This article originally appeared in T&S Issue 41, Summer 2000.
When child sexual abuse occurs within the family, it is often seen as different from abuse that occurs outside: there is a long legal and medical tradition of viewing incest as a symptom of ‘family dysfunction’, for which the abuser’s wife or partner and even his victim(s) may be as much to blame as he is. But this view, arguesLesley Laing, depends on uncritically accepting what men say about their own and other family members’ behaviour. Here she describes a treatment programme in New South Wales, Australia, which challenges men’s right to define reality in their own interests: it demands that men ‘face up’ to their responsibility for child abuse by revealing the tactics they used to entrap children and deceive women.
Men who sexually assault children are viewed as deviant and dangerous predators, and the community attaches severe criminal penalties to the crime of child sexual assault. When a father is exposed as the perpetrator of sexual abuse against his child, the community is confronted with a terrible dilemma: now the threat to the child and family comes not from outside the family, but from the parent who is charged with the care and protection of the child and family.
Historically, society’s solution to this dilemma has been to deny the existence of incest. The silencing of victims was aided and abetted by the powerful institutions of the law and psychiatry, where the dominant discourse about incest was that it was rare, and that where it occurred, it was the fault of either the ‘seductive’ child, or the deficient, ‘collusive’ mother. With victims silenced and mothers shamed and blamed, the community could avoid the dilemmas raised in dealing with the incest perpetrator, dilemmas which prompt troubling questions about the nature of families and the power of fathers.
In the 1970s and early 1980s, second wave feminism created a context in which for the first time, women who had experienced sexual violence at the hands of men could speak out and be heard. Suddenly society was confronted with the reality that sexual abuse of children was common rather than rare; that it was perpetrated most commonly by persons known to the child rather than by strangers; and that among those perpetrators were fathers. A common policy response to this dilemma — reduced or minimal criminal sanctions for father/offenders in exchange for acknowledgement of guilt and legally mandated participation in therapy — was proposed as the best way to reduce further trauma to the victim and family. It was argued that to respond to father/offenders in the same way as to extrafamilial offenders — with the full weight of the criminal law — risked further damaging the family and exposing the victim to an unsympathetic legal system, with no guarantee that the victim would receive protection .
Thus a very different response was proposed for intrafamilial, as opposed to extrafamilial, sex offenders against children. In the most popular type of therapeutic approach used in the specialist incest treatment programmes which proliferated in the United States from the late 1970s, men who sexually assaulted their children were constructed as different from other sexual offenders against children: they were seen as less dangerous, more amenable to treatment, and less likely to re-offend. Support for this view was drawn from two primary sources: a body of literature which explained incest as originating in the interactional patterns of family members, and in which the role of the mother is central; and a selective use of theories of sexual offending. In contrast to the treatment of extrafamilial offenders where a core treatment concern is deviant sexual responses to children, the role of sexual motivation in offending by fathers was minimised. In terms of a popular typology of sex offenders, the incest offender was seen as the prototypical ‘regressed’ offender whose sexual involvement with a child is a departure, under stress, from a primary sexual orientation towards adult women. In contrast to the image of the predatory extrafamilial offender, incest is often portrayed as occurring within the context of an otherwise loving father/child relationship.
‘Dysfunctional’ families
Particularly influential in supporting this differential approach to incest offenders was a body of family psychiatry literature published over a 20 year period starting in the 1950s. In this literature, incest is seen as a ‘symptom’ of family dysfunction, the key to which is a troubled marital relationship. The focus of this literature is on blaming mothers for creating the familial conditions in which incest can occur, chiefly due to the woman’s failure to conform to rigid, stereotypical roles as wife and mother. While the mother’s personality and actions are carefully scrutinised, the father is seen as a pathetic figure, almost an innocent victim of his wife’s pathology. Despite the sexist notions underlying this literature, it was adopted enthusiastically by the newly developing incest treatment programmes. According to a book published by Henry Giaretto in 1982,
Incest can be regarded as a symptom of a dysfunctional family: a family headed by parents who are unable to develop a satisfying marital relationship and who cannot cooperate effectively as parents (p. 4).
Such formulations continue to be highly influential in the American and European literature. Unlike the extrafamilial offender who was viewed as a dangerous sex offender, incest offenders were viewed as troubled men in dysfunctional families, the incest a symptom of ‘family dysfunction’ for which their wives shared equal responsibility. Reconstitution of the family was frequently the goal of intervention.
There is, however, considerable research evidence which challenges many of the core assumptions on which this type of incest treatment has been based. For example, research by Gene Abel and others in 1988 established that contrary to accepted belief, incestuous offenders have also frequently abused children outside the family. Of offenders identified because of incest against a girl victim, 49 per cent had also assaulted girls outside the family; 12 per cent had been involved in incest with a male victim; and 12 per cent had assaulted a male victim outside the family. In a 1992 study of 118 biologically incestuous fathers, the researchers Williams and Finkelhor found that 34 per cent had committed a sexual offence as a juvenile and that 58 per cent had sexually abused someone in addition to their daughter. These findings challenge the notion that incest is predominantly a result of internal family dynamics, that it is about meeting non-sexual needs and that it is regression under stress to previously uncharacteristic behaviour.
The assumption that incest is part of an otherwise loving relationship appears to greatly understate the complexity of offender/victim interactions, which an emerging literature on offender tactics, including the use of threats and force, is highlighting. A number of studies of both victims and offenders suggest that a considerable proportion of incest offenders are also physically violent to their partners and children. For example, the Australian researchers Goddard and Hiller found that there was domestic violence in the families of forty per cent of cases of child sexual assault presenting to a Children’s Hospital.
It could be argued, then, that offenders inside the family pose a greater, rather than a lesser threat to children than those outside. Because of his access to the child, the incest offender is in a unique position to identify the child’s vulnerabilities, to use this knowledge to create the conditions for entrapment of the child, and to shape the perceptions of the mother and other family members about his victim/s. Arguably, treatment programmes based on notions of family dysfunction and assumptions that incest offenders are different from and more treatable than extrafamilial offenders have remained popular, despite emerging evidence to the contrary, because they maintain the ‘status quo’: men who abuse their children are converted from dangerous sex offenders into troubled men in difficult marriages who are amenable to treatment and who can be restored to their position of power and trust in the family. Effectively the silence about incest is restored.
Making offenders responsible
Is it possible then to ‘treat’ incest offenders in ways which locate responsibility for the abuse solely with the offender and which lift the burden of guilt and responsibility from its victims, both children and mothers? Between 1989 and 1994 I conducted a study of the NSW Pre-Trial Diversion Treatment Programme which operates in Sydney, Australia. The programme has a legislative base and involves a co-ordinated response by the criminal justice system and the NSW Department of Health. Incest offenders who plead guilty and are assessed as eligible by the treatment programme are diverted from the criminal justice process to a two year treatment programme, but can be returned to the legal system if they breach the stringent conditions of programme attendance. These include the offender moving out of the residence where his victim and family live, having no contact of any kind with the victim and other children in the family without the permission of the Programme Director, and making satisfactory progress in treatment.
The NSW programme differs in several significant respects from other programmes in its stated goals and underlying premises. For example, the programme is based on the explicit premise that women are not responsible for their partners’ abusive behaviour, and family reunification is not the goal of the programme. Rather, it is a child protection programme which aims to prevent further sexual abuse. The treatment programme draws on current developments in sex offender treatment, rather than focussing on the hypothesised family dynamics in cases of incest. In particular, it draws upon the growing body of research about the tactics by which offenders target, abuse and silence victims. The treatment programme emphasises the offender taking responsibility through a process of making transparent the tactics which he has used to abuse the child — a process termed ‘facing up’.
My research addressed the following questions. Does participating in the treatment programme increase offenders’ acceptance of responsibility and empathy for the harm caused? Do changes in the offender’s stance regarding responsibility and empathy help the victim and mother (and their relationship) to recover from the impact of the sexual assault? Is there a shift in the power relationships in the family? Are the child’s needs and safety given priority?
The research sample comprised clients who were accepted into the programme over a two year period and who were prepared to participate in the research. Fourteen of the 15 offenders who were assessed as eligible to enter the treatment programme agreed to take part, together with 13 of their women partners. They participated in in-depth interviews at intake, mid-treatment (12 months later-at this stage ten women participated) and completion of treatment (2-3 years after intake). Victims who completed the programme were also invited to participate in a research interview (for ethical reasons, it was not considered appropriate to interview the young people until they had completed treatment). There were 15 victims in the programme at intake, 14 female and one male. Using the severity of abuse classification system developed by Diana Russell, the majority of the victims in the study had experienced sexual abuse at the ‘very severe’ level. Ten of the offenders were stepfathers, four were biological fathers and one was an adoptive father.
The following discussion describes changes in the mothers’ perceptions about the abuse, the issue of responsibility, and their relationship with the abused child between the start of the programme and the mid-treatment interviews, approximately a year later. In order to maintain confidentiality, ‘O’ refers to the offender, ‘V’ to the victim and ‘M’ to the mother whenever direct quotations from the interviews are used.
The mothers at the beginning of the research
At the beginning of the programme, the women were still reeling from the impact of the disclosure and were struggling to rebuild shattered lives:
I was in shock, traumatised. It destroyed me, like an atomic reaction. I felt sick, numb, dead.
In all couples but one, the crisis precipitated by the disclosure had been resolved with a decision to continue the marital relationship, based on a belief that the man would not re-offend. Consequently all but one of the women entered treatment believing that the issues arising from the abuse had been largely resolved. Hence the requirements that the men move out of the family home and have no contact with any children in the family were experienced as creating additional stress and as undermining their efforts to rebuild the family.
Shame, embarrassment and a desire to protect others contributed to reluctance by the women to tell others about what had happened. The subsequent isolation of the women meant that in most cases the offender was their main source of support, and their main source of information about what had occurred: ‘No. I know nothing, only what I’ve been told through O’. At this stage of the programme, less than half of the women attributed sole responsibility for the abuse to the offender. Some blamed themselves and their partner, and others included the victim in those held accountable. For example:
I had a little to do with it…O. is very demanding sexually…partly because I was so cold. O. ninety per cent, me ten per cent.
The three of us are responsible: O. more, then me and V. equally. Me, maybe I didn’t take any care, didn’t talk to V. properly. I was pregnant, and left her to do the housework and look after herself…V. by not telling me.
I have so many questions — why it went on so long, why she’d go out with her father when he was sexually abusing her…I don’t want to go through life wondering why.
At this stage, the mothers fell into two groups: half the women were estranged from the victims, and angry with them, whereas the other half reported improved relationships following disclosure of the abuse. An example of improvement was a case in which the woman had decided to divorce her husband, and had been engaged in extensive discussions with her daughter about the abuse and the abuser’s tactics. With the offender threatening her, and her relatives siding with the offender, this woman and her daughter grew closer: ‘the two of us against the world’. For another woman reporting an improved relationship, the disclosure enabled her to make sense of her daughter’s difficult behaviour, which she had, until then, been attributing to adolescent rebellion. In another case, the improved relationship was more worryingly based on the victim’s recanting of much of her disclosure, a recanting which confirmed her father’s (minimal) acknowledgement of the abuse, its duration and the accompanying violence.
For women in the ‘estranged’ group it was very difficult to empathise with the child’s experience of abuse.
Maybe it never happened, I just don’t know…If it was going on for so long, why bring it up, she knew it was wrong…she knew what was wrong or right from the word go, so why did she let it carry on? Was she abusing the law system to be able to move out from home?
…that’s probably the reason why she didn’t dob him in. She was enjoying what she was doing and what he was doing to her, so why would she? Then she got sick of it or something, I believe.
For women who reported long standing difficulties in their relationship with the child, the sexual abuse appeared to have made things worse.
She wanted her own way. Maybe to hurt O. and myself. She wants me to get back with her (biological) father …I’ve never had real love from her like it should be…she blamed me for the separation from her (biological) father.
Were these the ‘bad’ mothers of the literature who ‘fail to protect’ and who have created such poor relationships that their children could not come to them when abused? Allied with their partners against the programme, and in fifty per cent of cases, estranged from and angry with their victim children, it would be understandable if they were viewed as ‘collusive’ mothers who were prepared to sacrifice their children for their relationship with the offender. However, the interviews with the offenders revealed the context within which these women’s views of their children were being shaped.
‘Of course I’m totally responsible, but…’
In their initial interviews, the men were eager to assert their total responsibility for the sexual abuse. This is understandable, given that some acceptance of responsibility was a condition of entry to the treatment programme and diversion from criminal justice proceedings. However, this acceptance of responsibility was soon revealed to be quite superficial. Through their discussions about the sexual abuse and its impact, the men revealed that they were involved in a process of actively attributing responsibility for the abuse to other people-most commonly the victim and at times their partner-and to other factors such as alcohol or stress.
Blaming the victim for encouraging, initiating or enjoying the sexual contact was a theme in the explanations for the abuse of more than half the offenders. For some men the attribution of responsibility to the victim was quite blatant:
There were many times when I wasn’t interested in sexually assaulting her, regardless of what I’ve done, and I remember on a number of occasions I would be leaning on the edge of the pool like so minding my own business and she would fondle me underneath the water, I didn’t ask and I didn’t come near her to do it…
For others, the responsibility was presented as shared:
It was like a love affair. On many occasions she approached me. I never forced her.
In fact, agreeing to plead guilty and claiming to accept responsibility for the abuse did not mean that the offenders were accepting all their victims’ allegations. In half the cases there were discrepancies between the victims’ accounts of what had occurred, and the accounts of the offenders in their interviews at programme intake. They actively disputed their victims’ accounts of the duration of the abuse, the extent of the sexual behaviours involved, and of their use of threats and force (despite both physical and psychological coercion being reported clearly in the victims’ police statements). However, because of programme entry requirements, some men explained that they were not disagreeing with the victim’s account in their interviews with treatment staff. For example:
[She] says a couple of times I came into her bedroom and pulled her out of bed. I don’t remember, but it must have happened . . . I can’t recall, but I won’t argue.
The offenders were asked their views about the timing and delays in the victims’ reporting the abuse, so that I would be able to identify any ability to empathise with the victims’ experience of the abuse. When asked, for example — ‘Why do you think that the child disclosed at the time s/he did?’ — not one man answered that the child disclosed in order to end the sexual abuse. Consistent with the age of the victims at programme intake (most were adolescents) four men attributed the disclosure to the adolescent victim’s attempts to get more freedom from parental rules and restrictions. For example:
To get more freedom. We’d just moved house, and she’d had to change schools. When it came out she wanted to stay with her friends where we used to live… like ‘killing two birds’, getting back plus getting it out into the open.
Several of the men gave answers which suggested that the child’s disclosure was motivated by bad intentions towards them. For example:
She thought she was pregnant and was trying to blame me for it.
…she’d virtually stopped it, but guilt got to her and revenge at me, because I was playing a harder role in the family, her mother had handed discipline over to me…Maybe she thought it was an opportunity to get rid of me and get her [biological] father back..
Though they claimed to be honest and open with their partners once the abuse was disclosed, the men were in fact carefully controlling the information which they shared with their partners about the abuse. Some indicated that they only admitted as much as they had to, particularly where their partner was concerned.
At disclosure [my wife] didn’t know the full extent of it. . . it was only months later that I admitted it totally.
During that period of months, his partner had decided to reunite and as a consequence was estranged from her daughter. Another man explained that he was saying one thing to the treatment programme, and another to his wife:
I have to plead guilty to get into the programme, but I don’t agree with all that [victim] says. I told my wife it’s not all true.
What were the offenders telling their partner about the abuse? Five women reported being told by the offender that the child encouraged the sexual contact. For example: ‘She (victim) tried and he stopped her, she wanted intercourse, he said ‘no way’. Five women reported that their partner was telling them that the child enjoyed the sexual contact: ‘O. said V. actually participated.’ Two women were being told by the offender that the child initiated the sexual contact: ‘Yes, V. initiated it. He told me she’d call him into the bedroom…’
A new understanding — the women one year later
In taking responsibility, the programme required the men to ‘face up’ to family members about the abuse and the tactics they employed to perpetrate it and to maintain secrecy. As a consequence, their partners at mid-treatment had come to hold a very different view about the abuse, their partner and about the issue of responsibility.
I suppose just the underhanded way which they do it, the secrecy of it all, the tactics used.
In contrast to the situation at intake, where many women saw both themselves and their victim daughters as sharing some responsibility for the sexual abuse, at this stage of treatment all the women attributed sole responsibility for the abuse to their partners. For example, one woman who judged herself as partly responsible at intake because of sexual problems within the marriage now took a different view:
O. is totally responsible for what he did as far as I’m concerned. I might be responsible, partly responsible for the problems between us, but that’s got nothing to do with his solution to the problem as far as I’m concerned.
At mid-treatment, eight of the ten women demonstrated an understanding of the tactics which the offender had used to abuse the child and to avoid detection. This represented an enormous change, since at intake only one woman (the sole woman planning to separate from her husband) had demonstrated such an understanding.
The sorts of tactics which the women identified related to the offender’s choice to target a particularly vulnerable child, a range of tactics to prevent the child from telling anyone about the abuse, including tactics to undermine the mother-child relationship, and emotional manipulation and isolation of the child. Awareness of the offender’s tactics, particularly in dividing mother and victim and making the child feel complicit, gave the women a new view of the abuse, and in most cases resulted in increased empathy for the victim and an improved mother-victim relationship. Two women talked about their ideas about why a particular child was targeted for abuse, because the offender was aware of a pre-existing troubled mother-child relationship:
V. and I always had a bit of a problem, like it wasn’t an actual mother and daughter relationship and he built around that, to keep that, instead of trying to get me to get closer to V…I mean I didn’t see it but he dragged me away further from her, so she really thought well I can’t go to mum, because mum’s not going to listen.
A number of the women described how the offender went about undermining the mother-daughter relationship. For example, one man did this by telling the child that the abuse was her mother’s fault; another did this by siding with the daughter against the mother over discipline issues. One of the most powerful ways that the offenders had ensured the child’s silence by undermining the mother-child relationship was to give her the idea that her mother knew about the abuse, thus blocking access to the child’s most likely ally. Three women described how they came to realise that their daughters blamed them for the abuse, because the girls believed that their mothers had known what was going on. One woman said that she had been in the programme for some time before she realised this:
O. had said all along, ‘I always made sure you were in the house’, whether he said that innocently or whatever, thinking, thinking, thinking, why the hell would he say something like that, and then sort of I think, gee, V. must have been under a funny impression if I was always there, and then I checked with her and said ‘V. did you think I knew because I was always there?’ and she said yes…she blamed me that I knew it, she obviously thinks that I knew.
Another woman discussed how the offender would abuse the child in the spa, outside the kitchen window, where her mother was cooking. She later understood why the child had been so keen for her mother to come into the spa, and why she had stormed off when her mother said she was too busy. Other offenders used the tactic of simply telling the child that their mother would not believe them.
One woman demonstrated her awareness of the ways in which the offender had emotionally manipulated her daughter, to make her feel complicit in the abuse:
He used to say to her; ‘If I abuse you again, say no’, and then she’d say no the next time and he’d say things to her like ‘You don’t love me then, you don’t care’… blackmail!
Inviting the child to protect the mother from hurt, or the offender from going to jail, was another common tactic reported by the women: ‘He kept saying: “don’t tell mum it will destroy her”‘ constantly saying that all the time…’ Another woman described her partner’s tactic of isolating the victim from others in the family who might have helped her:
It’s just the way that they manipulate everybody…They push the victim in the background and the victim just thinks well, I can’t go to mum because mum won’t believe me, I can’t go to me brother or something… they just kinda manipulate, and they put a bond around everybody else and the victim feels I can’t tell anybody, nobody’s going to believe me, they’re just going to think I’m making this up…
Two women mentioned the ways in which their husbands had deceived them, concealing their actions by appearing to be helpful to them. One man would offer to mind the children and cook meals while his wife went to work, using his ‘helpfulness’ as an opportunity to gain access to his victim. Another feigned concern for his wife:
Now I think of it is, when I used to go to bed early, he’d come up, quite often I’d just go to bed and read, he’d keep coming up, it never worried me, I just thought he was coming up over concern. He was coming up to check if I was asleep, you know!
Several women described how their knowledge of the offender’s tactics answered their questions, many unspoken, about the victim’s role in the abuse:
You go through that (wondering if the child liked it), it goes through a mother’s mind, well why did they leave it for so long, they must have wanted to do it, they must have, things like that…
The degree to which the offender had ‘faced up’ to the abuse, particularly about his tactics to enforce co-operation and the child’s silence, was reflected in the mid-treatment changes in both the mother-child relationship, and in the mother’s empathy for the victim’s suffering and entrapment. The women’s ideas about why the child did not disclose immediately also revealed an increase in empathy for the victim’s position in most cases. Apart from the one woman who did not believe her daughter and who answered ‘don’t know’ to this question, all the other woman gave an explanation which demonstrated understanding of the victim’s entrapment. Eight of the ten women linked the child’s failure to disclose directly to actions on the part of the offender, attesting to the power of the offender’s making transparent his tactics in increasing the mother’s understanding of the victim’s entrapment:
…she couldn’t talk to me because of how O. had torn that relationship apart…He just kept saying, ‘You’ll destroy your mother’, constant things like that, all the time.
The women now understood the child’s silence in the context of her desire to protect the mother and family:
It was me having a breakdown that gave him the edge. She didn’t want me to have that again I suppose, so she was terrified.
One case illustrates the link between the offender making his tactics transparent, increased empathy by the mother for the victim, and the improvement in the mother-victim relationship. At intake, one teenage girl was unable to live with her mother because of friction, and had left to live with grandparents. The woman said in the initial research interview that she was desperate to find out why her daughter had not told her what was happening and why she had continued to willingly spend time with a father who was abusing her. These questions suggested she saw her daughter as sharing responsibility for the abuse. At the second interview, the mother reported that the daughter had returned home within a short time of the family entering the programme. It was apparent that this woman was extremely empathic with the victim’s experience of the abuse, and now understood the barriers to her disclosing, given a new understanding of her husband and his role in the abuse:
The way he was so cunning…the way he made it hard for her to disclose. I find that very difficult, I didn’t think he could do anything like that…just the way he made it so hard for her to disclose, the things he said to her — ‘if you tell anybody you’ll break up the family,’ things like that. He made it so hard for her, made her feel guilty, blaming her for what was happening…
Prior to the offender admitting to these tactics, the mother knew only from the victim that she had been given cigarettes and money. This additional information, and developing an understanding of how the offender had emotionally manipulated the victim to increase her sense of complicity, enabled the mother to view her daughter’s position with sympathy and compassion, rather than with confusion and anger.
Making tactics transparent
The requirement that the men ‘face up’ to family members about their tactics challenges the offender’s power by addressing his ability to divide family members through secrecy. As long as offenders control the information which is available to family members, their power in the family is unchallenged. If mother and child are divided or in conflict they are unlikely to discuss the abuse, and the offender is able to deceive his wife about the sexual behaviours involved, the tactics used, and the victim’s role in the abuse, in particular painting a view of the child as a willing participant. Even in cases where the mother does not overtly blame her daughter, the offender’s failure to disclose his tactics of entrapment can feed a mother’s unspoken fears that the child was in some way a willing participant. This unspoken fear builds a barrier between mother and victim, as some of the women acknowledged at the completion of treatment. However, they could only discuss this ‘worst fear’ after it had been allayed by the offender’s facing up to the tactics he used to entrap and silence the victim.
Much of the offender’s behaviour following disclosure and during treatment can be understood as aiming to return to the family with his power as little challenged as possible. However, requiring the offender to make transparent the tactics which he used to entrap and abuse the child, and which he employed after disclosure to minimise the consequences of his actions, can provide those affected with a new understanding of their experience. This process also provides protection against further abuse, since the offender’s tactics lose their power once they are exposed.
It would be easy to see women who are initially resistant to the programme as denying the seriousness of the abuse, or as cruelly rejecting the victim. But their behaviour has to be seen in relation to the offender’s use of secrecy and division as tactics for preserving his power. By maintaining a focus on the offender and his tactics, it is possible to avoid blaming mothers and to hold the man accountable. One of the young survivors, who throughout the abuse and for many months into treatment lived with the belief that her mother knew about the sexual abuse, described the change in her relationship with her mother and the new understanding about her stepfather’s manipulation of power which she had come to through participating in the programme:
Well, the relationship between me and my mum has grown incredibly close, like we don’t have any secrets whatsoever…When I went to the programme I realised how he was hiding it and how he was being so awful to her that she (mother) couldn’t see anything, she could only see him because he was the main figure in the household, and everyone else just had to do things for him…
While the context for this research was a programme which treated all members of the family, it is suggested that any treatment — whether of child victims, adult survivors, mothers or offenders — needs to actively counter division and secrecy and make transparent the tactics, intentions and effects of the offender’s continuing abuses of power.
References
Gene G Abel, Judith V Becker, J Cunningham-Rathner, Mary S Mittleman and J Rouleau ‘Multiple Paraphilic Diagnoses Among Sex Offenders’ Bulletin of the American Academy of Psychiatry and Law, 1988, 16, 153-168.
Henry Giaretto Integrated Treatment of Child Sexual Abuse (Science and Behaviour Books, Inc., 1982).
C Goddard and P Hiller ‘Child Sexual Assault in a Violent Context’ Australian Journal of Social Issues, 1993, 28, 20-33.
Diana E H Russell The Secret Trauma (Basic Books, 1986).
L M Williams and D Finkelhor The Characteristics of Incestuous Fathers (Family Research Laboratory, University of New Hampshire, 1992).