feinauer (1989) su^^ested that adults sexualIv abused as children may seek therapy during a crisis. For example, when an experience causes a resurgence of the repressed feelings associated with the initial abuse, the person may seek help. Feinauer (1989) noted that a crisis often occurs when adult survivors of child sexual abuse enter intimate situations, especially t^hose of a sexual nature. Memories may surface at that time, or difficulty with sexual relationships m.ay lead the individual into therapy to examine other issues. The therapy may result in the resurfacing of memories either inadvertently or through the guidance of a therapist. Repressed memories also add to the difficulty in p I early defining sexual abuse and complicate comparison across studies. For example, a survivor may repress certain memories which are harder to accept such as completed penetration, while remembering others such as genital fondling. This might affect definition as vvell as outcome in that a survivor may be placed in one comparison group based on less intrusive abuse,, vvhile more severe abuse actually occurred. Also, man\' o^ tie studies reviewed used, hospitalized psychiatric patients who had no memories of sexual abuse as comnari'?on groups for hospitalized psychiatric patients with memories of sexual abuse (Beck & van der Ko 1 k. 1987; Br i ere -^ Runtz. 1987; Bryer et al., 1987; Carson, Council, & VoIk, 1989: Feinauer, 1989; Livingston, 1986: Root, 1989). It is possible that at least some of the patients with no memories were sexually abused but repressed these memor ies. Despite the problems enumerated above, several aspects of child sex abuse have been studied, empirically. Most studies have examined the effects of child sex abuse on adult self-image and behavior. The reported effects of child sex abuse on the survivors a.s adults range from mild to debilitating (Morrow & Sorell, 1989), Research studies would appear to be in agreement with the conclusion that the effects of child sex abuse on adult survivors are significant and need further study (Bagley & Ramsay, 1985: Brunngraber, 1986; Carson, Council, ^ Vo1k, 1988; Livingston, 1986; Root, 1989). Areas suggested for further study include: (a) childhood sexual abuse m relation to adult adjustment (Bagley & Ramsay, 1!^8.'; Carson, Council, Ar Vo I k, 1988), (b) characteristics of family of origin of the survivor (Carson et al., 198H) (c) the relationship between child sex abuse an'l addictions (Carson et al,, 1988; Root, 1989), (d) samples of non-hospitalized subjects (Livingston, 1986) as well as random samples of survivors (Brunngraber. 1986), and. (e) factors related to therripeutic outcome. The Concept of Inner Child An important concept which has not yet been studied empirically is that of the inner child, a concept frequently encountered in the self-help literature and in therapy concerning sex abuse survivors. One reason for the lack of empirical study may be the difficulty and/or vagueness in defining the concept of inner child. For example, inner child is described as a "sense of softness, a sense of trust and wonder" by Bass and Davis ft (1988) in the popular self-help book The__Courage to Hea 1 . In another popular book, Bradshaw (1990) described the inner child as (a) the spontaneous wonder ?ind creativity within a person and, (b) the core material around which internal experiences are organized. This core material is composed of the earliest feelings, beliefs and memories a person has and it is formed in response to the stresses of the childhood environment, Bra.dshaw (1990) described the core material as the filter through which all new experiences pass. He used this concept to explain why some people choose the same destructive patterns repeatedly through life, Bradsha w (1990) noted that this concept of core material or inner child is comparable to what Freud called the 'repetition compulsion." According to Bradshaw (1990). since it was the inner child who first organized a person's experience, it is important to make contact with the inner child as a way to change the core material, or the way life is experienced. From this perspective, inner child work involves learning true seIf-nurturance by helping the adult claim and use adult powers to nurture the inner child who never received the needed nurturance. The definitions and descriptions suggested by Ba s *=; and Davis (1988) and Bradshaw (1990) are vague and nebulous. Using symbolic interaction theory, the current project presents a coherent theoretical definition of the construct of inner child. From a symbolic interactionist perspective the inner child is seen as a symbol representing a sense of self developed during childhood. In the popular literature the concept of the inner child i.s described in terms of process and content (Bass & Davis, 1988; Bradshaw, 1990; Miller, 1981). Process oriented discussions often focus on ways to get in touch with the inner child, such as doing inner child work The inner child process is seen as a metaphor for getting in touch with inner problems related to early- childhood experiences (Miller, 1981). Survivors of childhood sexual abuse have specific traumatic events from childhood and/or adolescence which are stored deep in the memory or unconscious. Getting the adult in touch with these childhood traumas may be important in 10 working through the problems experienced in adulthood. According to several authors ^Bass -^ Davi^;, 198^-; Bradshaw, 1990; Miller, 1981) because everyone wa ^ n^^re a child, and because children are truthful an.'^ spontaneous in play, the symbol of inner child can he'n survivors get in touch with the truth of what they experienced as a child. Inner child work is facilitated by a number of processes including guided imagery . hypnotherapy, anger work, art therapy, and nondominant hand writing. Content oriented descriptions include the different representations of inner childhood experiences. The concept of inner child is seen as a symbol of the experiences of childhood. Popular literature describes several types of inner children. Two main types of inner children described in popular liter?^ture are: (a^ the wounded child which is the sense of self developed as the result of the trauma and the fear surrounding the trauma, and (b) the ideal, divine, or wonder child who was untouched by the abuse. The divine or wonder child represents the spontaneity, innocence and wonder of childhood (Bass & 11 Davis. 1988; Bradshaw. 1990). It is the ideal rhild who attempts to please adults in order to hide or overf^ome the childhood trauma (Bass & Davis. 1988: Miller, l98l). There may also be a representative of the actual uonmieH child who took the brunt of the abusive experience(s). There may be symbolic inner children representing other emotions, events, or ages as vvell. Different symbolic inner chihiren may he attached to different adult emotions. For example, when an adult survivor feels anger or rage at a current situation (rage which is often very exaggerated for the actual situation), such rage may be an expression of a different symbolic inner child than when one laughs at a child's toy or at a memory. Abrams (1990) suggested that perhaps the real child, forced to adapt, became a little adult and began to identify- with a false self. He suggested that when this happens, the child within becomes abandoned and lost. He indir^ated that the inner child is a vehicle for memories of both the actual child and the idealized child. The^ie memories may emerge as the wounded child who remembers the actual abuse or the ideal child who behaved well so 12 that adults would love him/her. Most likel>. representations of both will develop. Symbolic interaction theory addresses d.i^feren<"es between real versus ideal senses of self (Duval Sr Wickland, 1972; Hewitt, 1989; Rogers, 1961). A<-cording to such theorists, the greater the disparity between the real versus ideal senses of self, the greater the problems experienced by the individual. The real self can be represented by the wounded inner child who experienced the actual abuse. The ideal self can he represented by the ideal inner child, who worked hard to overcome or hide the trauma of the abuse. Symbolic interaction theorists discuss roles enacted by individuals. Different roles m.ay develop based on the wounded inner child, and others develop based on the ideal inner child. Symbolic interactionists state that the greater the disparity between roles, the greater the difficulty in fulfilling roles. Rogers (1961), who is noted in the symbolic interactionist literature as a self-theorist (Burr, Leigh, Day, & Constantine. 1979; Hewitt, i989), described sel f-a<"tua I i zat ion which involves attaining 13 consistency between what one actually is versus v%h?tt one ideally would like to be. Rogers (1^61) considered self-actualization to be the ultimate goal in life :'or individuals. SeIf-theorists also have stated that awareness of differences between real versus ideal senses of self lead to tension and behaviors aimed at reducing that tension (Duval & Wicklund, 1972; Kohut. 1977, 1980; Rogers, 1961). Symbolic interaction also emphasizes the importance of symbols. The inner child is described in the literature as a. symbol. From the sym.bolic interar^tinn perspective, the inner child would be described as a symbol based on a sense of self developed as a child. Symbolic interaction theory suggests that people have multiple senses of self, including a physical self, a social self, an "I" the self as actor, and a "me" the object of one's knowledge (Burr et al., 1979; Hewitt . 1989). Different senses of self may be represented by various symbols such as a wounded child or an ideal child as described in the popular literature. Although the concept of inner child is prevalent in the popular literature, it has not yet been studied I 4 empirically. The prevalence of discussion of the concept of inner child in the popular literature suggests the value of this concent m the healing process of survivors of nhild sex abuse. Empiricai studies of the concept of inner child would help determine (a) the symbolic existence of wounded and ideal inner children, fb) the nature of their manifestations and the extent to which these correspond to popularized descriptions, and (c) the nature of the relationship between the wounded and ideal inner child and how this relationship corresponds to adult adjustment. Before the concept of inner child can be examined empirically a more coherent definition must be developed. Through symbolic interaction thec^y, this project presents a theoretical definition of the construct of inner child. Theories used in the popular literature to describe the inner child will be presented. Aspects of symbolic interaction theory which pertain to a definition of inner child will then be presented. Because of the importance of inner child work in therapy with sex abuse survivors, empirical 1.' research of adult adjustment in survivors of child sex abuse will also be presented. This project will (a) present symbolic interaction theory as a. guide to describing outcomes of child sev abuse and the inner nhild, (b) define inner rhild through symbolic interaction theory, fc) examine- descriptions of the content of a wounded and an iileal inner child, (d) exam.ine the am.ount of dlscenancv between these different representations of inner children, (e) examine the relationship between the amount of discrepancy between these inner children and adult adjustment, and (f) examine the relationship between severity of abuse, discrepancy between inner children, and adult adjustment CHAPTER II LITERATURE REVIEW Brief Overview of Literature of Childhood Sexual Abuse Potentially debilitating effects of child sex abuse on survivors may lead them to seek help from a therapist or from self-help literature. Such activities may lead to familiarization with the concept of inner child. Because of the importance of inner child work in therapy with survivors, empirical studies of outcome will be reviewed in this section. Following their review of the literature, Morrow and Sorell (1989) concluded that reported effects of child sexual abuse range from no adverse effects or mild deleterious effects, to severe or debilitating adverse effects upon victims. Using symbolic interaction theory as a guide, they suggested that factors associated with the sexual abuse experience itself, and factors associated with the response of the child and the child's social environment following the sexual abuse or its disclosure, may be involved in 16 17 determining the different effects seen in survivors of child sexual abuse. Several effects of child sex abuse are often found in populations of survivors which may bring them into therapy or hinder them in life. Depression, anxiety, interpersonal problems (especially with men), anger, and physical complaints are often reported among populations of survivors of child sexual abuse (Bagley & Ramsay, 1985; Brunngraber, 1986; Carson, Council. & Volk, 1989; Fischer. 1983; Livingston, 1986; Murphy et al., 1988; Roland, Zelhart, & Dubes, 1989; Root, 1989; Wheeler & Walton, 1987). Sexual promiscuity, prostitution, sexual dysfunction, avoidance of sexual relationships and avoidance of men are all found among populations of women survivors (Beck & van der Kolk, 1987; Brunngraber, 1986; Feinauer, 1989; Fromuth, 1986; Roland, Zelhart, & Dubes, 1989; Rowe &. Savage, 1988; Wheeler & Walton, 1987). Sexually promiscuous or inappropriate seductive behavior is described by Miller (1981). She theorized that a child who is sexually abused may feel forced to earn love, particularly in sexual ways, and these feelings may be carried over into adulthood. 18 Another well-established effect of child sexual abuse often seen in populations of survivors is poor self-esteem (Carson, Council, & Volk, 1988, 1989; Fromuth, 1986; Morrow & Sorell, 1989; Murphy et al., 1988; Root, 1989). Hodson and Skeen (1987) suggested that children with low self-esteem may be sought out by perpetrators. Several studies examining adult adjustment following child sexual abuse have found survivors to be avoidant, socially withdrawn, and dissociative (Beck & van der Kolk, 1987; Briere & Runtz, 1988; Carson, Council, & Volk, 1988, 1989; Fischer, 1983; Murphy et al., 1988; Wheeler & Walton, 1987). Poor self-esteem may be directly or indirectly related to child sexual abuse. Sexually abused children are often told that they are worthless. Other children may be more emotionally than verbally abused, developing the notion that they are not worth attention, and/or that their only value is as a sexual object. According to symbolic interaction theory, because these messages are coming from significant people in the child's life, they carry a strong impact on the development of the child's self-esteem. 19 Studies have also indicated that adult survivors of child sexual abuse may attempt to avoid, numb, or repress intrusive recollections of the trauma (Brunngraber, 1986; Root, 1989). Root (1989) suggested an inverse relationship between substance abuse and symptomology, in that intrusive experiences are less frequent and less intense while an individual is abusing a substance such as occurs during binge eating or drinking episodes. She noted that a preoccupation with obtaining, hiding, or resisting a substance such as food or alcohol, and life-like dreams of having eaten or consumed the substance, become more intrusive and all-consuming than the original trauma. Accordingly, substance abuse, such as that involved in bulimia and alcoholism, provides emotional and physical anesthesia for memories of past traumas. Substance abusers may only present themselves for treatment when the substance abuse no longer provides the anesthetic effect. Root (1989) stated that through substance abuse the survivor of child sexual abuse successfully avoids or represses intrusive and painful memories of the abuse, and this method of coping may have adaptive qualities for some 20 women who do not have a repertoire of positive skills for coping with the negative effects of the trauma. She suggested that long-term substance abuse is reinforced by the successful avoidance of feelings and memories related to the child sexual abuse. Research reviewed suggests several different issues related to differential outcome in adult survivors of child sexual abuse. Symbolic interaction theory has been suggested as a theory to help understand differential outcomes (Morrow, 1986; Morrow & Sorell, 1989). A brief description of symbolic interaction theory as it relates to outcomes of childhood sexual abuse will be presented in this next section. Several strengths were seen in the research reviewed on differential outcomes of adult adjustment to childhood sex abuse. Most studies used measures with reported reliability and validity, and analyzed data appropriately with statistics such as ANOVA (Bagley & Ramsay. 1985; Briere & Runtz, 1988; Brunngraber, 1986; Carson et al. , 1988, 1989; Einbender & Friedrich, 1989; Feinauer, 1989; Fromuth, 1986). The Beck Depression Scale was used most often as a measure of depression. 21 The Coopersmith and Rosenberg measures of self-esteem were most often analyzed as measures of self-estee m The use of well documented measures makes results more comparable across studies. Although several strengths were noted, some weaknesses were also noted. Many studies researched subjects in psychiatric hospitals or people who were participating in som.e form of therapy at the time of the study which greatly limits the genera 1izabiIity of the results (Beck & van der Kolk, 1987; Briere & Runtz, 1987; Bryer et al,, 1987; Carbon et al,, 1989; Feinauer, 1989: Livingston, 1986; Root, 1989), Of these studies, m.any used a comparison group of hospitalized subjects or those undergoing therapy for reasons other than childhood sexual abuse (Beck & van der Kolk, 1987; Briere & Runtz. 1987; Livingston, 1986). Overall, however, thn studies reviewed on adult survivors of child sexual abuse appear valid and well conducted. 22 Symbolic Interactionism and Outcome of Adult .Survivors Symbolic interaction theory has been used informally in guiding several studies of survivors of child sexual abuse (Brunngraber, 1986; Bryer, Nelson. Miller, & Krol, 1987; Einbender & Friedrich, 1989; Murphy et al., 1988; Rowe & Savage, 1988), and formally by Morrow (1986). Morrow and Sorell (1989) suggested that symbolic interactionism offers a conceptual framework which might help in understanding factors related to differential effects of child sexual abuse on survivors. They suggested two aspects of symbolic interactionism as particularly helpful. These include (a) the importance of the individual's "definition of the situation" in determining the effects of that situation on the individual, and (b) the response or expected response of others as this influences how individuals perceive themselves. The subjective definition an individual forms of the situation as the individual adjusts to the various obiective realities of the sexual abuse is important in understanding the child's behavior at the time of the 23 abuse. It is also important in understanding the behavior of the adult survivor later in life. This subjective definition may change as the child victim matures and adds new self-definitions to current on e ^ How a child perceives the situation will affect the child's self-esteem which in turn affects behaviors. Because significant others influence an individual's self-concept and behaviors more than others in general, and because most child sexual abuse involves significant others in the child's life, child sexual abuse is expected to have a significant impact on the self-concept and behaviors of individuals sexually abused as children. For example, a child who has his./her life threatened and./or experiences physical abuse in conjunction with sexual abuse might come to hate the situation and the perpetrator, and may chose p^s an adult to avoid any similar contact with persons similar to the perpetrator (i.e,, avoid all men, or all sexual contact). Children who perceive the child sexual abuse as the way to receive attention might become sexually promiscuous as they enaci a seductive role in ^4 their attempts to seek attention and affection from men (Miller, 1981). Theories of Inner Uhild The inner child has been examined inform?* I ly through theoretical riiscussion in the popular literature. Freudian and .Jungian theories have been included in the discussion of the inner child and what it symbolizes, The^e thenries will be presented below and their shortcomings noted.. Symbolic interaction theory will then be introduced with special attention given to aspects which apply to the formation of a t heoret if^a I definition of inner child. Freudian Theory Sigmund Freud suggested that the experiences of r hildhood shape an individual's later life and in doing so recognized the im.portance of early childhood experiences (Miller, 1984). Miller (1984) adopted Freud's position and posited that childhood is the key to understanding all of later life. Miller has written several books on the inner child and early childhood trauma. In her earlier works, as a therapist, Miller 9 r) (1984) contended that it was not enough to ask direct questions about the past, stating that some questions are more likely to conceal rather than reveal. She believed that in focusing on early trauma, a therapist could learn a lot by observing how patients mistreat themselves. For example, self-injurious behaviors such as cutting or burning one's self may have several meanings, (a) it may indicate an image of self as deserving to be hurt, (b) the physical pain may be used to repress emotional pain from childhood, or (c) the pain created through self-injurious behaviors may recreate pain experienced in childhood. In her earlier work in discussing child sexual abuse, Miller (1984) described psychoanalytic issues including (a) shielding the parents, and (b) concealment of trauma. She noted that these issues are not limited to classical psychoanalysis, but are found in other forms of therapy as well. Miller (1984) suggested that patients would improve simply by being able to articulate their feelings, formulate their resentments, and experience their rage toward their parents in an atmosphere where they trust they will be taken serious Iv- 26 and not judged. She believed that the problems experienced by the adult patient could best be ascertained by examining the child-rearing ideology of the parents of the patient, the power structure within the patient's family of origin, and the resultant nature of the patient's childhood situation. She noted the importance of the child's experience because she believed that children often experience feelings much more intensely than do adults. Miller recommended the reconstruction of the childhood experience during therapy. She also stated that this therapeutic experience could lead to an important period of mourning accompanying what is learned. The adult survivor may be able to get in touch with the child's experiences by describing the inner child representing such experiences. The period of mourning involved in getting in touch with childhood experiences may be expressed in the form of depression often experienced by adult survivors. Although in her early works she took a psychoanalytic stance, recently she has denounced psychoanalytic theory. It was in 1988 that Miller 27 (1990) broke away from traditional psychoanalytic theory stating that therapy based on psychoanalytic theory confirms a person's self-deception. She stated that it viewed childhood trauma as fiction, thus making it difficult for adults to believe the facts of childhood. She believes that the basic psychoanalytic belief that childhood traumas are only fantasies encouraged denial of the problems a person experienced, as a child. Miller (1990) noted that in today's society it is seen as a virtue to not take seriously one's own suffering as a child. She stated that learning to take such suffering seriously is an important step in therapy. She suggested that therapists should identify with a patient's suffering child and become an advocate to that child. Miller (1990) contended in her more recent work=: that it is important for survivors of abusive childhoods to gain emotional access to their childhoods and to gain access to verifiable childhood realities. She suggested that a person approach childhood step by step to assimilate the knowledge previously banished from conscious memory. ?8 Miller also addressed problems with adult sexual experiences. She suggested that wounds to the soul of the actual child are encountered again with each bonding relationship in adulthood (Miller, 1981). The experience of sexual traumas are reencountered with each sexual experience as an adult. This recurrent theme makes it difficult to experience intimacy and heal the deeply felt wounded love relationship of the past. Miller (1981) also stated that it is difficult for people to experience being loved for who they are, when, as a child, they were loved for their achievements, successes, and .sacrifices. Such conditional love may lead to inappropriate love seeking behavior in adults. Most of Miller's work related to the process of inner child work. She did, however, comment on the content aspect of the inner child as well as describing the inner child as a manifestation of self. As noted by Miller, Freudian theory offers insight into the experiences of a child as relating to that individual's behavior as an adult. Freudian theory does not fully describe the notion of inner children. Miller is not only not able to relate Freudian theory directlv to the ?Q notion of inner child, she also does not offer a clear definition or theory of her own. Jun.^ian Theory Another theory, suggested by Bradshaw (1990), to validate the concept of inner child is Jungian theory. It was Jung (1990) who discussed the child archetype an unconscious, pre-existent form that seems to be part of the inherited structure of the psyche corresponding to instinct. Jung (1990) stated that child archetypes are part of everyone, and are the cause of neurotic and psychotic behaviors seen in some people. He stated that they act like neglected and maltreated physical organs in a dysfunctional system. Jung (1990) further posited that archetypal behaviors most often appear in times of crises when a person is most vulnerable. According to Jung (1990), archetypal qualities are often found in symbols, and the best attempts to define archetype translate into another metaphoric language. To Jung (1990), the eternal child determines the ultimate worth or worthiness of a, person. From this perspective, the 30 child archetype, or inner child, may have effects on adult behavior, sense of worth, and self-esteem. Although Bradshaw (1990) suggests that Jungian theory may help explain the notion of inner child, he does not effectively relate Jungian theory to inner child as the inner child is considered to be based on childhood, experiences and is not innate. Bradshaw does not offer an explanatory theory of his own either. There are some similarities between Freudian theory, Jung's archetype, and the concept of inner child. All speculate that experiences in childhood are related to inappropriate behaviors in adults, and are manifested during times of crisis. Another similarity between Freud, Jung, symbolic interaction theory, and the concept of inner child is the emphasis on the effects of childhood experiences on adult behaviors. Freudian and Jungian theories currently presented in the popular literature to validate the concept of inner child do not fully address the complexities involved in the concept of inner child. Neither Freudian theory (as described by Miller, 1984) nor Jung's archetype (as Bradshaw [19901 described it) 31 explains behavior nor describes fully the conditions under which behavior presumably varies. Neither addres.ses multiple selves or symbols. In contract symbolic interaction theory addresses each of the^e issues. Miller's criticism of Freudian theory as confirming self-deceptions appears valid. Neither Miller nor Bradshaw present a theory which is completely helpful in describing and defining the inner child. The following section will describe the functions of theory in general and symbolic interaction theory in particular in relation to the concept of inner child. Symbolic Interaction and the Concept of Inner Chi Id Rychlak (1968) described four functions of a theory as the descriptive, delimiting, generative, and integrative functions. The descriptive function is to describe a behavior pattern in terms of a set of categories, labeled "constructs," selected to represent the sequence in question. One aspect of this function IS to explain behavior and to describe fully the conditions under which it presumably varies. Two other 32 aspects of this function are reducing propositions and constructs into simpler ones, and operationally defining propositions and constructs. The delimiting function relates to limiting the scope of theoretical constructs and propositions. The generative function indicates that a theory must stimulate or suggest constructs and relations between constructs which provide questions to be used in the pursuit of knowledge. The integrative function refers to the bringing together of theoretical constructs and propositions into a more or less consistent and unified whole, including the notion of interdependent unity (Rychlak, 1968). Symbolic Interaction Symbolic interaction theory places emphasis on interpretive and defining aspects of the human mind (Burr, Leigh, Day, & Constantine, 1979). From this perspective objective reality is experienced subjectively, thus individuals must be studied through subjective symbols. Symbolic interaction theory attempts to explain the conditions under which behavior varies by examining the subjective definition each 3.'^ individual gives a situation. With the emphasis on the subjective, the scope of theoretical constructs and propositions are delimited in such a manner that qualitative methods are often used in studies using this theoretical perspective. Symbolic interaction theory has generated much research especially on topics such as self-concept and roles. It is integrative in that it views the human mind in relation to the social self which is seen within the structure of society. Symbolic interaction theory stresses the inter re I atedne.ss of the personality of the individual with society. All behaviors reduce to the relationship between the human mind, social self, and the structure of society. The self is seen as separate from society, yet interdependent. The emergence of parts of self is stressed in relation to existing parts of self, and new role expectations. Symbolic interactionism is organismic. Individuals are seen as active in constructing their worlds. This theory always considers mental variables as intervening processes between external stimuli and behavior. Humans are seen to live in symbolic as well as physical worlds 34 Symbolic interaction theory is an idealistic theory in that reality is considered to be constructed, with the objective external world separate from the perception and cognition of the perceiver. Morrow (1986) suggests that symbolic interactionism offers a conceptual framework which might help in understanding factors related to differential effects of child sexual abuse on survivors. He suggests three aspects of symbolic interactionism as particularly helpful. These include (a) the stress on the importance of the individual's 'definition of the situation" in determining the effects of that situation on the individual; (b) the response or expected response of others as this influences how individuals perceive themselves; and (c) the notion that people are seen to assume roles in life and their behavior is in accordance with these role expectations. Symbolic interaction theorists have written a great deal about the self including: (a) describing facets or aspects of self; (b) explaining general perspectives of the development of the self; (c) placing the self in context of social interaction; and (d) describing roles 35 enacted by the self (Burr, Leigh. Day, & Constantine, 1979; Harter, 1983; Hewitt, 1989). If the inner chil'i is described as a. symbol of a sense of self developed during childhood, and. the principles and a^^sumptions y^^ symbolic interaction theory are applied to this description, then a greater understanding of both the development of the inner child and its place in the adult's life may be gained. The extensive works of Harter (1983), Burr et al, (1979), and Hewitt (1989) will be used to illustrate symbolic interactionist perspectives on the development of the sense of self which may form the basis for constructs of inner children. Harter (1983) conducted an in-depth review of the literature on the developing sen.se of self. She looked at constructs that could be meaningfully cast into a developmental mold m examining the developing sense of self. Harter's review included the writings of many of the founders of symbolic interaction theory such as James and Coo ley. Harter (1983) also discussed Laing, Erikson, Levinson, Gergen, and Sullivan. Burr et al. (1979) and Hewitt (1989) specifically reviewed literature describing assumptions 3 6 of symbolic interaction theory. Although Harter (1983), Burr et al. (1979), and Hewitt (1989) did not directly address the term inner child, much of what th,ev- discussed can be applied to the concept of inner fhild when it is defined as a sense of self. Table 2-1 summarizes the concepts to be presented in the following sect i o n ,s . Facets or Aspects of Self Multiple senses of self. One symbolic interaction assumption which may be related to the concept of inner child is the assumption that the self has several different parts. There is the physical self, as it relates to the body, and the social self, as it relat e <; to society (or other significant people). Authors of popular literature on the notion of the inner child suggest that each individual will have at least one wounded inner child and at least one ideal inner child. When the inner child is defined as a sense of self created during childhood, multiple inner children may be viewed as multiple senses of self. The notion of multiple senses of self is different from the diagnosis 3 7 of multiple personality in that an individual's senses of self will generally be blended into a unified whole where in the diagnosis of multiple personality disorder, different personalities are created which will to hide or protect other personalities which will not be uni f ied . Discussions of multiple selves generally focus on the "me", the social sense of self which others see in a social context, and the "I" a private sense of self (Hewitt, 1989). In discussing the adult self, James focused on the self as subject, the "I," and. the self as object or what is objectively known, the "me He further differentiated between the material "me," the social "me," and the spiritual "me." Mead also distinguished between the "I" (the unpredictable, spontaneous and unique aspect) and "me" (the roles individuals have and the stable aspects) parts of the self based on the ability to take the role of the other and view oneself from the standpoint of another (Burr et al., 1979; Hewitt, 1989). The inner child might be seen as a "me", what is known. The "I" knows about the inner child who was abused and acts in a manner consistent ;.^8 with a sense of self developed based on the abuse. The "I" also knows the inner child who acts in an achieving way to overcome or hide the abuse. Most attention has been devoted to the me," emphasizing how the social self emerges through interaction with significant others (Harter, 1983). The pioneers of symbolic interaction theory emphasized several different selves within a person and emphasized the development of self in relationship to others, especially significant others. The senses of self which become known to a person as inner children are formed based on interactions with others, generally significant others, in the child's life. The "me" is considered to consist of parts of the social self that are learned and repetitious (James, 1948), which are based on social roles (Hewitt, 1989). It is possible that a wounded inner child self with low self-esteem, would develop based on the repetition of a buse such as a sense of self as a victim or as a bad person for having participated in the abuse. An ideal inner child may be developed to try to hide or overcome 3H the low self-esteem by trying to make good grades and win awards throughout childhood and adolescence. Inte,Oration of senses of self. Another important aspect of multiple senses of self involves a. sense of unity among one's self-conceptions, a sense of continuity of these seIf-attributes over time, and ^ sense of mutuality between the individual's conceptions of the self and those that significant others hold of the self (Erikson, 1968). Several theorists have focused on the integration of such multiple selves (Harter, 1983). Adolescence appears to be a time of general movement toward the attainment of a relatively stable integrated identity (Erikson, 1968; Harter, 1983) . There are many individual differences in the path taken toward such attainment and also in the amount of integration of identity attained (Harter, 1983). The literature holds many clinical accounts of adults who seem unable to integrate their various se1f-definitmns into a unified sense of self, leading to problems in adulthood (Harter, 1983). Survivors are often unable to integrate the sense of self they would like to have with -10 the self who was abused. These senses of self, taking the form of inner children, may not be capable of integration. A lack of integration of key senses of self may be seen in differences in scores of perceived self-concept of different inner children such as a wounded inner child and an ideal inner child. Just as a lack of integration of senses of self are related to poorer personal adjustment, greater differences between self-concept of wounded and ideal inner children would be expected to be related to poorer personal adjustment The conflict between such multiple "me's" may be observed in the different roles one might choose to adopt in adulthood. People may adjust their behavior based on the specific nature of the interpersonal relationship and the situational context (Gergen, 1968), Potential hazards involve role confusion experienced when an individual is not able to select and integrate the roles the individual wishes to pursue. The senses of self, or inner children, that develop as a result of abuse may cause difficulty in choosing desired adult roles because of the need to attend to both the beliefs that the adult who has this wounded inner child is bad 4 I or deserving of abuse, which may be quite strong, and to the desire to deny such beliefs by enacting more ide^i r o 1 e .s . Subjective perceptions. Another assumption relaterl to facets of the developing self which might be applied to the concept of multiple inner children and differential outcome involves subjective definitions. A key assumption of .symbolic interaction theory emphasizes subjective factors in the idea that it is an individual's subjective definition of a situation that determines its impact on an individual's self-concept and behavior (Burr et al., 1979; Hewitt, 1989), This assumption is referred to as "Thomas' dictum. " It should be noted, however, that Thomas' statement referred to subjective meaning given in adjustment to an objective reality. This dictum would imply that an objective reality is experienced in a subjective manner as the individual's thought processes mediate the objective facts. This process might explain why similar situations (or the same situation within one family) may evoke different responses. Each individual present in a given situation, or similar situations, interprets the 42 situation subjectively, thus, an individual's view need not correspond to that held by others. Morrow (1-^6) also noted Thomas' notion that rival definitions of a situation may lead to disorganization and stres-^; Fmm a symbolic intera.ct ionist perspective individuals must be studied through subjective symbols. The inner nhild is a subjective symbol based on how a child perceives life's experiences. A potential hazard exists in the ability for individuals to misinterpret reality (Epstein, 1981). One's experiences are not the only factors involved in whether something will be assimilated into the individual's self-theory. The need for internal consistency and the need to maintain the organization of the self-system must also be considered (Epstein, 1981), In order to satisfy these conditions, at times it may be necessary to sacrifice empirical validity (Epstein, 1981). Empirical validity is defined as physical, verifiable facts of the situation. Sacrificing empirical validity might be seen as denying the facts of reality in favor of a notion which better fits with the individual's self-theory. The facts a person is willing 4 3 to accept about a situation will also be perceived differently if the organization of a self-theory is under stress and the organism's defenses are inadequate (Epstein, 1981). Sex abuse is a definite stress to the self-system. Children are not equipped with adequate defenses to cope with such abuse. Denial of the abuse or other changes in self often occur, sacrificing verifiable facts. Senses of self or inner children may develop whir-h do not necessarily correspond with the verifiable facts of a situation, or they may develop in order to deny or distort the verifiable facts that are at variance with self-theory. For example, a happy child with no perception of self as deserving pain and humiliation may form a sense of self as deserving the abuse despite the fact that the child did nothing to instigate such abuse. This sense of self may be represented as a wounded inner child. Or the child may develop a sense of self as happy or "perfect," ignoring the pain and trauma brought on by the abuse. This "perfect" sense of self may be represented as an ideal inner child. 44 Symbolic interaction theory stresses that the self has several parts, or multiple senses of self. Multiple inner children may develop based on the multiple sense of self such as a wounded inner child and an ideal inner child. Symbolic interaction theory also suggests that an individual's subjective definition of an experience will determine its impact on self-concept and behavior. General Perspectives on Development Self: Reflexivity, Indelibility. Affect Reflexivity; Several assumptions of symbolic interaction theory address general perspectives on the development of self. These perspectives include (a) reflexivity, (b) indelibility, and (c) affect. For example, the symbolic interaction assumption that humans are reflexive and that their introspection gradually creates a definition of self is helpful in guiding studies describing the concept of inner child when inner child is described as a sense of self developed during childhood and carried throughout life. In an initial, rudimentary differentiation process, infants begin to distinguish between what is self and what is nonself 4.n (Harter, 1983). The differentiation process mav break down in a child who is sexually abused as physical nnrt of others may become inappropriately mixed, in the child's mind with parts of the child's physical self. Such a child may develop an inappropriate sense of boundaries of the physical self as others behave in physically intimate and inappropriate ways with the child. IndelibiIity. The assumption that the human mind is indelible, integrating newly acquired meanings and values with existing ones, can also be applied to the concept of inner child. The sense of self formed as a sexually abused child does not disappear but is added to. Thus, the wounded child self exists alongside an ideal child self. The child may see self as a victim. yet also develop an ideal sense of self who tries to overcome the abuse by being good. Affect. Another issue addressed by symbolic interaction theory which is related to the concept of inner child is the issue of affect. Emotions aroused during the self-evaluative process are critical to the sense of self (Harter, 1983). From a symbolic n interactionist perspective, emotions are considered to be directly related to behaviors (Epstein, 1981; Harter, 1983; Horney, 1945; Lynch, 1981: Sullivan, 1953) Feelings of worry and shame are noteworthy in light of this observation (Harter, 1983). The affective reactions that the judgment of others arouse in the self eventually become incorporated into the self in the sense that they are evoked by the "'I'" ' s judgment nf the "me." Thi.s proces.s may begin by age eight or earlier when the "I" appears to be able to observe others, observe the "me," and to compare others with "me. " It is about the age of eight when children begin to describe feeling proud or ashamed. The sense of shame involved in child sexual abuse is often carried with the individual throughout life in the form of seIf-judgment of the inner self or inner child. Individuals tend to display a need to avoid anxiety aroused by threats to one's self-esteem caused by peje,-.t ion or negative evaluation by others (Sullivan, 1953). Horney (1945) stated that self-demeaning feelings are the cause of anxiety. She believed that to cope with such anxiety, an individual will construct an 47 idealized image in an attempt to enhance self-esteem. Survivors experiencing anxiety may construct an idealized image such as the idealized inner child described by Bradshaw. Self-concept may be viewed as a set of rules for processing information that in turn regulates behavior (Lynch, 1981). Lynch (1981) examined the affective consequences for the child when rules about the self are not validated. These included frustration, anxiety. aggression, and apathy. According to Lynch (1981), such effects may eventually lead to alterations in the self-concept, A change in self-concept may occur based on abuse. For example, a survivor may have developed a certain sense of self as a good, happy, loved child. This sense of self may be invalidated by the painful experiences of sexual abuse, A negative sense of self or inner child may develop during the abuse forming multiple senses of selves or inner children. An inner child based on a sense of self which developed during a period of sex abuse does not disappear but is added to. Another way to view the importance of affeet is that an individual's goal is to optimize the 4H pleasure/pain balance and maintain self-esteem (Epstein, 1981), A child observes threats to the sense of self as the cause of pain, and such feelings of pain a^e perceived as "something in the body that appears to have an identity of its own" (Epstein, 1981), This might be represented in the wounded inner child. The self is not only defined by its constituent components and the emotions they arouse but behaviors are important as well, especially the self-seeking and self-preserving acts related to emotions (James, 1948). Behaviors may be developed to avoid anxiety or pain (Epstein, 1981; Sullivan, 1953), Individuals, children in particular, often behave in order to obtain the approval and satisfaction of the significant others m their lives based on the values they have incorporated from them (Sullivan, 1953). Sullivan (1953) believed that children have senses of self representing the "good me" and the "bad me." Children's behaviors are then directed toward adhering to the "good me" in an attempt to avoid anxiety. The "good me" could be termed the ideal inner child, and the ""bad me" could be termed the wounded inner child. 49 Affect has been theorized to be related to sense of self and thus behavior. People have a need to avoid anxiety which effects self-concept and behavior CHarter, 1983). Behaviors are associated with feelings, especially self-seeking and self-preserving acts related to emotions (Burr et al., 1979; James, 1948; Sullivan, 1953), Lynch (1981) addressed problems which occur when a set of rules about self are not validated. These problems include frustration and anxiety. Childhood sex abuse causes pain, anxiety, and invalidation. -At least two different inner children based on senses of self, a wounded inner child with a low se1f-concept, and an ideal inner child with a much higher self-concept will develop within a survivor. Self in the Context of Social Interaction: Expectations and labeling^ An area of interest which has received less attention than the general development of self is that of self in relation to others. A key assumption of symbolic interaction theory is that all individuals exist within a social context and that society is a 50 determinant of behavior (Burr et al., 1979; Hewitt, 1989; James, 1948). James conceived of the individual as comprised of several social selves which are based on their relationships with others, and stressed the social sources of self-esteem (Meltzer, Petras, & Reynolds, 1975). Included in social aspects of the self are expectations others have of one, and the labels others use in describing one's behaviors. Expectat ions. Charles Coo ley elaborated on James' ideas of the individual in relation to society, developing the concept of the "looking glass self" (Burr et al., 1979). The looking glass self comprises the expectations others have of an individual, or the expectations the individual imagines others have of the individual, and these expectations effect the development of the self as a social product. Cooley elaborated three components of this self: (a) the imagination of one's appearance to the other; (b) the imagination of that person's judgment of one's appearance; (c) and some sort of self-feeling such as pride or mortification. Survivors often develop a strong sense of shame especially in regards to sexual .". 1 behaviors which may be related to the perceived judgment from others of the original abuse. Such a sense of shame might have been internalized, leading to development of an inner sense of self as bad for participating in the abuse. This might be labeled a<=: a wounded inner child. Cooley considered some, more intimate groups, to have a more powerful influence on the 1 nd i V idua, I ' s evolving self than other, le^s intim?\te groups. Regarding self-concept and society, Kinch's ( i MH.'^ ) formalized symbolic interactionist view of the self-concept can be summarized into the following propositions: (a) the individual's self-concept is based on that individual's perception of the v%ay others are responding to the individual; (b) the person's seIf-concept functions to direct that person's behavior; (c) the individual's perception of the responses of others toward that individual reflects the actual responses of others toward the person; (d) the way the individual perceives the responses of others toward self will influence the individual's behavior; (e) the actual responses of others to the individual will determine t ht- 52 way the individual views self: (f) the actual responses of others toward the person will effect the behavio'^ of the individual; (g) the behavior that the individual manifests influences the actual resnon'^e'=; of others toward that individual. La be I i ng , Socializing agents effect not onlv- behavior and self-concept but the socializing agents' labeling of a. child's behavior becomes a source of seIf-description (Harter. 1983). Children come to learn self-labels and to identity their feelings and attitudes by observing self-behavior and applying the appropriate se I f — descr iptor s much in the sa.me way others would, describe the same behavior (Bem, 1967). Because the individual ha.s .sole access to a personal history whif^h others do not have access to, differences may exist between one's self-perceptions and the perceptions others hold about one. Survivors often harbor secrets about their past which may lead to perceptions of self of which others are not aware. A survivor may have developed a sense of self as hurt, sad, abandoned, and undeserving of love. These feelings may become part of a wounded inner child. In an attempt to overcome these 5 3 negative feelings and hide this inner child, the survivor may chose the role of overachiever in an attempt to earn love. Society may see what appears to be a confident achiever, not knowing about the abu-^^e or the wounded inner child. Di fferent iat ion . One prevalent theme which er^er.^es in the literature of self in relation to others involves the differentiation of self from others. Aceording to Harter (1983), Piaget's findings reveal that a feature of preoperational egocentrism involves the young child's assumption that others are aware of the child's thoughts and dreams. Research has revealed that young children must learn to differentiate their emotional reactions from those of others, and that with age, children learn to differentiate, with increasing realism, their own emotions from events that provoke feelings in others (Harter, 1983). As this happens, children learn that rather than assuming that they are the causes of ?> 1 1 parental emotions, adults have feelings which are independent of the child and the child's actions. When a child is sexually abused, however, a blurring of boundaries often occurs and the perpetrator's labeling 5 4 of the event creates confusion and distress. For example, the perpetrator may tell the child something like, "You want this," which conflicts with the child's self-perception and hinders the child's differentlatlo n p r o c e .s s Bannister and Agnew (1977) conducted a study in which adults were asked to describe how as children thev became aware of themselves. Several themes emergt^d including a sense of causality and control, an understanding of the difference between one's own possessions and those of others, and the awareness of how other.s perceived them, A child's sense of control may be disrupted when sex abuse occurs since the child has no control , Awarenes.s of how others perceive the child may also become confused. Perpetrators often make statements to a child which are contradictory to what the child believes or to the way the child perceives the situation. Also, should the child try to tell others about the abusive situation, the child is often not be I ieved ( i , e , , "You 're lying .'" ) which m ight 1 ead to t he belief that all adults believe the child is lying resulting in deep confusion about oneself. A child will also develop a sense of self based on the child's perceptions of others' attitudes about the child and the abuse. For example, adults often react with anger when they are informed of possible abuse. The child will often assume the anger is toward the child and develop a sense of self as bad or deserving of such anger. Thus, labeling and the failure to label ("I'm angry at the situation, not at you. " ) give rise to conflicting image*^ of the self and difficulty in differentiating self from others and self from others' views of self. Such negative images from others may add to an existing wounded inner child or emerge as a wounded inner child The process of differentiation from others does not always go smoothly. For an individual confused about identity, any physical closeness with either sex brings about both a desire to merge with the other and a conflicting fear of losing autonomy (Erikson, 1968). Survivors of childhood sexual abuse are likely to be confused about their identities because of the difficulty in integrating the sense of the self who experienced the abuse with the self the individual desires to be and the self as described by others. An 56 individual confused about identity may feel a sense of engulfment at the thought of interacting with others (Laing, I960) and may defend against feelings of engulfment by isolating the self from others (Erikson, 1968; Laing, 1960). Survivors often experience a sense of isolation if not actual physical isolation (Brunngraber. 1986; Fromuth, 1986; Wheeler & Walton. 1987) On the other hand, individuals who have not developed an integrated sense of identity may seek a sense of identity through sexual interactions (Erikson, 1968). One characteristic often found among survivors IS difficulty with sexual relationships ranging from sexual promiscuity to avoidance of sexual intimacy (Beck fk van der Kolk, 1987; Brunngraber, 1986; Feinauer, 1989; Fromuth, 1986; Roland et al., 1989; Rowe & Savage, 1988; Wheeler * Walton, 1987). To summarize, society plays an important role in the development of senses of self. Others in a individual's social environment, especially significant others, affect an individual's behavior, self-concept, and self-description. One important theme which emerges 57 in the literature of self in relation to others involves the differentiation of self from others. It is therefore expected that others in a child's social environment, especially significant others, will affect the child's developing senses of self and thus the inner children based on these senses of self. Roles Enacted bv the Self Another symbolic interaction area applicable to the concept of inner child as well as to outcome of child sex abuse involves roles. Role enactment, role strain, and role transition, several propositions of symbolic interaction theory can be applied to further explain the concept of inner child and differential outcomes of child sex abuse. The following definitions are from Burr et al. (1979). A role is defined as a set of prescriptions defining what behavior a person occupying a particular position should perform. Role making is described as improving, exploring, and judging what is appropriate on the basis of the situation. Role enactment refers to how one performs the role. Role strain refers to the amount of stress an individual feels internally when the individual perceives difficulty in fulfilling role obligations. Role transition refers to the ease or difficulty of moving into and out of social roles. Role consensus is described as the amount of agreement about role expectations. Role congruence is the compatibility among roles. Role diversification describes the amount of incompatibility between roles. Low role consensus low role congruence, and high role diversification will all contribute to role strain (Burr et al., 1979). Several propositions from Burr et al. (1979) wb.ieh are useful in guiding studies of adult survival of child sexual abuse include the following. (a) The more important a role (or role expectation) is to an individual, the greater the effect role enactment has on that person and the greater the ease of transition into that role. (b) The amount of consensus, or the extent to which different individuals involved in the situation agree, on relevant role expectations in a relationship influences the satisfaction with the relationship and lessens role strain. (c) The greater the perceived clarity of role expectations, the higher the quality of D H role enactment, and the less role strain. (d) The greater the self-role congruence, the higher the quality of role enactments, (i.e,, the goodness of fit between the individual and the role, whether the individual seems to like the role, and is involved in and committed to that role). (e) Sanctions influence role enactment, (i.e., the greater the perceived reward, the less the role strain.) (f) The greater the diversification of a person's role.s, the less consen,sus the per.son will perceive in the expectations about those roles, and the greater the role strain, (g) With some exceptions, the greater the role incompatibility the greater the role strain. (h) The greater the perceived role strain that results from performing a role, the less ease in making the transition into a role. Role strain. Role strain for a sexually abused child may be high both as a child and later as an adult. A female may fulfill the roles of sister, daughter, student and many other roles. The sexually abused child is coerced by the perpetrator to enact a sexual role with the perpetrator which is inappropriate. This inappropriate sexual role is probably very important to 60 the child, though very painful, for many reasons. The role is important because it is most often enacted with a significant person in the child's life. If the child is threatened, the role may be perceived as an important form of protection in that, if the child does not perform this role, the harm may be worse. It may also be that the child perceives this role as a way to earn I ove . One contribution to high role strain is role consensus which may be low when involved individuals view the child's role differently than the child does. For example, a significant adult in the child's life who is not a perpetrator may see the child's role as that of a happy daughter, while the perpetrator may see the child's role as that of a sexual partner. Or the perpetrator may view the child's role one way in front of others and another when alone with the child during the abuse. Such mixed expectations would lead to lack of role clarity, increasing role strain. This lack of clarity would also make it difficult for the child to enact different roles. Different senses of self may 61 develop based on different role expectations which may be symbolized as different inner children. Self-role congruence may be low for the sexually abused child which will also contribute to high role strain. Children may feel committed to the role as a form of protection against further abuse or as a wav to earn love and attention. Perceived sanctions will also affect role enactment and role strain Per ce i ved sanction.s for the role of abuse vary greatly depending on the circumstances. Some children receive rewards of money, food, or other gifts. For many children the perceived reward is self-preservation, since they may believe that the perpetrator will not otherwise harm or kill them if they cooperate. Another perceived sanction involves the attention received from a significant other in the child's life, especially if the perpetrator only pays attention to the child during acts of sexual abuse. Role diversification may be high for a sexually abused child, leading to low role consensus and high role strain. Most of society will see the child as a child. Siblings may see the child as a protector or 6? role model. A parent may see the child as a "helper." The perpetrator sees the child as a sex partner. Role strain will be high as the child is confused about which role is to be enacted at which time. High role strain and low role consensus may lead to the development of multiple senses of self, thus multiple inner children. A particular inner child may develop based on one sense of self which is different from other senses of self. For example, a sad wounded inner child may develop as a symbol of the role enacted during the abuse which may differ from the sense of self as a happy child in other contexts. Imp Ii cat ions. It deserves mentioning that symbolic interaction theorists recognize that the influence on an individual's self-concept by significant others in that individual's life is greater than that of others in general. Morrow (1986) noted that symbolic interactionist theorists have suggested that the greater the perceived value of the relationship between an individual and another, the greater the influence of the other's responses in defining the individual's self-ima^e. Morrow (1986) also stated that individuals are more likely to incorporate into themselves the roles by which significant others identify them. Ba^ed on these suggestions, it is expected that the role a child must enact during the sex abuse by a significant other will have an important and lasting impact on the child's sense of self as well as roles enacted later in life. Inner children may develop based on the roles enacted as children that influence the sense of self. The symbol of an inner child is more than just another role, however. Several roles in adulthood may he based on one inner child symbol. For example, a wounded inner child symbol may lead to roles related to being a virtim including working for an inappropriately demanding or abusive boss, being married to an abusive spouse, and/or being parent to an abusive or domineering child. In summary, an important issue in symbolic interaction theory involves roles, including role enactment, role strain, and role transition. Many of the roles a child is coerced into enacting during sex abuse situations may lead to role strain. Role strain is the amount of stress an individual feels when the individual perceives difficulty in role enactment. Role 64 strain is also related to the fact that different j-ier^nle involved in the sex abuse and other aspects of the child's life may view the child's role different Iv- triMn the child does. Different roles or experiences in childhood lead to the development of different inner children. Several adult roles may be based on each different inner child. Disparities between inner children and between roles enacted, may be related to a.djustment problem.s. Issues involved in the abuse and the people involved effect the self-concept of the child being abused, thus the inner child developed based on the abuse. The perceived self-concept of the inner child developed at that time, in turn, will affect adult roles and adult adjustment. Although the concept of wounded and ideal inner child has not been studied empirically, several a'=;nerts of symbolic interaction theory help in understanding the concept of inner child. As reviewed, these were: facets or aspects of self; general perspective on the development of self such as reflexivity, indelibility and affect; self in context of social interactions including expectations and labeling; and roles including role strain. Summary of Theories of Inner Child Authors of self-help books have attempted to describe the process and content of the concent of the inner child, yet no clear definition has been presented to date in that literature (Abrams, 1990; Bradshaw, 1990; Miller, 1981). Miller (1981) initially suggested Freudian theory as a guide to understanding the development of the inner child because of Freud's emphasis on the effects of experiences of early childhood on adult life. She later broke away from Freudian theory, denouncing it because of Freud's belief that early childhood sexual trauma was fantasy. Miller (1990) noted that this belief in early sexual trauma as fantasy undermined the survivor's attempts to accept, understand, and overcome the trauma of childhood sex abuse. Although Miller continues to employ the concept of inner child work as important in working with survivors of childhood trauma, she does not put forth a n n coherent definition of inner child, nor provide a theoretical basis for the concept. Bradshaw (1990) suggested Jungian theory as a guide to understanding the concept of inner child. He suggested that the inner child is similar to the child archetype described by Jung. Jungian theory, however, does not address how the child archetype is developed nor describe the content of the child archetype. For these reasons Jungian theory is not considered an appropriate theoretical basis for the concept of inner child. Symbolic interaction theory addresses these shortcomings of the theories currently suggested in popular literature and leads to testable hypotheses concerning the inner child. In the popular literature reviewed for this project, authors (Abrams, 1990; Bradshaw, 1990: Miller, 1981) agreed that inner child work is a process through which survivors can get in touch with repressed feelings and memories of the early traumas of childhood sex abuse. In this project, symbolic interaction theory has been applied to the concept of inner child to further the understanding of the development and content nf the inner child. Symbolic interaction theory addressee (a) facets and aspects of the self, (b) general per ^nec t i vec; on the development of self, (c) the self in the context of social interaction, and (d) roles enacted by the self. When inner child is defined as a symbol of a sense of self developed during childhood, symbolic interaction theory, as it applies to self, helps to further understanding of the development of inner children. Symbolic interaction theory also applies to the literature on differential outcomes and adjustment in survivors of childhood sex abuse. Symbolic interactionism supports the existence of multiple senses of self or multiple roles and the existence of multiple inner children which have been described in the literature (Bradshaw, 1990; Burr et al., 1979; Harter, 1983; Hewitt, 1989; Miller, 1984), The self-help literature agrees that within each survivor there exists both a wounded inner child as well as some form of ideal inner child. These inner children represent opposing feelings and perhaps opposing experiences leading to tension within the survivor. Several theorists and therapists (Burr et al., 1979; 68 Duval & Wickland, 1972; Kohut. 1977, 1980; Rogers, 1961) have addressed the tension, stress, and. anxiety cr<^ate" when there exists within a person multiple senc;es of self representing opposing emotions. The theories; concerning incongruences among senses of self or roles will be discussed in the following section. Theories of Disparity Within the Self Disparities between roles. Symbolic interaction theory addresses disparity within the self in terms of role theory (Burr et al., 1979). As discussed in the previous section, different roles will reflect different inner children. When exploring the role to be enar^ted, a survivor will judge one type of behavior as appropriate in a situation which evokes feelings based on the wounded inner child who feels bad about self, and another type of behavior as appropriate in a situation which evokes feelings based on the ideal inner child who feels good about self. For example, when entering an intimate situation which evokes feelings of shame experienced by the wounded inner child, the survivor may deem withdrawal from the situation as the appropriate >~) !-i role or behavior. However, when faced with an upcoming athletic competition which evokes feelings of pride at winning experienced by the ideal inner child, the survivor may deem active participation as the appropriate role or behavior. Role strain is the amount of difficulty felt m fulfilling the obligations of roles (Burr et al., 1979) and as such involves cognitive strain and emotional distre.s.s. The greater the disparity between roles, the greater the difficulty felt in trying to fulfill multiple roles. High levels of role strain will lead to feelings of considerable guilt and anxiety about not being able to perform the behaviors judged to be appropriate for the situation (Burr et al., 1979), When a person is not well suited to a particular role, such as when the role violates self-conceptions or values, the role may require behavior which the survivor regards as wrong for the self. Burr et al. (1979) noted that such extreme incongruence between beliefs about self and role expectations creates severe psychological effects such as somatic dysfunction, a lack of concentration, anxiety, and guilt. Burr et al. (1979) further posite.i 70 that the more an individual perceives roles as incompatible the greater the role strain, and the greater the psychological dysfunction. Such problems a <=; anxiety, depression, low self-esteem, and relationship problems, as are often found among populations of survivors, are then outcomes of role strain. Behaviors related to disparity. Role strain leads to behaviors directed at resolving the cognitive role strain (Sarbin & Allen, 1964). Such behaviors may include compartmentalizing behavior, changing feelings, changing beliefs, using tranquilizers, and other methods. They suggested that a role may continue for a period of time without disruption, and that it is only after attempts to reduce role strain through such methods have failed that the behavior involved in the role may be altered. Such alterations might appear, for example, in a situation where a young girl turns to alcohol to numb the physical and emotion pain of the abuse in an attempt to reduce the cognitive strain she experiences. Because the alcohol succeeds in reduein^ the strain, the abuse may continue even into the survivor's adult life as she continues to inter^c^ with 7 1 abusive people and continues to drink to numb her feelings. Symbolic int eract ioni st s believe that exper i ^=-nee "^ are evaluated according to actual, perceived personal sensations as well as through the influence of others' perceptions (Burr et al., 1979; Hewitt, 1989; Rogers, 1961). Rogers (1961) gives an example of a young boy discovered fondling his genitals. The boy may evaluate the personal, perceived sensation as pleasure at the touch. If a significant adult in the child's life discovers him fondling his genitals and admonishes him, calling him bad for such behavior, an uncomfortable discrepancy is created between the child's physical sensation and the significant other's evaluation of the situation. Rogers (1961) suggested that the individual will seek to reduce the discrepancy. Attempts at reducing the discrepancy may involve distortion or misperception of the child's own perception of the exper i ence. People have both an ideal self they strive to live up to, and a real self based on their perceptions of realitv (Duval & Wicklund, 1972; Rogers, 1961). Popular 79 literature suggests that survivors have multiple inner children, at least one wounded inner child based on the child's perception of the abuse, and one ideal mne- child (Bass & Davis, 1988; Bradshaw, 1990; Miller 1981). When discrepancies occur between the real-self and the ideal self, or between wounded and ideal inner children, tension occurs (Duval & Wickland, 1972). Such tension leads to changes in attitudes or behaviors with attitudes most likely to change. Individuals will attempt to reduce the discrepancy or avoid awareness of it (Duval &. Wicklund, 1972). The literature reviewed suggests that a wounded inner child will develop representing the real self which is based on the individual's perceptions of the abuse. An ideal inner child will develop representing the ideal self to which the individual strives. Roles will evolve based on the wounded inner child as well as on the ideal inner child. Discrepancies between these roles will contribute to role strain. Discrepancies between the wounded inner child and the ideal inner child and the roles based on each will lead to (a) tension within the self creating a need to change some 7 p. roles or change one's attitude about the roles one enacts, (b) a need to avoid situations which remind one of the discrepancies, and/or (c) behavior which will numb or repress awareness of the discrepancies. Thus it would be expected that difference scores between the perceived self-concept of a wounded and an ideal inner child would be related to adjustment, including adult adjustment. Summary and Overview of the Literature Although the concept of inner child has not been studied empirically, differential outcomes in adult adjustment following child sex abuse have been investigated. Negative psychological effects related to discrepancies between senses of self has received much attention in the literature (Duval & Wickland, 1972; Kohut, 1977, 1980), but has not been empirically studied with respect to manifestations of the inner child. Symbolic interaction theory is helpful in both explaining different outcomes of child sexual abuse and in developing a coherent theoretical definition of inner child. Svmbolic interaction theorists identified several senses of self of individuals which may be equivalent to the concept of different inner ehildren, as discussed in the popular literature. Persons may develop inner children based on senses of self developed during childhood. The self-help literature on inner children discussed each individual as having at least two inner children, a wounded inner child and an ideal inner child. Attached to each inner child are feelings which develop into roles enacted as children and adults. The wounded inner child may be associated with feelings of shame, guilt, anger, fear, insecurity, lack of trust, low self-esteem, abandonment, and others. Such negative feelings may be related to victim type of roles such as becoming involved in an abusive relationship, working a low status job, promiscuous sexual behavior, self-injurious behaviors including the role of addict, or suicide attempts. The ideal inner child may be associated with feelings of pride, positive self-esteem, power, control, security, and others. These positive feelings may be related to achievement oriented roles such as a high status jobs, higher education degrees, 7 5 highly approved of relationships, award winning attainments, and others. From a symbolic inte^artion perspective, several factors will affect the amount of disparity between the wounded inner child and the ideal inner child including (a) severity of abuse and (h) perceived negative evaluation or blame from others. As a practical matter, therapy may also alter the disparity between a wounded and ideal inner child. Symbolic interaction theory suggests that the greater the disparity between senses of self and the roles enacted, the greater the strain and negative effects experienced by an individual, The greater the disparity between seIf-descriptions of a wounded inner child and an ideal inner child, the greater the experted negative outcome and problems with adjustment in the adu1t survivor. Hypotheses Individuals have multiple senses of self. Based on senses of self developed in childhood, at least one wounded inner child (based on negative experiences in childhood) and one ideal inner child (developed to 76 overcome or avoid the pain and anxiety of the wounded inner child) will develop in individuals who suffered sexual abuse in childhood. Based on the^e assumption^ the first hypothesis to be tested is: (1) Wounded inner child self-concept scores will be s igni f icant 1 >- lower than ideal inner child scores of self-concept. Discrepancies between wounded and ideal inner children (defined as senses of self developed in childhood) leads to role strain and distress. Thus the second hypothesis to be tested is: (2) The greater the disparity between self-descriptions of a wounded inner child and an ideal inner child, the less the adjustment in adulthood. Several studies have shown a relationship between severity of sexual abuse experienced in childhood with adult adjustment. Since wounded inner children ar^:^ based on the experience of the abuse, the more severe the abuse, the lower the perceived self-concept of the wounded inner child. And the more severe the abuse, the greater the disparity between the wounded and ideal inner child reflecting the difference between the nainful existence of the wounded inner child and the 77 image of the ideal inner child to which one aspires. Severity of abuse, wounded inner child self-concept, and disparity of self-concept of wounded and ideal inner child, will be related to a lack of adjustment in adulthood. Based on these hypotheses, an overall model as presented in Figure 2-1 will be tested. Table 2-i. Applications of Symbolic Interaetinn Thenrv A^^ S ^S Um 1 I f 1 (I ri v; - - ---_J.--__^ — --1 About Self to the Concepts of the Wounded Inner ^^hi and the Ideal Inner Child symbol i c Wounded Inner Ideal Inner Interact ion Chi Id rhi Id The self has At least one An ideal inner several parts wounded inner child will child vv 1 1 1 develop based exist ba sed on a sense of on a sense of self in relation self developed to a desire in relation to to overcome the act u. a I abuse. or hide the abuse. Humans are reflexive. .\ wounded An ideal inner 1nner child as child as the V 11.'t 1 m may be '• favor i te " may formed base Humans are The wounded An ideal inner indeIible. sense of self chiId based integrat ing developed as a on a sense of newl y sexua I ly self attempt ing acquired abused child to overcome meanings and does not or deny the values with disappear but abuse does not existing ones IS added to. d i sappear 7q Table 2-1 continued SymboIic Wounded Inner Ideal Inner Interaction Chi Id Chi Id but is a d d e d t o . Behaviors are Chi Idren Children develop often related develop a an ideal inner to affect and wounded inner child based on may be eIic i ted ch1 Id based a sense of self by the necessity on a sense of represent ing t o avo id such self representing the "good me" feeIings as the ""bad me' which may be anxiety. which may be relat ed t o relat ed t o denying or fee 11ngs of overcom ing worry, shame, fee Iings of and anxietv. worry, shame, and anxiety. Expectations A vvounded An ideal inner that others have Inner chiId chiId may of an individua i may deveI op develop based affect the based on on the social development of the social be Iief that self as a social t">e 1 1 e f t ha t a child is product . a girl IS good for doing bad for such good things being involved as earning in sexual good grades a c t i V i t v . in an at t empt to hide the abuse. Socia1iz ing A wounded An ideal inner agents' labeling inner chiId chiId may of a chiId's may be based be based on behavior becomes on negative positive labels a source of 1 abe 1s the such as "good self-descriptions perpet rat or student* social ca11ed the agents give 80 Table 2-1 continued Symbo1ic Wounded Inner Idea I Inner Interaction Chi Id Chi Id <^hi I d dur ing t he child the sex abuse out side of the abusive sit ua t ion. Each person Each survivor Each survivor enacts several will have will have roles. at least at least one wounded one ideal inner chiId, I nner chiId. RoIes enact ed A sad inner A happy inner influence sense child may chi1d may of self. develop based develop based on the role on the roles enacted during enacted in t he abuse. an at t empt to hide or overcome the abuse. 81 c o 09 I "3 so H o o 0) c o Q) 0) 0) o u 3 > CO CHAPTER III METHODS Procedures Part icipant s The participants were 34, female, adult (18 years of age or older) survivors of child sexual abuse, who were currently in or have been in therapy with a therapist who helps survivors become familiar with their inner children. Clients of the therapists who were male, or under the age of 18 years, or were not survivors of childhood sexual abu.se were excluded from this project. Approximately 100 i."^ackets were distributed to therapists in three different states who specialize in inner child work with sex abuse survivors. Therapists who use inner child work were contacted to identify participants. The contact was in person when possible and by phone followed by mai1 if it was not possible to contact them in person. A few packets were also left in the Human Development Family Studies office at Texas Tech Universitv and students in a few classes were 82 83 informed of the project and asked to take a packet if they chose to volunteer. The purpose, theoretical background, and procedures were explained to the therapists. Therapists were asked to distribute packets to their clients who volunteered to participate in the study. Two therapists volunteered to send packets, along with a personal letter, asking current and previous clients to consider participation. The packets contained the questionnaires, stamped envelopes addressed to this researcher, instructions to (a) complete the information anonymously, and (b) return the packet in the envelope included. Clients were assured that the information completed on the questionnaires would be kept confidential and returned directly to this researcher. Therapists were assured that this study should not cause any damage to the participants. Therapists were, however, asked to read through a blank copy of the questionnaire in order to be prepared in the unlikely event that completing the questionnaire triggered emotional turmoil in one of their clients. 84 Following completion of the study, copies of a summary of the findings will be sent to each participating therapist to be distributed to each participant who would like one. Most of the information gathered in this study used optical scan computer sheets. This involved blackening in circles with a pencil. Texas Tech pencils were provided as keepsakes. A total of 36 women responded by mailing the packet to this researcher. Two of the 36 respondents failed to complete the questionnaire. One of these two stated that it was too painful to complete and the other stated that it was too long to complete. Of the 34 who completed the questionnaire, all reported having a wounded inner child and completed information on a wounded inner child. Thirty reported having an ideal inner child, but only 27 completed enough of the information requested on the ideal inner child to be calculated in the analyses. These numbers suggest that survivors who have participated in therapy involving inner child work recognize a wounded inner child, and that most recognize an ideal inner child, although perhaps with less clarity. 8 5 Respondents ages were very evenly distributed between the ages of 18 and 57. Two participants were also in the 58 or older category. The majority of participants were currently married or involved in a significant relationship. The majority of respondents were heterosexual, with a few reporting other sexual preferences. The majority of respondents were white and protestant, The reported financial situation of the family of origin was evenly distributed among the categories of ""not at all well off", "less than well off", and "comfortable". The participants as a whole were well educated with most having some college. Approximately half of the respondents were unemployed/students or homemakers and slightly less than half were manager/professionals. The demographic description of the participants in this project is presented in Table 3-1 Measures Several measures were used to gather information for this study. Background information concerning basic demographic information was gathered. Open-ended 86 questions concerning inner children were also asked. A structured inner child measure, the Song and Hat tie Inventory (SHI), was used to measure the perceived self-concepts of wounded and ideal inner children. Measures of adult adjustment included the Rosenberg self-esteem scale, the Beck depression inventory, and the Beck anxiety inventory. Information concerning aspects of the childhood abuse were gathered through a questionnaire created for this study. Several of these aspects were combined to form a scale termed "severity of abuse". Other information concerning aspects of the abuse which were not included in the severity scale were treated as abuse background information. Back.^round information. A set of questions designed for this study gathered background information (see Appendix A), including participant's age, ethnic background, and religious preference. Information about the participant's family of origin was gathered including birth order, number of siblings, and childhood financial status. Another group of questions involved current family of procreation status and included marital status, number of children, and current family 87 financial status. Other questions addressed participant's primary occupation and schooling status. Open-ended questions. In order to help orient the respondent toward and clarify images of a wounded and an ideal inner child before answering questions regarding the self-concept of each, an example of each type of inner child was given followed by open ended questions. The open-ended questions provided descriptive language for the discussion of wounded and ideal inner children. Four open-ended questions were included on the questionnaire with regard to a wounded inner child as well as four additional questions with regard to an ideal inner child. These questions were: (1) What do you call your wounded inner child? (2) Approximately what age do you believe your wounded inner child is? (3) Describe the physical characteristics of your wounded inner child including such aspects as hair, eyes, expression, clothing, etc. (4) State three emotions your wounded inner child experiences. Participants were asked to answer to these open-ended questions on paper provided. All 34 respondents 88 reported information on at least one wounded inner child and 30 reported information on an ideal inner child. Son.g and Hat tie Inventory. Participants were asked to complete the Song and Hattie Inventory (SHI) under two sets of instructions. One set asked for responses for their wounded inner child and the other set asked for responses for their ideal inner child. The Song and Hattie instrument was derived from a specific theory about the dimensionality of self-concept (Hattie, 1992). Hattie (1992) suggested that self-concept involves a set of beliefs that are hierarchical, multifaceted. and latent. He further posited that self-concept can guide, mediate and regulate behavior in various social settings. The Song and Hattie inventory is a papei—and- pencil questionnaire which contains five items for each of seven dimensions for a total of 35 items. The items are answered on a 5 point scale from strongly agree to strongly disagree. The seven dimensions include: (a) classroom self-concept, (b) achievement self-concept, (c) ability self-concept, (d) peer self-concept, (e) family self-concept, (f) confidence self-concept, and 89 (g) physical self-concept. All 35 items are added for a total self-concept score. The reported estimates of test-retest reliability for each scale are: (a) classroom r. = .64, (b) achievement r. = .69, (c) ability £ = .70, (d) peer r_ - .69, (e) family T_ = .80, (f) confidence n = .60, (g) physical r_ - .78 (Hattie, 1992). The reported estimates of internal reliability for each scale are: (a) classroom a = .78, (b) achievement a = .94, (c) ability a = .89, (d) peer a = .85, (e) family a = .78, (f) confidence a = .68, (g) physical a = .76 (Hattie, 1992). A study designed to select items that maximized reliability and convergent validity also maximized divergent validity and were unifactorial (Hattie, 1992). The convergent and divergent validities were determined using an original 211 items, by dividing each scale into two random groups and then assessing intercorrelations within and between scales. The number of items per scale were then reduced. After comparing the Song and Hattie test to two other common test of self-concept, Purdie (cited in Hattie, 1992) concluded that the tests are measuring similar underlying dimensions. 90 Difference between wounded and ideal inner child self-concept. Difference scores were calculated by subtracting the scores of wounded inner children on the Song and Hatti inventory (SHI) from the scores of the ideal inner children on the same measure for each individual. Because for each participant the wounded inner child score was lower than the ideal inner child score the use of absolute values was not necessary. The mean difference score was 46.98 with a standard deviation of 28.84. The Rosenber.^ self-esteem scale. A nine-item, paper and pencil version (Payne, 1987) of the Rosenberg self-esteem scale (RSES) (Rosenberg, 1965) was used to indicate current level of self-esteem in adulthood. Items are answered on a 5-point scale from never to almost always. In discussing internal consistency, Wylie (1989) reported numerous alpha coefficients for the Rosenberg self-esteem scale ranging from .72 to .87. Wylie (1989) further reported three test-retest reliability coefficients of .85, .63, and .91. Wylie (1989) also reported that when items have face validity for measuring the intended construct, the Coefficient of 91 Reproducibility for Guttman-scale scores for satisfactory reliability is usually considered to be a minimum of .90 and that the Rosenberg self-esteem scale showed a score of .92. Convergent and discriminant validity are also reported to be good (Wylie, 1989). Beck depression inventory. The Beck depression inventory (BDI) (Beck, 1967) is a 21-item, paper-and- pencil questionnaire with multiple choice responses to select. This measure was used to indicate current level of depression in adulthood. It has been used as a measure of depression over the past 25 years (Beck, Steer, &. Garbin, 1988). Beck, Steer, and Garbin (1988) reviewed 25 years and it has become one of the most widely used instruments for detecting and measuring intensity of depression in normal and psychiatrically diagnosed populations. Beck, Steer, and Garbin (1988) reported internal consistency of the BDI. Within 15 nonpsychiatric samples, the reported mean alpha was 0.81 and the mean coefficient alpha for the 9 psychiatric populations was .86. They further reported that the short form of the BDI appears to have a comparable level of internal consistency to that of the longer form. 92 Several studies have reported that the BDI discriminates between depressed and nondepressed individuals (Beck, Steer, & Garbin; 1988). Beck anxiety inventory: Beck, Epstein, Brown, and Steer (1988) reported on the Beck anxiety inventory (BAI), a 21-item scale to measure clinical anxiety. The Beck anxiety scale was used to indicate current level of anxiety in adulthood. It uses a 4-point scale from not at all to severely. Unlike other measures of anxiety, this scale has low correlations with depression inventories and as suggested by Beck, epstein, Brown, & Steer, (1988) this measure can be used to clarify outcome research and theoretical investigations of the two syndromes. The Beck Anxiety Inventory showed high internal consistency (a = .92) and test-retest reliability over 1 week, £(82) = .75 (Beck, Epstein. Brown, &• Steer; 1988) . Severity of sexual abuse. A scale to measure severity of abuse was created based on research from several sources including Morrow (1986), Courtois (1988), and Westerlund (1992). Other empirical studies reviewed also suggested similar topics as related to 93 severity (Bagley & Ramsay, 1985; Browne & Finkelhor, 1986). Empirical studies indicated three areas of abuse which appear to be related to severity as it is associated with adjustment: (1) duration of the abuse, (2) acts involved in the abuse, and (3) relationship of the perpetrator (Bagley &. Ramsay, 1985; Browne & Finkelhor, 1986; Courtois, 1988; Kenda1 I-Tackett, Williams, &. Finkelhor, 1993; Westerlund, 1992). Based on these empirical findings, scores for "severity of abuse" were obtained by adding the numerical values for responses on questions 176, 178-186, 196-204, 212, and 213. These are also presented in Table 3-2. The specific questions are presented below. Durat ion. Duration of abuse was assessed through question 176 with response (A) = 1 through response (E) = 5. 176. I believe the sexual abuse continued for 1 (A) 3 months or less 2 (B) 4-12 months 3 (C) 1-2 years 4 (D) 3-5 years 5 (E) 6 years or more 94 Acts of abuse. In Morrow's (1986) study, scattergram analyses of data revealed that vaginal intercourse was associated with the highest distress on adjustment measures and fondling with the least. Attempted intercourse, anal intercourse, and oral sex had distress scores that fit somewhere between the distress scores given for vaginal intercourse and fondling. Thus it was possible to build a scale of severity such that vaginal intercourse was assigned 5 points, fondling 1 point, and attempted intercourse, anal intercourse, and oral sex 3 points each. Acts involved in the abuse were examined through questions 196-104, 212, and 213. For question 196 (A) = 0 no (B) = 5 yes. definitely (C) = 5 yes, probably (D) = 0 not applicable 196. I believe the sexual abuse involved sexual intercourse (a male put his penis into my vagina). For questions 197-200, and 202 (A) = 0 no (B) = 3 yes, definitely (C) = 3 yes, probably (D) = 0 not applicable 197. I believe the sexual abuse involved attempted sexual intercourse (a male tried to put his penis into my vagina, but did not succeed). 95 198. I believe the sexual abuse involved the insertion of objects into my vagina. 199. I believe the sexual abuse involved the insertion of objects into my anus (including enema equipment). 200. I believe the sexual abuse involved mouth-genital contact (his/her mouth(s) to my genital or his./her genitals in my mouth). 202. I believe the sexual abuse involved anal intercourse (a male put his penis into my anus). For questions 201. 203. and 204. (A) = 0 no (B) = 1 yes, definitely (C) = 1 yes, probably (D) = 0 not applicable 201. I believe the sexual abuse involved fondling or touching of genital or breasts. 203. I believe the sexual abuse involved unwanted touching or kissing. 204. I believe the sexual abuse involved watching me undress or bathe. For questions 212 and 213, (A) = 0 no (B) = 5 yes, definitely (C) = 5 yes, probably (D) = 0 not applicable 212. I believe that I was threatened with physical harm or death if I did not comply during the abuse. 213. I believe that someone I cared about was threatened with physical harm or death if I did not comply during the abuse. 96 Relationship of perpetrator. Intrafami Iia1 abuse, particularly by father figures, has been associated with more severe effects than abuse by nonfamilial males (Browne &. Finkelhor, 1986; Finkelhor, Ho ta ling, Lewis, &. Smith, 1990; Kenda I 1-Tacket t et al., 1993). Research further indicates that the longer the duration, the greater the distress and the use of force, the greater the distress (Kenda11-Tackett et al., 1993). Father figure was assessed as question 178-180 with (A) = 0 no (B) = 5 yes, definitely (C) = 5 yes, probably (D) = 0 not applicabl 178. My biological father 179. My stepfather 180. My adoptive/foster father Nonfather male perpetrators were assessed through questions 181-186 with (A) = 0 no (B) = 3 yes, definitely (C) = 3 yes, probably (D) = 0 not applicable 181. My mother's boyfriend 182. My grandfather or stepgrandfather 183. My brother or stepbrother 184. My uncle or stepuncle 97 185. A male cousin 186. An unrelated male The scores on each of these questions involving duration, acts, and perpetrators were added together to create the scale "Severity of abuse". Internal consistency reliability was calculated on the severity scale created for this study, resulting in an alpha coefficient of .83. QH Table 3-1 . Percent of Respondents Reporting Background Information Percentage Relationship situation: Marr ied 57% Current significant relationship 20% Dating one or more 9% Not currently dating 14% Relationship satisfaction: Very dissatisfied 14% Moderately dissatisfied 17% Moderately satisfied 42% Very satisfied 20% Mi ss ing 7% Sexual preference: Het erosexua1 71% HomosexuaI 14% Bi sexua1 6% Undecided 3% CeIibate 3% Mi ss ing 3% Birth Order On Iy Child 6% First Born 23% M I d d 1 e Bo r n 40% Last Born 28% Miss i ng 3% Race 85% White 3% Hispanic 6% Black 7% Other Re I igion 80% Protestant 3% Catholic 17% Other Family of Origin 28% Not welI off 20% Less than we I I off Comfortable 28% .Hp Table 3-1 continued Percentage Moderately well off 17% Very well off 3% M1ssing 3% Current family financial Not well off r>% •Less than well off 20% Comfor tab 1e 60% Moderately well off 3% Very we II off 11% Occupat ion Not em.p 1 oyed./student 31% Ma nagerial ./professio na I 43% Other 26% Educat ion Some CO I 1ege 45% BacheI or's 48% High School 7% 100 Table 3-2. Percentage of Respondents Reporting Abuse Issues Percentage Abuse began Infant-3 years 28% '4-6 years 40% 7-9 vea r s 14% 10 - 1.3 years 12% 14 - o 1 f.i e r 3% Mlss ing 3% Abuse ended Infant -3 years 3% 4-6 years 9% 7-9 vea rs 17% I 0-13 vea r s 46% 14-0Ider 23% Mi ssing 2% Durat ion 3 months or less 6% 4-12 months 9% •3 - .5 years 37% +6 years 40% Missing 9% Frequency 1-2 times 9% 3-10 times 31% 11-30 times 14% + 30 42% Missing 4% Perpetrator" : •Father (5) 40% •Stepfather (5) 20% •Mother's boyfriend (3) 20% •Unrelated male (3) 54% Mother 20% Unrelated female 22% Type of abuse experienced' •Intercourse (5) 54% •Attempted intercourse (3) 51% •Oral (3) 60% 01 Table 3-2 continued Percentage •Fondle (1) 91% •Anal (3) 31% •Unwanted touch./kiss (1) 88% •Watching (1) 62% Fought the perpetrator 60% Were offered favors 51% •Self was threatened (5) 62% •Other was threatened (5) 48% Memory Very incomplete 14% Somewhat incomplete 23% Somewhat complete 43% Very complete 6% Missing 14% Involved in 12 step programs 0 months 17% < 3 months 14% 3-6 months 7% 7 months to one year 7% > o n e v e a r 5 1 % Ml ss ing 4% Inv-olved in survivor groups 0 months 17% < 3 months 11% 3-6 months 9% 7 months to one year 20% > one year 43% Involved in individual therapy 0 months 1"^^ <3 months 3% 3-6 months 6% 7 months to one year 14% > one year 60% In-patient treatment for sexual abuse Not at all "^7% one time 20% two or more times 3% 10? Table 3-2 continued Percentage Involvement with self-help literature > one year 85% < one year 15% * may be more than one response • included in the severity scale CHAPTER IV RESULTS Preliminary Analyses Preliminary analyses were conducted prior to the multivariate analysis of variance, Pearson Product-Moment correlations, and the path analysis which tested the hypotheses. The preliminary analyses included: (a) reliability tests for each measure used in this study, (b) frequency statistics of scores on all measures, and (c) correlations among the variables of the study. Reliability of Measures Internal consistency reliability was calculated on all measures in this study using Cronback's alpha. Alpha coefficients include: .96 for the Rosenberg Self-Esteem Scale (RSES) used to calculate adult self-esteem; .94 for the Beck Depression Inventory (BDI) used to calculate adult depression; .92 for the Beck Anxiety Inventory (BAI) used to calculate adult anxiety; ,96 for wounded inner child on the Song and Hattie 103 104 Inventory (SHI) used to calculate self-concept of wounded and ideal inner children; .96 for ideal inner child on the SHI; and .83 on the severity scale. These coefficients are considered to be adequate to establish reliability of the measures for this study. Scores on Measures Scores on the RSES ranged from 16 to 48 with a mean of 33.6 and a standard deviation of 10.2. The maximum score possible on the RSES is 50 with 50 being the highest expression of self-esteem. Rosenberg (1981) reported a mean on the RSES of 30.4 with a standard deviation of 15.31 for a general, non-clinical population. The self-esteem of this sample was about average for a non-clinical population. Scores on the BDI ranged from 19 to 61.66 with a mean of 33.06 and a standard deviation of 11.21. The maximum score possible on the BDI is 76 with 76 showing the greatest depression. Beck (1967) reported a range on the BDI from 32 to 37 as mild depression as measured by the BDI, with 38-41 bordering on the diagnosis of clinical depression. Based on Beck's (1967) ranges. 105 this sample would generally be considered mildly depressed. Scores on the BAI ranged from 21 to 65.94 with a mean of 34.23 and a standard deviation of 10.50. The maximum score possible on the BAI is 84 with 84 showing the greatest amount of anxiety. Beck, Epstein, and Brown (1988) reported a score on the BAI of 45 for the group diagnosed as clinically anxious, and 34 for the non-c1inically anxious group, Based on the findings of Beck, Epstein, and Brown (1988), the sample in this study were not as anxious as persons diagnosed as clinically anxious. Scores for wounded inner child on the SHI ranged from 43.05 to 155 with a mean of 85.75 and a standard deviation of 28. Scores for ideal inner child on the SHI ranged from 87.85 to 175 with a mean of 148.75 and a standard deviation of 23.8. The maximum score possible on the SHI is 175 with 175 indicating a very good self-concept. Scores on severity ranged from 7 to 52 with a mean of 29.76 and a standard deviation of 12.34. The maximum score possible for severity is 71 with 71 showing the most severe abuse. 106 Intercorrelat ions Amon.g Adjustment Variables Pearson product-moment correlation coefficients were calculated to determine the correlations among the adjustment variables: scores on the RSES, the BDI, and the BAI. These correlations are presented in Table 4-1 These correlations indicate that the greater the level of depression and the greater the level of anxiety, the lower the level of self-esteem. Also, the greater the level of depression, the greater the level of anxiety. IntercorreI at1ons of Aspects of Abuse and the Severity Scale Pearson product-moment correlation coefficients were calculated, to determine the correlations among the items included in the questionnaire which provided information about the abuse but were not included in the severity of abuse scale. These correlations are presented in Table 4-2. Several types of abuse not included in the severity scale were also positively associated with severity including: the use of animals in the sexual abuse act, sadistic acts, when the child fought her perpetrator, and when favors were offered. 107 Background Variables Pearson product-moment correlation coefficients were calculated to determine the correlations between the demographic and background variables and the various scales used in this study. These results are presented in Table 4-3. Age was negatively associated with depression, suggesting that the younger the current age of the participant, the greater the reported level of depression. Relationship satisfaction was negatively associated with depression and anxiety and positively associated with self-esteem. This would suggest that the more the respondent was satisfied with her current relationship, the lower her reported levels of depression and anxiety and the greater her reported level of self-esteem. The number of siblings reported in the family of origin, the greater the reported severity of the abuse. Number of children the respondent has was negatively associated with the difference score between wounded inner child scores of self-concept and ideal inner child scores of self-concept. The greater the number of children, the smaller the difference score. Current family financial 108 situation was also negatively associated with depression and positively associated with self-esteem. The higher the financial situation, the lower the reported level of depression and the greater the reported level of self-esteem. Women who have been in one or more 12-step program for longer periods of time reported lower levels of depression and anxiety, and higher levels of self-esteem. The longer a woman had been involved in group therapy for survivors, the lower her reported level of anxiety. Women who had been involved in in-patient treatment for sexual abuse reported higher levels of depression, higher levels of anxiety, and lower levels of self-esteem. Also, women who reported using self-help literature for longer periods of time reported lower levels of depression, and higher levels of self-esteem. For the variables of religion, race, and occupation, separate analysis of variance were conducted. No significant differences were found between groups based on any of these variables. 109 Qualitative Description of Prticipants' Inner Children In order to help orient the respondent toward and clarify images of a wounded and an ideal inner child before answering questions regarding the self-concept of each, an example of each type of inner child was given followed by open ended questions. All 34 participants recognized at least one wounded inner child. Several noted more than one wounded inner child. Most noted a name for their wounded inner child although a few referred to them by age. The age of wounded inner children ranged from 2 years to 19 years, with a mean a^e of 7. a median age of 6. The most common age was 5 years, with 20% of the participants recognizing a 5 year old inner child. The ages of 3, 6, and 7 were also common. The expressions most often noted on the wounded inner child was nervous (55%), scared (65%), and near tears (44%). The most frequently noted feelings of the wounded inner children were fear (65%) and sadness (67%). The emotions of anger, shame, loneliness, and unloved were also often noted. Other feelings associated with the wounded inner children included no refection, guilt, longing, hurt, hopelessness, and controlling. The wounded inner children were frequently described as skinny, and/or malnourished, with short "chopped" straight hair. Others were described as fat. Most were described as "unkept" or "unclean." Most were reported as wearing dresses. None were described using any positive attributes although 2 were described using the word happy, along with two negative feelings. Thirty participants reported information on an ideal inner child. Four were unable to do so. Several participants did not have a name for their ideal inner child but most were able to report an age (97%). The ages ranged from 3 to 16 with an average age of 8, and a median age of 6. The most commonly reported ages of ideal inner children were 4 and 6 with 12% of participants reporting ideal inner children of these ages. Several participants recognized more than one ideal inner child also. There were 44 wounded inner children reported as compared to 39 ideal inner children. Most of the ideal inner children were described as having sparkling eyes (71%). The most common feelings reported for ideal inner children were 111 happy (57%), loving (47%), and free (41%). Also frequently reported were peace, curious, adventurous, humor, wonder, and joy. The most common description of clothing was "comfortable" (79%) with no one mentioning a dress. Major Analyses To test the first hypothesis that wounded inner child scores of self-concept will be significantly lower than ideal inner child scores of self-concept, a repeated measures analysis of variance was conducted between the mean wounded inner child score and the mean ideal inner child score on the Song and Hattie inventory. The analysis indicated a significant difference between mean scores for wounded inner child and for the ideal inner child on the SHI, F(l,23) = 50.93, £<.001, with mean scores of 85.75 and 148.75, respectively, and standard deviations of 28 and 23.8, respectively. Thus the first hypothesis was supported. To test the second hypothesis, that the greater the disparity between self-descriptions of a wounded inner child and an ideal inner child the greater the negative 112 adjustment in adulthood, a difference score was calculated using absolute values between scores on the Song and Hattie scale for the wounded inner child and the ideal inner child. Then, three Pearson product-moment correlations were conducted to determine the relationship between the absolute value of the difference score and the scores of participants on (a) the Rosenberg Self-Esteem Scale (b) the Beck Depression Inventory, and (c) the Beck Anxiety Inventory. No statistically significant correlations were found between the difference score and (a) the RSES (r=-.06; E>.05), (b) the BDI (r=.06; J2>.05), and (c) the BAI (r = -.ll; E^>.05). Thus the second hypothesis was not supported. Several partial correlations were also conducted using current age and length of time in therapy as control variables. No significant correlations were found using control variables. To test the model depicted in Figure 2-1 a path analytic model using Linear Structural Equations (7) (LISREL 7) (Joreskog & Sorbom, 1989) was conducted. The covariance matrix analyzed using the LISREL 7 is 113 presented in Table 4-4. The results are presented in Figure 4-1. The analyses indicated that severity of abuse was not significantly associated with wounded inner child self-concept, difference scores between wounded and ideal inner child self-concepts, or lack of adult adjustment. Wounded inner child self-concept was associated with both the difference score and adult adjustment: the lower the wounded inner child self-concept the greater the difference score and the greater the difficulties in adult adjustment. Difference scores were also related to adult adjustment indicating that, contrary to the hypothesis, the greater the difference between wounded and ideal inner child scores on self-concept the fewer the difficulties in adult adjustment. A LISREL 7 conducted with length of time in therapy included as a control variable failed to run. 14 Table 4-1 Intercorrelations of Dependent Variables RSES BDI BAI - . 86^^ — . ni* * BDI 79* + BAI •• n < -01 I 15 Table 4-2. Correlations of Aspects of Abuse with Severitv ? e V e r 11 v 1. Age at onset - . 36 2. Age at end . 27 3. Unrelated, female .27 4. Group sex . 10 5. Pictures taken . 35 6. Animals involved .47^ 7. Sadist ic . 52^^ 8. Fought the perp . 40^ 9. Favors offered . 38• p . 05 * • n ,01 11-^ Table 4-3. Background Information Correlated with Scaled Scores BDI BAI RSES DIFF SEV 1. \^e .35^ - . 22 . 29 -. 16 - . 2? 2. Pel Sit .00 .02 . 14 -.47 . [^ 3 . RelSat .44^ -.44^ , 46^ . 33 . 14 4. * of sib .27 . 32 -, 19 - .03 . 42 + 5 . Re Iig ion .31 , 30 -,22 . 19 .44 + 6 . Occup - . 26 - . 20 . 14 - . 07 - . 4 1 • 7. «of chd .07 . 16 - .08 - . 54^^ -. 14 8 . Cur. F. -.44^^ - . 29 . 4 5 • • .06 - . 37 9 . 12 Step -.44^^ - . 40 + + . 46^^ -. 17 -. 37^ 10 , Surv. -.32 - . 36^ , 27 , 22 -.11 1 1. Ind. -.00 .05 ,05 -.41^ .22 12 . SA In-pat lent . R2^^ .5.5 • • -.41^ -23 .37 13 . Self-Help Lit. -.34^ -.24 .41^ - . 29 -.02 • J2 < .05 ••n< .01 2 . Relationship situation 3 . Relationship SJ3 1 1 s f a c t ion 4 . Number of sibl in^s in f am.i Iy of or igin 6 . Occupa 11 on 7 , Number of children in fam 11y of p r o c r e a tion 8 , Current finane ial status 9 . Involvement in a 12 step group 10 , Involvement in a therapy or suppor t group for survIvors 1 1 Involvement in individua I therapy 12 In-patient treatment for sex abuse 13 . Involvement wi th self-he I p I i t e r a urt e I 1 Table 4-4 Covariance Matrix Ana Iv-zed Dif f WIC BDI BAI RSES Sev Dif f 1 .34 WIC - . 75 . 65 BDI -.04 -. 14 . 35 BAI -.07 - .08 .23 . 2 5 RSES - .08 . 33 -.52 -.32 1 .04 Sev -.07 -1 .62 2 . 96 2.4 -3.43 152.33 1 16 <0 to (O XJO • lO c • •^ •.-1 0) .«..' o. w •*- c to • (1> O o > o CO CHAPTER V DISCUSSION This study examined the concept of the inner child among a population of adult women survivors of child sexual abuse. The study was one of the first to empirically examine the idea of the inner child. Survivors of child sexual abuse have been the topic of many studies, with several examining the relationship between severity of abuse and adjustment later in life. This study examined further the relationship between adult adjustment and severity of child sex abuse as well as how these associations are related to or mediated by inner children. Over 100 packets, with self-addressed, stamped envelopes for return to this researcher, were given to therapists to be distributed to their clients who volunteered to participate in this study. Therapists were not asked to keep any record of how many of the packets were distributed, therefore there is no way of knowing how many survivors took a packet and tried or intended to participate. The return of 34 completed packets indicates at least a 33% return rate 119 120 which is common for mail out type surveys (Kerlinger, 1973). Given the sensitive, painful, and personal nature of the information gathered in this study, this return rate is considered good. Blank paper was included and the participants were asked to make comments or suggestions. Many participants chose to write personal comments. Most of these participants indicated that they were very pleased to be able to have a voice in enlightening the world about the issues involved in child sex abuse and the recovery from it. Many also stated that they were pleased to be able to speak out about their own personal traumas. A few also indicated that they had not before been introduced to the idea of the ideal inner child, writing that they were anxious to familiarize themselves with this new concept. Theorists have suggested that people have several senses of self (Burr, Leigh, Day, & Constantine, 1979; Duval &. Wickland, 1972; Harter, 1983; Hewitt, 1989; James, 1948; Kohut, 1977). Past and contemporary scholars have also theorized that events that occur during childhood have an effect on adult behavior 121 (Bradshaw, 1990; Erikson, 1968; Harter, 1983; Jung, 1990; Miller, 1981). Authors of popular, self-help literature have written that adults who were sexually abused as children will have a sense of a wounded inner child and a different, ideal inner child (Abrams, 1990; Bradshaw, 1990; Miller, 1981). The authors of such popular literature have not offered a theory which adequately defines inner child, described how inner children develop, nor do they present an adequate theory to help in understanding the concept of inner children. Symbolic interactionism is a theory which helps explain how different senses of self develop and/or may yield wounded and ideal inner children. Thus, symbolic interaction theory helps explain the possible relationship between severity of abuse, wounded and ideal inner children, and adult adjustment. Symbolic interaction theory may also help explain differences found from study to study. Several senses of self develop with at least one based on actual traumatic experiences, and one developed based on attempts to overcome or avoid negative senses of self (Burr et al., 1979; Hewitt, 1989; Kohut, 1977. 122 1980). For survivors sexually abused as children, a wounded inner child develops based on a sense of self formed during the abuse situation(s) and an ideal inner child develops in an attempt to overcome and avoid awareness of the wounded inner child. Because wounded inner children and ideal inner children are formed for such different reasons, it was expected that perceived self-concept of wounded and ideal inner cnildren would be significantly different from each other. All participants of this study were able to discuss and describe at least one wounded inner child whether or not they had previous contact with the concept. Eighty-eight percent of the respondents were also able to identify at least one ideal inner child. This study has demonstrated a significant difference between the perceived self-concepts of wounded versus ideal inner child. Qualitative information gathered during this study indicated that, for this sample, the average wounded inner child was 5 years old, nervous, scared, and experiencing sadness and fear. Most female survivors were also familiar with at least one ideal inner child. 123 Of the 34 survivors who responded to this study, 30 reported information on at least one ideal inner child. The average ideal inner child reported for this sample was 6 years old, had sparkling eyes, and was happy, loving, and free. Based on theoretical conceptualizations of discrepancies between senses of self it was hypothesized that individuals whose perception of the self-concept of their wounded inner child was significantly lower than their perceptions of the self-concept of their ideal inner child would have more difficulties with adjustment in adulthood. Taken separately, the difference score between self-concept of wounded and ideal inner children was not significantly related to any of the three measures (BDI, BAI, RSES) used to study adult adjustment. Partial correlations using age and length of time in therapy as controls also showed no significant correlations. Perhaps it is not length of time in therapy, but amount of recovery which mediates between difference scores and adult adjustment. While length of time in therapy could be expected to be related to amount of recovery, this relationship was not 124 examined in this study. Symbolic interaction theory suggests that it is not only the facts, such as the amount of time a survivor has actually participated in therapy, but the survivor's perception of the therapy, or amount of recovery, which matters. It is possible that even though length of time in therapy differed among the participants, the perceived amount of recovery may not have been represented by length of time in therapy. Given the emotionally painful nature of the questions asked on the questionnaire, perhaps only survivors who had attained a substantial amount of recovery were able to complete the packet. Studies examining recovery level would be helpful in understanding more completely the complex relationship between difference scores of perceived self-concept of wounded and ideal inner children and adult adjustment. When a path analytic model was used which controlled for the effects of severity, the difference score was found to be significantly related to adult adjustment. Based on theory (Duval & Wickland, 1972; Kohut, 1977, 1980), it was expected that the greater the difference score the greater the amount of depression, 125 the greater the amount of anxiety, and the lower the adult self-esteem. This was not the case. The findings of this study indicated that the larger the difference between perceived self-concept of wounded and ideal inner children, the fewer the difficulties in adult adjustment. The poorer the self-concept of the wounded inner child, the greater the difference score between self-concepts of wounded and ideal inner children. Perhaps, since survivors with greater difference scores have poorer wounded inner child self-concepts, they worked harder than those with smaller difference scores to develop the ideal inner child to overcome and avoid the pain associated with the wounded inner child. Based on a stronger need to overcome and avoid the wounded inner child, survivors with greater difference scores may have come to rely more on an image of an ideal inner child than others. Put another way, the greater the distance the survivor was able to put between her ideal inner child and her wounded inner child, the better adjusted she reported herself. Although theory led to the belief that discrepancy would represent role strain and tension, the findings supported a view that there 126 may be a special case. When discrepancy could indicate distance from a negative, then better adjustment may follow, rather than greater tension and poorer adjustment. It is also possible that greater discrepancy may lead to greater tension in younger survivors, thus motivating them to change their attitudes and/or behaviors. The need to avoid such tension may result in better adjustment in older survivors. Studies specifically comparing a group of younger survivors to a group of older survivors would help in understanding this issue. Studies gathering qualitative information about this phenomenon would also be illuminating. For example, how do survivors perceive differences between their wounded and ideal inner children and what effect do they perceive this difference to have on their adjustment. Contrary to expectations, severity of abuse during childhood was not found to be significantly related to perceived self-concept of wounded inner child, difference scores, or adult adjustment. It is possible that therapy mediates the effects of severity on perception of inner children and on adult adjustment. 127 Because of the limited sample size a LISREL 7 conducted to test this theory statistically could not be completed. This sample was specifically solicited from therapists who use the process of inner child work. Therefore all participants were involved in some form of therapy including, 12-step groups, survivor groups, or individual therapy. A study using a control group familiar with the idea of the inner child, perhaps through self-help literature, but who are not and have not been in therapy with a therapist who introduces the concept of the inner child, would help to examine how therapy mediates between severity/difference scores and adult adjustment. Literature suggested that the relationship between severity of abuse and adult adjustment is unclear, with some studies reporting a significant relationship between the two and others reporting no significant relationship (Browne &. Finkelhor, 1986; Finkelhor, Hotaling, Lewis, & Smith, 1990; Kendal1-Tackett, Williams, & Finkelhor, 1993). Taking the symbolic interactionist perspective of emphasis on the subjective rather than the objective reality, perhaps it was not 128 the objective facts measured by the questionnaires used, but rather the survivor's subjective experience of how severe the abuse was which is actually related to adult adjustment. One study suggested, for example, that perhaps it is not the blood relationship of the perpetrator, but rather the perceived emotional closeness which is associated with the amount of trauma experienced (Kendal I-Tackett et al., 1993). A study examining the relationship between the objective facts currently being measured by questionnaires, and the survivor's subjective perceptions of the severity of abuse would help better understand the relationship between severity of abuse and adult adjustment. Based on Beck's (1967) ranges, this sample would generally be considered mildly depressed. Based on the findings of Beck, Epstein, and Brown (1988). the sample in this study were not as anxious as persons diagnosed as clinically anxious. The self-esteem of this sample was about average for a non-clinical population. The finding that age was significantly and negatively associated with depression (r. = -.35; n < .05) suggests that the younger the survivor, the more 129 depression she reports. It is possible that the different findings between studies may be related to the average age of the sample. The failure of partial correlations using age as a constant conducted with thi'^ sample may be related to the fairly small sample size. It is possible that younger survivors (i.e., late teens or early twenties) who are closer to the age of abuse have more difficulties with adjustment, than older survivors who have had more time to distance themselves from the abuse and to have significant experiences in their lives that provide sources of esteem. It is also probable that older survivors have had more opportunity to work with forms of therapy including 12-step programs, groups, and self-help literature. Because all participants in this study were involved in therapy, the lack of adjustment difficulties is not too surprising since that is usually the desired outcome of therapy. Implications and Limitations This study helps researchers, therapists, and survivors understand feelings and behaviors involved in surviving child sex abuse. It has introduced the idea 130 of inner children and examined how this concept may be related to adult adjustment. Severity of abuse was also examined in this sample of survivors in therapy, as it relates to adult adjustment. Although several aspects of adjustment in adult survivors have been examined empirically, this project is one of the first to study the concept of inner child empirically. Strengths of this study include a decent return rate on a mail out survey, especially one concerning such a sensitive subject, a sample comprised of survivors from multiple geographic locations, a sample of non-hospitalized survivors, and the use of reliable measures. A study using a sample drawn from a pool of clients of therapists who introduce inner child work, though somewhat limiting the generalizabi1ity of the study, is helpful since the participants were already familiar with the concept of inner child. Generalizabi1ity of the study is further limited by the inclusion of female participants only. However, since most studies of aspects of adult survivors of child sex abuse have involved females only, results of this study are 131 comparable. Future studies including male participants will be important in furthering the understanding of the concept of inner child. Because of the extremely personal nature of this study, mail out packets were used to ensure confidentiality of participants, making this sample somewhat self-selective. The small sample size limited the power of the statistics used as well as the generalizabi1ity of the findings. The fact that 85% of the participants were white, 80% were protestant. and 60% reported their current financial situation as comfortable also limits generalizabi1ity. However, participants were from multiple geographic locations covering three states. Studies involving larger samples comprised of different races, cultures, and SES are needed to better understand the relationship between severity of abuse, wounded and ideal inner children, and adult adjustment. Researchers need to agree upon a comprehensive definition of severity of abuse and how to measure it before the relationship between severity and adult adjustment can be fully understood. Survivors' 132 perceptions of severity should be included in the definition rather than simply checking off of abuse items . More work is needed to truly understand what part wounded and ideal inner children play in the lives of survivors of child sex abuse, particularly in relationship to severity and adult adjustment. Of particular interest may be the effect of the difference between perceptions of wounded and ideal inner children on adult adjustment. A more extensive qualitative look at survivors' subjective perceptions of wounded and ideal inner children would be helpful. This study provided a theoretical background for the inner child, which had not yet been presented by authors of popular literature. This study was also one of the first to actually examine the concept of the wounded and ideal inner child empirically. The notion of inner children has been presented in popular literature and therapy for many years. This study was important not only because it was one of the first the empirically examine inner children, but also because it examined the association of severity of abuse to inner children and the association of each of these ideas to 133 adult adjustment. For this sample of adult women survivors familiar with their inner children, severity was not associated with wounded inner child, difference scores between wounded and ideal inner children, nor to adult adjustment. The lower the wounded inner child score on self-concept the greater the difference between wounded and ideal inner child scores on self-concept. 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(1968). A philosophy of science for personality theory. Boston: Houghton Mifflin. Sarbin, T., & Allen, V. (1964). Role enactment, audience feedback, and attitude change. Sociometry. 21, 183-193. Sullivan, H. (1953). The interpersonal theory of psychiatry. New York: Norton. Westerlund, E. (1992). Women's sexuality after childhood incest. New York: W.W. Norton & Company. Wheeler, B. R., & Walton, E. (1987). Personality disturbances of adult incest victims. Social Casework: The Journal of Contemporary Social Work. M. 597-602. Wylie, R. C. (1989). Measures of self-concept. Lincoln: University of Nebraska Press. APPENDIX A QUESTIONNAIRE Please answer the following questions to the best of your ability. There are no right or wrong answers, only those that are true for you. Use a *2 or softer pencil to completely fill in the circle on the answer sheet. 1. Your age: (A) 18-27 (B) 28-37 (C) 38-47 (D) 48-57 (E) 58 or older 2. Your Sex/Gender: (.\) male (B) female 3. Describe your current relationship situation: (A) Not dating currently (B Seeing one or more people, none seriously (C) Current significant involvement (D) Engaged (E) Married 4. How satisfied are you with your relationship si tuat ion: ^A) Very dissatisfied (B) Moderately dissatisfied (C) Mod erately satisfi ed (D) Very dissatisfied 5. Your marital status: (A) single, never married (B) married (C) divorced/separated, no remarriage (D) remarried (E) involved in a committed relationship, not married 6. Sexual preference (check one): (A) Bisexual (B) Heterosexual (C) Homosexual (D) Undecided (E) Celibate 7. Your birth order: (A) only child (B) first born 140 141 (C) middle born (D) last born 8. Number of siblings: (A) 0 (B) 1 (C) 2 (D) 3 (E) 4 or more 9. Your ethnic background: (A) White, Caucasian (B) Hispanic (C) Black (D) Other 10. Your religious preference: (A) Catholic (B) Protestant/Christian (C) Jewish (D) Other 11. How many children do you have: (A) 0 (B) 1 (C) 2 (D) 3 (E) 4 or more 12. Which best describes your childhood family's financial status? (A) Not at all well off (B) Less than well off (C) Comfortable (D) Moderately well off (E) Verv well off 13. Which best describes you current family (or your self if not married or with a partner) income? (A) Not at all well off (B) Less than well off (C) Comfortable (D) Moderately well off (E) Very well off 14. My primary occupation is: (A) Not employed; employed part time and/or student (B) Homemaker (C) Sales, Clerical, or Blue Collar (D) Manager, Professional, Teacher (E) Farmer 15. I: (A) Did not complete high school (B) Have a high school diploma (C) Have some college, vocational training, business col lege (D) Have a Bachelor's degree 16. Beyond the bachelor's degree I have: (A) Not applicable (B) Some graduate work (C) Master's degree or equivalent (D) Master's plus work toward a Doctorate 142 (E) Doctorate or equivalent Please read each statement below and pick out the one statement m each group that best describes the wav vou have been feeling the past week, including today. ' Be sure to read all the statements in each group before making your choice. 17. A - I do not feel sad. B - I feel sad. C - I am sad all the time and I can't snap nut nf it. D - I am so sad or unhappy that I can't stand it. 18. A - I am not particularly discouraged about the future. B - I feel discouraged about the future. C - I feel that I have nothing to look forward to. D - I feel that the future is hopeless and that things cannot improve. 19. A - I do not feel like a failure. B - I feel that I have failed more than the average person. C - As I look back on my life, all I can see is a lot of failures. D - I feel I am a complete failure as a person. 20. A - I get as much satisfaction out of things as I used to. B - I don't enjoy things the way I used to. C - I don't get real satisfaction out of anything anymore. D - I am dissatisfied or bored with everything. 21. A - I don't feel particularly guilty. B - I feel guilty a good part of the time. C - I feel quite guilty most of the time. D - I feel guilty all of the time. 22. A - I don't feel I am being punished. B - I feel that I may be punished. C - I expect to be punished. 143 D - I feel that I am being punished. 23. A - I don't feel disappointed in myself. B - I am disappointed in myself. C - I am disgusted with myself. D - I hate myself. 24. A - I don't feel that I am any worse than anybodv else. B - I am critical of myself for my weaknesses or mi stakes. C - I blame myself all the time for my faults. D - I blame myself for everything bad that happens. 25. A - I don't have any thoughts of killing myself. B - I have thought of killing myself, but I would not carry them out. C - I would like to kill myself. D - I would kill myself if I had the chance. 26. A - I don't cry any more than usual. B - I cry more now than I used to. C - I cry all the time now. D - I used to be able to cry but now I can't cry even though I want to. 27. A - I am no more irritated now than I ever am. B - I get annoyed or irritated more easily that I used to. C - I feel irritated all the time now. D - I don't get irritated at all by the things that used to irritate me. 28. A - I have not lost interest in other people. B - I am less interested in other people than I used to be. C - I have lost most of my interest in other people. D - I have lost all of my interest in other people. 29. A - I make decisions about as well as I ever could. B - I put off making decisions more than I used to. C - I have greater difficulty in making decisions than before. 144 D - I can't make decisions at all any more. 30. A - I don't feel I look any worse than I used to. B - I am worried that I am looking old or unattract ive. C - I feel that there are permanent changes in my appearance that make me look unattractive. D - I believe that I look ugly. 31. A - I can work about as well as before. B - It takes an extra effort to get started at doing something. C - I have to push myself very hard to do anything, D - I can't do any work at all. 32. A - I can sleep as well as usual. B - I don't sleep as well as I used to. C - I wake up 1-2 hours earlier than usual and find it hard to get back to sleep. D - I wake up several hours earlier than I used to and cannot get back to sleep. 33. A - I don't get more tired than usual. B - I get tired more easily than I used to. C - I get tired from doing almost anything. D - I am too tired to do anything. 34. A - My appetite is no worse than usual. B - My appetite is not as good as it used to be. C - My appetite is much worse now. D - I have no appetite at all anymore. 35. A - I haven't lost much weight, if any, lately. B - I have lost more than 5 pounds. C - I have lost more than 10 pounds. D - I have lost more than 15 pounds. 36. A - I am not more worried about my health than usual . B - I am worried about physical problems such as aches and pains, or upset stomach, or const ipat ion. 14.5 C - I am very worried about physical problems and it's hard to think of much else. D - I am so worried about my physical problems that I cannot think about anything else. 37. A - I have not noticed any recent change in my interest in sex. B - I am less interested in sex than I used to be. C - I am much less interested in sex now. D - I have lost interest in sex completely. Using the following scale please rate how much you have been bothered by each of the following over the past week : (A) Not at all bothered (B) Somewhat bothered (C) Quite bothered (D) Severely bothered—I could barely stand it 38. Numbness or tingling 39. Feeling hot 40. Wobbliness in legs 41. Unable to relax 42. Fear of the worst happening 43. Dizzy or lightheaded 44. Heart pounding or racing 45. Unsteady 46. Terrified 14r^ 47. Nervous 48. Feelings of choking 49. Hands trembling 50. Shaky 51. Fear of losing control (A) Not at all bothered (B) Somewhat bothered (C) Quite bothered (D) Severely bothered—I could barely stand it 52. Difficulty breathing 53. Fear of dying 54. Scared 55. Indigestion or discomfort in abdomen 56. Faint 57. Face flushed 58. Sweating (not due to heat or exercise) Please read the following statements and darken in the letter on the answer sheet that best describes you according to the following list: (A) Never (B) Seldom (C) At times (D) Often (E) Almost always 59. I feel I'm a person of worth, at least on an equal basis with others. 147 60. I feel I have a number of good qualities 61. All in all, I am inclined to think I'm a failure, 62. I am able to do things as well as most people. (A) Never (B) Seldom (C) At t imes (D) Often (E) Almost always 63. I feel I do not have much to be proud of, 64. I take a positive attitude toward myself. 65. On the whole, I am satisfied with myself. 66. I wish I could have more respect for myself. 67. I certainly feel useless at times. 68. At times I think I am no good at all. Please read the following statements and darken in the letter on the answer sheet that best describes you at this time according to the following list: (A) Strongly disagree (B) Moderately disagree (C) Sometimes agree/sometimes disagree (D) Moderately agree (E) Strongly agree 69. It is hard for me to make decisions. 70. It is hard for me to say "no". 71. It is hard for me to accept compliments graciously 72. Sometimes I almost feel bored or empty if I don't have problems to focus on. (A) Strongly disagree 148 (B) Moderately disagree (C) Sometimes agree/sometimes disagree (D) Moderately agree (E) Strongly agree 73. I usually do not do things for other people that they are capable of doing for themselves. 74. When I do something nice for myself I usualIv feel guilty. 75. I do not worry very much. 76. I tell myself that things will get better when the people in my life change what they are doing. 77. I seem to have relationships where I am always there for them but they are rarely there for me. 78. Sometimes I get focused on one person to the extent of neglecting other relationships and respons ibilities. 79. I seem to get into relationships that are painful for me. 80. I don't usually let others see the "real" me, 81. When someone upsets me I will hold it in for a long time, but once in a while I explode. 82. I will usually go to any lengths to avoid open conf1ict. 83. I often have a sense of dread or impending doom. 84. I often put the needs of others ahead of my own. Please read the following statements and darken in the letter on the answer sheet that best applies. 85. During the period of time that the sexual abuse was going on, I believe I felt that the sexual abuse situation was: 149 (A) all my fault (B) a lot my fault (C) somewhat my fault (D) a little my fault (E) in no way my fault 86 Now I feel that the sexual abuse situatinn was: (A) all my fault (B) a lot my fault (C) somewhat my fault (D) a little my fault (E) in no way my fault 87. I have told , outside of group or therapy, about the sexual abuse. (A) no one (B) someone 88. I have told only one friend about the sexual abuse. (A) yes (B) no 89. I have told two or more friends about the sexual abuse. (A) yes (B) no 90. I have told one or more non-perpetrating siblings about the sexual abuse. (A) yes (B) no 91. I have told one or more non-perpetrating parents about the sexual abuse. (A) yes (B) no For each of the following persons (questions 92, 93. 94, and 95) darken in the letter of the prhase which best describes their responses to your disclosure according to the following scale: (A) I have not told this person/not applicable (B) generally positive, non-blaming, understanding (C) neither positive nor negative (D) generally negative, blaming, not understanding (E) some negative, some generally positive 1 50 92. One friend 93. Multiple friends 94. Non-perpetrating siblings 95. Non-perpetrating parents 96. The person(s) who perpetrated the sexual abuse with me: (A) Has not been confronted by me (B) Has apologized to me or told me it was not my fault (C) Has not said anything to me regarding the sexual abuse (D) Denied that the sexual contact with me happened (E) Admits it took place but blames me. 97. How long have you attended 12 step self-help group meetings such as AA, Al-Anon. CODA. ISA etc.? (A) have not participated (B) less than 3 months (c) 3-6 months (D) 7 months to a year (E) more than a year 98. How long have you participated in groups for survivors of sexual abuse which are lead by a therapist: (A) have not participated (B) less than 3 months (c) 3-6 months (D) 7 months to a year (E) more than a year 99. How long have you participated in individual therapy for the sexual abuse: (A) have not participated (B) less than 3 months (c) 3-6 months (D) 7 months to a year (E) more than a year 151 100. I have received in-patient treatment for chemical dependency: (A) not at all (B) 1 time (C) 2 or more times 101. I have received in-patient treatment for emotional/psychological problems but not specifically for sexual abuse or chemical dependency: (A) not at all (B) 1 time (C) 2 or more times 102. I have received in-patient treatment specifically for sexual abuse: (A) not at all (B) 1 time (C) 2 or more times 103. As an adult (18 or over) I have sought help through reading self-help literature: (A) have not done this (B) less than 3 months (C) 3-6 months (D) 7 months to 1 year (E) more than one year 152 Wounded Inner Child You may or may not be familiar with the term "woun^ied inner child". The following example is a desrriptmn nf a wounded inner child given by a survivor of ebild sexual abuse. "Tabatha is six years old. She has short, straight, brown hair and big. blue, very sad eyes. She is'wearing blue jeans which are a little too big. and a plaid shirt. She is hiding in the corner of a big box in the middle of the school playground. Her eyes stay moi-^^t as if constantly on the verge of tears. She is very afraid. She must be coaxed out of the box. She trusts no one and does not want to be seen or heard. She responds quietly to questions, afraid of the wrath her voice might bring." Some survivors have a picture or a stuffed animal or doll which they feel captures the sense of a wounded inner child. If you have such a representation of a wounded inner child, you might want to look at it before you begin to answer the following questions about a wounded inner child. Please answer the following open ended questions on the blank pages provided. WI . What do you call your wounded inner child? W2. Approximately what age do you believe your wounded inner child is? W3. Describe the physical characteristics of your wounded inner child including such aspects as hair, eyes, expression, clothing etc. W4. State three emotions your wounded inner child exper iences. Your wounded inner child may be male or female. Even though the following statements address a female, please 153 answer for your wounded inner child, whether male or female. Please read the following statements and darken in the letter on the answer sheet that best describes your wounded inner child according to the following list: (A) Strongly Disagree (B) Moderately Disagree (C) Sometimes Agree/Sometimes Disagree (D) Moderately Agree (E) Strongly Agree 104. Persons of her age group enjoy her company. 105. She is an attractive person. 106. She has confidence in herself. 107. She is a cheerful person. 108. She is sure of herself in school situations. 109. She is proud of her ability in academic work. 110. She is just as nice as she should be. 111. She is happy with the school work she does. 112. She wishes she had been born into another family. 113. She feels good about her academic ability. (A) Strongly Disagree (B) Moderately Disagree (C) Sometimes Agree/Sometimes Disagree (D) Moderately Agree (E) Strongly Agree 114. She would change many things about herself if she couId. 154 115. She thinks that she has the ability to get good grades in school work. 116. Her looks bother her. 117. She feels that her family trusts her. 118. Her friends have confidence in her. 119. She feels left out of things in class. 120. She is loved by her family. 121. She is popular with others of her own age. 122. She is proud of her report card. 123. She feels that she is trustworthy. 124. She gets along well with other people. 125. She thinks her ability is sufficient to cope with school work. 126. She is satisfied with her school work. 127. Her family is disappointed in her. 128. She is an important person to her friends. (A) Strongly Disagree (B) Moderately Disagree (C) Sometimes Agree/Sometimes Disagree (D) Moderately Agree (E) Strongly Agree 129. She is proud of her school work. 130. She thinks that she is capable of getting the results she would like to obtain in school work. 131. She has respect for herself. 132. She feels unwanted at home. 155 133. In the kinds of things we do in school, she feels she is as good as the other people in her class. 134. Most of her teachers do not understand her. 135. She is happy with her physical appearance. 136. She feels worthless in class. 137. She feels good about her school work. 138. She thinks she is good at all times. 156 Ideal Inner Child You may or may not be familiar with the term "ideal inner child". Many refer to the ideal inner child as the spontaneity and sense of wonder experienced as a child. The following example is a description of an ideal inner child given by a survivor of child sexual abuse. "When I first encountered Regie I thought she looked like the fairy who used to open the Wonderful World of Disney show. I thought she could fly and flitter around that way. I still giggle when I think how silly I was to believe Regie could fly. She has a very impish quality about her with a big grin that squints up her eyes and rosy red cheeks. Regie is four years old. She is always happy and very confident and assertive. She isn't afraid of anything or anyone. She loves baby kittens and puppies. Her 'job' is to protect Regina, who seems to be very afraid of everything. She doesn't let anyone know about Regina. " Some survivors have a picture or a stuffed animal or doll which they feel captures the sense of a ideal inner child. If you have such a representation of an ideal inner child, you might want to look at it before you begin to answer the following questions about an ideal inner child. Please answer the following open ended questions on the blank pages provided. 11. What do you call your ideal inner child? 12. Approximately what age do you believe your ideal inner chiId is? 13. Describe the physical characteristics of your ideal inner child including such aspects as hair, eyes, expression, clothing etc. 14. State three emotions your ideal inner child exper i ences. 157 Your ideal inner child may be male or female. Even though the following statements address a female, please answer them for your ideal inner child whether male or female. Please read the following statements and darken in the letter on the answer sheet that best describes your ideal inner child according to the following list: (A) Strongly Disagree (B) Moderately Disagree (C) Sometimes Agree/Sometimes Disagree (D) Moderately Agree (E) Strongly Agree 139. Persons of her age group enjoy her company. 140. She is an attractive person. 141. She has confidence in herself. 142. She is a cheerful person. 143. She is sure of herself in school situations. 144. She is proud of her ability in academic work. 145. She is just as nice as she should be. 146. She is happy with the school work she does. 147. She wishes she had been born into another family. (A) Strongly Disagree (B) Moderately Disagree (C) Sometimes Agree/Sometimes Disagree (D) Moderately Agree (E) Strongly Agree 148. She feels good about her academic ability. 149. She would change many things about herself if she could. 158 150. She thinks that she has the ability to get good grades in school work. 151. Her looks bother her. 152. She feels that her famiIv trusts h er 153. Her friends have confidence in her. 154. She feels left out of things in class. 155. She is loved by her family. 156. She is popular with others of her own age. 157. She is proud of her report card. 158. She feel that she is trustworthy. 159. She gets along well with other people. 160. She thinks her ability is sufficient to cope with school work. 161. She is satisfied with her school work. 162. Her family is disappointed in her. (A) Strongly Disagree (B) Moderately Disagree (C) Sometimes Agree/Sometimes Disagree (D) Moderately Agree (E) Strongly Agree 163. She is an important person to her friends. 164. She is proud of her school work. 165. She thinks that she is capable of getting the results she would like to obtain in school work. 166 She has respect for herself. 159 167. She feels unwanted at home, 168. In the kinds of things we do in school, she feel she is as good as the other people in her class. 169. Most of her teachers do not understand her, 170. She is happy with her physical appearance. 171. She feels worthless in class. 172. She feels good about her school work. 173. .She thinks she is good at all times. 160 Ih^^^,o'^V^'^^ ^^^^^ patience and diligence in completing the questionnaire so far. There are a few mnre questions which are needed to complete the sUidv. The following questions are very personal and some mav he painful to complete. Please try to complete all questions. This information is important in describing the group of participants as a whole. Please be assured that your responses are completelv confidential. 174. I believe the sexual abuse began when I was years old: (A) infant-3 (B) 4-6 (C) 7-9 (D) 10-13 (E) 14 or older 175. I believe the sexual abuse ended when I was years old: (A) infant-3 (B) 4-6 (C) 7-9 (D) 10-13 (E) 14 or older 176. I believe the sexual abuse continued for: (A) 3 months or less (B) 4-12 months but less than 1 year (D) 1-2 years (D) 3-5 years (E) 6 years or more 177. I believe the sexual abuse occurred: (A) once or twice (B) 3-5 times (C) 6-10 times (D) 11-30 times (E) more than 30 times Please read the following statements carefully. With the understanding that you may have been abuse by more than one person at a time or at different times, consider whether you believe this person was or was not 161 a perpetrator of your sexual abuse. Darken in the letter on the answer sheet according to the fnllnwin^ list: (A) no (B) yes. definitely (C) ves. prnhahlv (T>) nnt applicable 178. My biological father 179. My stepfather 180. My adopt ive./foster father 181. My mother's boyfriend 182. My grandfather or stepgrandfather 183. My brother or stepbrother 184. My uncle or stepuncle 185. A male cousin 186. An unrelated male 187. My biological mother 188. My stepmother 189. My adoptive/foster mother (A) no (B) yes, definitely (C) yes. probably (D) not applicable 190. My father's girlfriend 191. My grandmother or stepgrandmother 192. My sister or stepsister 193. My aunt or stepaunt 162 194. A female cousin 195. An unrelated female It is possible that more than one perpetrator were involved in the abuse and different perpetrators may have been involved in different acts. Please read the following statements carefully and indicate all that you believe apply according to the following scale: (A) no (B) yes, definitely (C) yes, probably (D) not applicable 196. I believe the sexual abuse involved sexual intercourse (a male put his penis into my vagina). 197. I believe the sexual abuse involved attempted sexual intercourse (a male tried to put his penis into my vagina, but did not succeed). 198. I believe the sexual abuse involved the insertion of objects into my vagina. (A) no (B) yes, definitely (C) yes, probably (D) not applicable 199. I believe the sexual abuse involved the insertion of objects into my anus (including enema equipment). 200. I believe the sexual abuse involved mouth-genital contact (his/her mouth(s) to my genital or his/her genitals in my mouth). 201. I believe the sexual abuse involved fondling or touching of genital or breasts. 202. I believe the sexual abuse involved anal intercourse (a male put his penis into my anus). 163 203. I believe the sexual abuse involved unwanted touching or kissing. 204. I believe the sexual abuse involved watching me undress or bathe. 205. I believe the sexual abuse involved group sex. 206. I believe the sexual abuse involved having my picture taken. 207. I believe the sexual abuse involved me in sexual acts with animals. 208. I believe the sexual abuse involved me in sadistic sexual acts. 209. I believe that at some point during the sexual abuse, I was impregnated. 210. I believe that at some point during the sexual abuse, I tried to fight off my perpetrator(s). (A) no (B) yes, definitely (C) yes, probably (D) not applicable 211. I believe that I was offered favors or enticements when abused. 212. I believe that I was threatened with physical harm or death if I did not comply during the abuse. 213. I believe that someone I cared about was threatened with physical harm or death if I did not comply during the abuse. 214. I believe my memory of the abuse is: (A) Very incomplete (B) Somewhat incomplete (C) Somewhat complete (D) Very complete Again, thank you for your participation!