Mental health articles

Agenda for Theoretical Development
While the theoretical knowledge base of child sexual abuse has advanced
considerably in the last 100 years, important problems remain, one of which is that
the theoretical literature base relates primarily to incest. Seduction by the daughter,
collusion by the mother, the influence of the dysfunctional family—all suggest a primary orientation towards father-daughter incest. Even much of the feminist
literature has a primary orientation towards intrafamilial abuse. This emphasis in the theoretical literature on father-daughter incest and other types of intrafamilial abuse
has also been reflected in the empirical literature. For example, of books and papers
published between 1966 and 1998, 123 were indexed under father-daughter incest and almost 2,200 were indexed under intrafamilial abuse, whereas only 15 were
indexed under extrafamilial abuse (Bolen, 2000a). This bias is also found in
treatment centers in which the majority of victims have been abused by relatives,
most often by father figures (Bolen, 1998a; English & Tosti-Lane, 1988). These statistics stand in stark contrast to findings in prevalence studies that report that
approximately 70% of all child sexual abuse is extrafamilial (Bolen, 2000a).
The regrettable effect of this overemphasis on intrafamilial abuse is a
concomitant de-emphasis on the full scope ofthe problem of child sexual abuse. If, for
example, child sexual abuse is conceptualized as a problem of a few dysfunctional
families, then the societal factors that allow sexual abuse to flourish can be ignored.
From a standpoint of societal acceptance of the scope of child sexual abuse, it may be far less threatening to consider that a few deranged fathers may abuse their
children than to accept that as many as 30% of girls and fewer males may be at risk of sexual abuse by someone other than a relative (Finkelhor et al., 1983).
Another important problem in the theoretical literature is that certain theories
of child sexual abuse remain myth-bound, often even in the face of contradictory
empirical literature. This is especially true of family systems theory, which
developed when no empirical literature was available and surely reflected the motherblaming,
father-aggrandizing society of that era. Given the current state of knowledge,
this biased view is no longer tenable. This is not to say that family systems theory has nothing to offer the understanding of child sexual abuse. Instead, intriguing
findings in the literature suggest that family dynamics may be risk factors not only in
intrafamilial abuse, but also in extrafamilial abuse (Alexander & Lupfer, 1987;
Briere & Elliot, 1993; Ray, Jackson, & Townsley, 1991). As such, a reformulation of
family systems theory that is concordant with the empirical literature and that expands
its view to all child sexual abuse is surely overdue. To continue to advance the historical conceptualization of family systems theory and other myth-bound theories,
even when the current empirical literature contradicts them, however, allows for the propagation of unsupported and biased literature.
Another important shortcoming in the theoretical literature is the failure to
operationalize existing theories. Only a few theories of risk of abuse have been forwarded, and none has been operationalized sufficiently to be tested empirically,
although the operationalization of theories of risk to offend has advanced further.
Therefore, proponents of these theories need to clearly explicate testable hypotheses.

A final important shortcoming is the lack of an overall model of child sexual
abuse. Current theories on child sexual abuse are typically unidimensional as, for
example, family systems theory’s unidimensional focus on families of father-daughter
incest. Even feminist theory, as important as it is to the understanding of sexual
violence, is unidimensional, focusing almost exclusively on societal factors that may
affect the prevalence of sexual abuse. The same can be said for social learning theory, conditioning theory, and attachment theory. While these theories, properly
operationalized, may be important to our eventual understanding of why certain
individuals abuse children or why certain children are at greater risk of abuse, none alone is sufficient to understand the problem of child sexual abuse.
Just as Kendall-Tackett, Williams, and Finkelhor (1993) called for an overarching
model to understand the development of symptoms after victimization, the same type
of model is necessary for child sexual abuse as a whole. One of the most fundamental
needs for this model is that it be theoretically and, as possible, empirically grounded.
The grounding of the model in the current empirical knowledge base should reduce the serious biases currently found in the literature. For example, recognizing that studies
concur that most nonoffending mothers are both supportive and noncollusive (Bolen,2000b) would remove the temptation to include some of the early tenets of family
systems theory that paint such a biased view of these women. Furthermore, this model
must capture the important ecological fiamework of abuse, recognizing that factors at all systemic levels impinge upon risk to offend and to abuse. Finally, this model must
capture the developmental trajectory of both the offender and victim. Work such as this has been done in the child maltreatment literature. For example, Belsky (1980)
presented an ecological fiamework of child maltreatment, whereas Cicchetti and Rizley (198 1) presented a transactional fiamework. More recently, Cicchetti and
Lynch (1993) combined these fiameworks to examine community violence. The purpose of Chapters 8 and 9 is, in part, to present a model such as this that is specific to child sexual abuse.
The course of theoretical development therefore needs to be four-fold: (a) to
focus all theories upon all types of child sexual abuse (not just intrafamilial abuse); (b) to operationalize existing theories; (c) to refute or reformulate biased theoretical
literature; and (d) to develop overarching models that synthesize the different levels of factors (individual, family and attachment, community, and societal) and that provide a transactional understanding of child sexual abuse.