Sexuality: A Developmental Approach to Problems.

Sexuality: A Developmental Approach to Problems. By Betty N. Gordon and Carolyn S. Schroeder. New York: Plenum Press, 1995, 157 pages. Cloth, $42.00; Paper, $23.00.

This book, written by two professionals at the University of North Carolina at Chapel Hill, arose from 15 years of clinical and research work with sexually abused children. In order to put this problem into a broader context, three of the six chapters of this compact book are specifically concerned with sexual abuse. The first chapter attempts to summarize the typical course of sexual development, including both physical changes and behavioral expression. The presented data emphasize the occurrence of a wide range of sexual encounters, such as masturbation, touching a parent's breast or penis, or sibling genital contact. They also conclude that in the United States such behavior is likely to occur without an appropriate level of knowledge concerning sexuality. About half of this chapter is concerned with sexuality education, especially what might be helpful in the prevention of sexual abuse. They conclude that any major reduction in child sexual abuse will require more than programs directed toward children alone. Additional suggested targets include adolescents who might be at risk of becoming abusers and changing depictions of sexuality in the mass media.

This general introduction is followed by a chapter dealing with a wide range of sexual problems including anatomical errors, delayed or precocious puberty, gender identity disorder, and oversexualized behavior. The problems were apparently chosen because they may be brought to behavioral clinicians. This probably explains why the first section concerns the children of gay and lesbian parents, although, as the authors indicate, there is no reason to believe that these children are at greater risk for abuse. Each subsection briefly summarizes what is currently known and something about what a clinician might be expected to do. The extent of these suggestions varies greatly in specificity for the various potential problems discussed. The most space is given to Gender Identity Disorder (GID). This discussion reflects what was known in the field at the time the chapter was written. Unfortunately, they do not question the use of this DSM-IV diagnosis, and they talk about cross-gender behavior without differentiating as to whether this refers to gender-role behaviors or gender identity, or both. Many readers will be distressed by their noncritical presentation of one intervention model that consists primarily of attempts to change nonstereotyped behavior. This lack of criticism is surprising, as later in the section the authors note that healthy people have both masculine and feminine characteristics and that some children who show cross-gender behavior with no concern about being the other sex may be well adapted. They also briefly speculate that the report of a high rate of pathology among those diagnosed with GID might be due to the social consequences. I found it frustrating that they did not consider what this might mean for appropriate therapeutic intervention as the proposed programs certainly were designed to change the behavior and not its perception by either the child or other adults. This chapter also suffers from a lack of critical examination of the assumption that surgery and sex reassignment should be done on the basis of the appearance of genitals.

The three chapter unit on sexual abuse begins with an overview of beliefs in this field about such matters as definition, frequency, perpetrator characteristics, and long-term effects. It concludes with a brief section on day care and child abuse, primarily of interest for its suggestions on how to choose a program. This is followed by chapters dealing with assessment and treatment. The three chapters are considered here as a whole and even those persons interested only in assessment or treatment need to read all three chapters, as issues raised in one are often relevant to an understanding of the others. This unit is impressive in that it does an outstanding job of being practical and of including theoretical information that is rarely found in books describing how to work with children who have been abused. For example, the authors include a section on the clinical implications of research on memory and suggestibility. Appropriately not taking sides in the repressed memory dispute, they note both that dissociation is a frequent reaction to stressful events and that it is possible by some procedures to change the nature of memory. They are also clear that, because of the nature of this phenomenon, abuse assessment is a clinical judgement and rarely can one be sure that abuse in fact has occurred. They give extensive written guidelines for approaching cases for the separate instances when abuse determination is to be made, when one is to offer a second judgement, therapeutic interventions when abuse has been declared, and those cases where problem behaviors exist that may or may not be due to abuse. They insert helpful bits of information throughout, sometimes arising from their perusal of the literature and sometimes from their own experience. They emphasize, for example, the importance of tape recording or videotaping all interviews by describing research showing that even when interviewers have been specifically trained not to use leading questions, approximately one in three subsequent interview questions are still of this nature. For those who are concerned with the possible effects of trials upon the abused, they cite a study demonstrating that children who were involved in court testimony (a drawn-out process) were less well-adjusted than those who did not testify. They also briefly note some work that people have done with those who are involved in the witness process.

The final chapter on sexuality and mental retardation was included because of the authors' experience that many clinicians do not wish to work with this population because of lack of information about these individuals; they also suggest that some categories of retardation are at higher risk for sexual abuse. This chapter is distinguished by a section on dealing with the mentally retarded adolescent sexual perpetrator.

Although the authors do not specify their intended audience, in my judgement this book would best be read by persons who are working in the field in a clinical or legal fashion. The book is outstanding in the presentation of specific protocols and other material concerned with assessing and treating child sexual abuse, and the use of general information about sexuality gives more credibility to their points--for example, that sexualized behavior in and of itself is not sufficient to prove a history of abuse. The book is frustrating in that the material does not always reach the same level with respect to other topics. I especially wish that the authors had not included the section concerned with sexual problems other than abuse. Instead, my preference would have been for the authors to elaborate on programs for abuse prevention. There are many brief statements and allusions to the relevant literature in the early chapters. Such a consideration should also include the topic of treatment for perpetrators, only briefly considered in this book. If we wish to understand the gamut of sexuality and prevent problems, then it is essential that we also learn more about why a large minority of sexual abusers repeat this behavior after discovery and various consequences, although the majority apparently do not.

Reviewed by Kathryn Norcross Black, Ph.D. Professor Emeritus, Purdue University, 23295 Grayshire Lane, Lake Barrington, IL, 60010; e-mail: [e-mail].