Book Review: Sexual Abuse: Boys Who Have Abused: Psychoanalytic Psychotherapy with Victim/Perpetrators of Sexual Abuse

Sexual Abuse Boys Who Have Abused: Psychoanalytic Psychotherapy With Victim/Perpetrators of Sexual Abuse John Woods. London (GB): Jessica Kingsley Publishers; 2003. 240p. CDN$39.95. Reviewer Rating: Good One approaches this book uneasily-a very sad task faces workers in the field of child abuse, and the task is all the sadder when the abused child becomes, in adolescence, an abuser himself. Nevertheless, as British psychoanalyst John Woods maintains in his first 2 chapters, psychoanalytic psychotherapy can help. This depends on the therapy being integrated within the larger social and custodial system by which the abuser is contained, and also it is modified in terms of an offense focus and adapted to specific management issues (p 18). Further, if therapists view adolescence as a time of hope, they may gain the needed balance between meeting the young person, on the one hand, as a victim, and on the other, as a perpetrator. The victim-perpetrator is removed from the morbid family system he came from-in which secrecy was sustained by blaming him for sexual transgressions by his elders-and is placed in a therapeutic system based on honest communication between abuser and therapist and, when necessary, between therapist and the containing environment. The abuse he has suffered-even as grisly as repeated anal intercourse perpetrated by his father-is defensively twisted by the boy, so that to mitigate his hurt and shame, he injures others-other children. Now it's your turn, he seems to be saying, as if, as supervisor Anne Alvarez claims, he's enjoying himself. In this way, the vulnerability he once suffered can temporarily be passed on to someone else. Understanding this twisted equation is essential if therapists, instead of adding to the abuses the boy has already suffered, are to work through their revulsion for his offenses and get on with being helpful. The therapist's understanding is also bolstered if common themes in abuse work are recognized-a boy's feeling socially, sexually, and intellectually inadequate, or feeling all he's good for is sex, or feeling that the therapist, like his perpetrators, may want to violate him. Indeed, it is to fend off such feelings that the abused-abuser finds refuge in a false self, a self that also functions to give a semblance of complying with the containments he is brought to live within. He seeks this refuge while also guarding his perverse fantasy life with the same secrecy with which his original molesters carried out their trespasses. As the boy comes to trust his therapist, however, the trappings of falsity ; may slowly fall away. Both being sexually provocative and also denying responsibility for his actions are aspects of a false self that come to interfere with treatment less and less. Treatment, of course, if it has a chance of success, is a multidimensional affair, usually in a residential setting where behavioural therapy, and often group therapy, are concurrent with psychoanalytic psychotherapy. The kind of team involved in this work necessarily has its own dynamics, and careful communication is of great importance, not only about the boy's concerns, but also about the concerns and stresses of the therapeutic team itself. While other children in the residential setting are reasonably shielded from the boy's boundary violations, members of the staff may be easy targets. Angry and hurting, his aggression gives him momentary respite, often at the cost of considerable stress to his caregivers. …

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