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<iy 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