Archive for the ‘Book Reviews’ Category

I may be walking into the lion’s den with this one, but here goes!

For a start – dreadful title.  The book should never have gone into print with this title and it is hard to escape the notion that it was contrived to create sensation.  From reviews elsewhere, it is evident that some people have reacted so strongly to the title that they have gone into hissy-fit mode without actually having read the book.

Susan Clancy is a researcher at Harvard University.  She studied a sample of over two hundred men and women who had been sexually abused as children and who responded to ads she had placed in the Boston Globe (and other newspapers) in the Boston area.

Briefly, what she found was that the majority of her subjects did not experience their sexual abuse as traumatic at the time it happened.  They were children, they did not understand sexual matters, they were puzzled, confused, sometimes pleased about the attention they received, but not traumatized at the time.  The trauma, with all its attendant psychological problems came later, when they realised and understood what had been done to them and all its implications.  Then came the sense of betrayal, of violation, shame, guilt, disgust, anger – all the things we associate with sexual abuse victims.

I must say that this came as no surprise to me – subject to the caveats in my notes below.  I have worked in a special prison unit for sexual offenders against children and I know only too well how most offenders “groom” their victims over time, to make their advances seem normal and innocuous, snaring children into sexual contact that can sometime be continued for years.  And, most sexual offenders are known to their victims, often being in positions of trust.

Susan C goes further, however in that she contends that sexual abuse therapists’ adherence to the trauma model of sexual abuse (that the abuse must have been traumatic at the time it occurred and that a child will only participate in abuse if forced threatened or coerced,)  discounts victims’ experience and “shackles (them) in chains of guilt, secrecy and shame.”  She thinks that adherence to the trauma model brings about a situation whereby victims do not find their experiences understood, do not experience satisfactory outcomes in therapy and that all of this allows a climate of sexual abuse to continue.

This, of course raises more hackles!

I have read the book carefully and it is plain to me that Susan C has a compassionate regard for victims of sexual abuse, has an understanding of the people she had contact with and is quite unequivocal that sexual abuse can never be seen as the responsibility of the victim, in any way, nor can victims be blamed for the abuse.  That said, I don’t necessarily agree with all she has said.

For a start, I wonder how many experienced sexual abuse therapists adhere to the trauma model in quite the way she has described.  I would be surprised if most nowadays do not have an understanding of the grooming process I alluded to above and how this can “normalise” the experience of abuse for a child – for a time.

More tellingly perhaps, I think she generalizes too extensively from the experiences of the subjects in her study.  She states in the introduction that she avoided recruiting subjects from therapists’ offices to avoid ending up with a biased sample ( i.e. those in therapy.)  Instead she placed ads in newspapers.  She does not appear to realise that in doing this, she would have ended up with a different form of biased sample – those who could read, who would read, who would respond to a newspaper ad, who could respond (many are in institutions, for example.)   

So the outcome is a book which seems to have sharply polarised many people and deeply offended some.  It is worth reading for the fact that it outlines a number of features of sexual abuse of children which should be evident.  And her ideas are worth exploring and debating.  At the same time, it contains a number of statements (victims make “errors of judgement” for example,) that would make many of us uneasy.  I suspect that had she been a therapist carrying out this research, she would have written a somewhat different book.

Additional notes for those who are interested:

There is a continuum of  severity of sexual abuse and of the way victims experience it.  I don’t think the book covers this particularly well.  It is not a smooth continuum either, but has various links and side-roads and can be very complex.  Below are some of my understandings of this – doubtless I have missed some things:

Warning – what follows is very unpleasant.

1.  The child is accosted by a stranger.  Intrusiveness can range from exposure to severe sexual assault/violation. This “stranger danger” is relatively rare, but it happens.  Injury may be extensive.  Depending on the level of intrusiveness, trauma may be immediate and severe, depending on severity of assault.

2.  Injury following sexual abuse (from any source) can be severe, requiring surgical intervention – bowel resection, anal repair, vaginal repair etc.  Trauma, in such cases, is immediate and severe.

3.  Abuse of child takes place within a subculture of endemic sexual abuse – either a family or community.  Adults know what is going on, but lack the will or knowledge to stop it.  Abuse may be accepted as part of growing up and victim’s feelings are not considered, or are discounted.  Offenders often do not consider they have done anything wrong.  Trauma us usually immediate and severe.

4.  Sexual abuse takes place in the context of other familial abuse – physical, psychological, intimidation, random severe punishment, scapegoating etc.  Often also a climate of violence, drug/alcohol abuse, neglect etc. Victim’s feelings are not considered and abuse may be seen as taking pressure off others.  Usually multiple and immediate traumas.

5.  Abuse takes place in the context of a severely dysfunctional family.  Caregiving parent sometimes knows of the abuse and colludes with the abuser.  Child may be punished for not complying with abuser’s demands.  Trauma is immediate and severe.  Probably multiple traumas.

6.  A variation of #4 above – abuse takes place in the context of wider community neglect, violence drug abuse, poverty, maltreatment etc.  No one knows, or particularly cares about the abuse.  Victim may or may not be groomed by offender.  Trauma may be delayed or immediate.

7.  A child may experience serial sexual abuse by several abusers.  These children often learn to please adults by complying with abuse advances, or may even initiate sexual contact.  Trauma may be delayed but always severe.

8.  Offender is known to the victim, and is often in a position of trust, for example baby-sitter, parent, uncle, aunt, older sibling etc.  The child is “groomed” so that the abuse, when it occurs appears innocuous or “normal.”  As noted in the book, the child may be puzzled, confused, vaguely disturbed, may be pleased to receive the attention and may respond to the abuse.  Trauma is delayed, but then often severe, especially if the child responds to the abuse.  I have heard people say “I went along with this sick ****.  I even enjoyed it – therefore I must be a sick ****.”

9.  A variation of #7 is that the victim is groomed by the offender, but also intimidated or coerced, or blackmailed into silence.  “If you tell, I will go to jail.  If you tell, no one will believe you.  If you tell you will go to jail.  If you tell I will hurt you (hurt your mother) etc etc.  The child is aware that something is dreadfully wrong and trauma develops rapidly.

10.  Children may be sexually abused by other children – either older or younger than them.  A degree of sexual contact amongst children may be considered normal (playing doctors and nurses sort of thing) but some assaults by children on other children may be quite disturbed and nasty and are committed by the next generation of sexual offenders coming on-line so to speak.  Trauma may be immediate and quite severe.

I note these categories as if they are clear cut and distinct.  They may be, but there may also be blurring or mixing of various features – for example, a child may be subjected to a grooming type abuse over time by a trusted person, in the context of a violent neglectful family who have inflicted physical and emotional abuse on the child.

Child abuse victims often become sexualized and act out sexually, sometime initiating sexual activity.  (See, for example, The Boy Who Was Raised as a Dog, Perry & Salavitz – reviewed on this site.)  This, unfortunately can play right into the hands of offenders, who smugly proclaim that it wasn’t their fault, as the child started it.  Yeah right!   Such children often also display a range of disturbed behaviour from an early age (school problems, emotional outbursts, alcohol consumption, difficult behaviour etc)

I would have to say that many of the (adult) clients I see, who have been sexually abused as children, have grown up in badly dysfunctional families and/or communities in which other forms of abuse (eg physical, emotional) have been common.  Most of these people, as kids, knew there was something badly wrong at the time.  They dreaded going to the swimming pool with Grand-dad, or off with Dad in his truck, or the regular visits from uncle Victor, but felt helpless to do anything about it.  Their trauma began immediately and sometimes continued for years. 

Whilst I recognise that many sexual abuse victims experience their abuse in the way that Susan C relates it,  I would hesitate to say that this is the majority experience without a lot more research backing.  It should be obvious from the above that the sexual abuse of children can be very complex and varied and that making categorical statements from a sample of people in one particular city, in part of one country, at one time, is not a good basis for wide generalization.


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This is an excellent resource for those who have suffered from concussion, or closed head injury and for those professionals working with such people.  I would quite like to own a copy so that I could lend it to head-injured people I work with.

Having said that, if I owned a copy, I would be tempted to take the scissors to some parts of it!

OK then, the good points: 

Comprehensive, easy to read, a wealth of information, great diagrammes showing how brain injury can happen.  The book consists of five broad sections:  An Overview; Physical Aspects; Mental Aspects; Emotional Aspects and Recovering.  There is also a glossary, resources and references for further reading.  Each category is broken down to cover topics like headaches, sexuality, vision problems, muscular/motor problems, memory etc etc.  There are sections for each identified problem on diagnostics, conventional treatment, alternative approaches and practical suggestions.  Subject to some of my gripes below, the information is easy to follow, and there is an enormous amount of good practical advice.  (And reality based advice – the principal author suffered a concussion head injury herself.) 

I think it is great to see comprehensive information on alternative approaches, like acupressure, acupuncture, massage, vitamins, homeopathy and the like.  Doubtless many experts, particularly those who are conventionally medically trained will harrumph about this, but too bad !  If people find these approaches helpful, well and good, I say.   (If I happened to have a head injury, I would make sure I took Co-enzyme Q10, Vitamin E, Magnesium and got plenty of vitamin D via sunlight.)

The not so good parts?  Well these are not so bad as to detract from the overall value of the book – more like the occasional puzzling item that has the potential to confuse or mislead.

I absolutely DO NOT like the term “mild” traumatic brain injury.  Some of these injuries are anything but mild and this is obvious from reading the case studies in the book.  This is hardly the authors’ fault, I guess, they are doubtless repeating a term that has become current in the US.  I had never heard of it until I saw it in the book and my work colleagues feel the same way about it.  The word mild has an enormous potential to mislead those who do not have a knowledge of head injury.  (Well … you’ve had a mild head injury, what’s the problem?  Get over it!)  Concussion or Closed Head Injury are much better terms and are more universally understood. 

There are lists of medications that are very outdated and of dubious value for their stated purpose.  Some examples: Who, nowadays uses Nardil (an anti-depressant with dangerous side-effects?  And Thorazine, Haldol and Navane for headaches??  These are potent anti-psychotics with horrendous side effects and their use for any sort of pain would be very dubious indeed. 

The principal author describes herself as a neuropsychologist, but throughout the book there are statements that a neuropsychologist should not be making.  There seems to be some confusing mingling of neuropsychological testing and personality testing.  Personality testing is not useful in neuropsychology. 

In places there is a shot-gun approach to problems, where, it seems, every disorder known to man is listed in conjunction with head injury.  Some of the connections made need to be taken with the proverbial grain of salt.  This has the potential to confuse and mislead. 

I think the book could do with a good editing in relation to these matters, but as stated above, they are relatively minor when compared to the wealth of good information and I would still like to have my own copy.

Additional information for those who are interested:

1.  In the book, it is suggested that if you are looking for a professional, you check their qualifications, how many head injured clients they have had, the journals they subscribe to, their professional associations, etc.  I don’t know how practical this is ?  Perhaps in the US ?  I suspect that in most circumstances, particularly if you are fronting up to the public health system, you probably won’t have this luxury.  I would suggest you would be better off trying to make sure you see someone who has empathy, a willingness to explore options with you and a willingness to challenge their own assumptions, training etc.  You could find someone with all the bells and whistles who is cold, clinical and arrogant.  If you start off by stating your symptoms and the person seeing you looks puzzled, tells you they can’t understand why it would be like that and perhaps suggests/implies it is “all in your head” – look elsewhere.

2.  There is an old saying in medicine – don’t make assumptions.  This can be applied when dealing with the medical and allied professions too !  Don’t assume that your doctor knows about head injury and its consequences.  Don’t assume that specialist physicians know either.  Don’t assume that psychiatrists know about head injury – they often don’t.  Don’t assume a neurologist will know.  Don’t assume that all psychologists know, or are qualified to investigate. 

 A couple of years ago, a young man was referred to me, he had been hit on the head at work and even though he was wearing a safety helmet, he was knocked to the ground stunned.  Three years later he was still having a substantial number of symptoms – fierce headaches, memory problems, sleep disturbances, noise intolerance, light intolerance, tiredness, difficulty processing information etc.  He had seen numerous doctors and specialists, who all professed to be puzzled, he had been denied insurance and injury compensation.  When he told me this, before we got anywhere near testing, I told him he had had a concussion and likely had post-concussion syndrome.  He looked at me quizzically and said “What’s concussion?”  Amazing!  He had seen doctors and specialists galore and no-one had recognised concussion and post-concussion syndrome. 

3.  Beware those who would over-test.  Some professionals just love to issue tests.  They would issue and recommend every test known to man.  There needs to be a point to testing, it needs to be for your benefit.  If you have had a head injury, testing, even the routine required testing, can be utterly exhausting.  (Take someone with you who can drive you home.)  Testing should demonstrate your  abilities and your deficits and should inform a programme, or advice as to what you can do to manage deficits. 

Two tests which are often used as a starting point in neuropsycholgical assessment at the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scale (WMS.)  The WMS, fairly obviously tests various aspects of memory.  The WAIS is an IQ test, but the purpose is not just to obtain an IQ score.  Each of the test sub-scales makes some assessment of a partcular brain function – memory, speed of information processing, ability to manipulate information, sequential reasoning etc.  The outcomes of these tests may suggest the need for further investigation, but as I state above, testing should not just go on and on.  Remember, at the end of it all, you will still have to manage your symptoms. 

It seems to be popular in the US to mix personality testing into neuropsychological testing.  I am an old fashioned neuropsychologist and regard this as a waste of time.  The book mentions a test called the MMPI (Minnesota Multiphasic Personality Inventory.)  It has always been controversial.  I think it would be much more useful if it was printed on tissue paper.

4.  Beware the use of alcohol and other drugs.  (I don’t think the book covers this well.)  Some people try to drink as they did before they had a head injury, only to find that even small amounts of alcohol absolutely flatten them.  Some, I have known, have tried stimulants such as methamphetamine and cocaine to try to pick themselves up, but this too is disastrous.  These substances cause brain cell damage at the best of times and losing more brain cells after a head injury is the last thing you need. 

Cannabis can give the illusion of being helpful, but again, this substance clouds consciousness at the best of times and that is not what you need.

Be cautious of drugs of the Valium family.  They can make you feel better but there is a price if they are used too long.  They are very addictive and the addiction is hard to shake.  They should only be prescribed as a short-term measure. 

Unfortunately there are no medications that can repair brain injury.  Only time and self-care can do that, though as stated in the book, natural healing methods, supplements and nutrition may be helpful.

5.  Brain injury effects can be cumulative.  Many people get a head injury through contact sport and return to their game of choice as soon as they feel better.  If they get another head injury, the effects tend to be worse and longer lasting.   And the next one … well, you get the picture.

6.  Most people who have a concussion, or so-called “mild” brain injury recover fairly well within a few months.  Some, however, don’t either because the damage was more severe, or for reasons we don’t really understand.  One of the most distressing things about head injury with long lasting effects is that sufferers start to think they are going crazy, or losing their mind, or begin to despair of ever getting well again.  If this applies to you, you may need some assistance dealing with the stress that this causes.  Getting in touch with a brain injury association, or a knowledgeable counsellor may help.

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This is an excellent book for those who are prepared to think critically about their beliefs – and not just Christian beliefs either!  It is excellent not only for the conclusions that John Spong reaches (I think others have been there before him) but for his account of how he reached the intellectual and theological position he holds today. (For biographical information on John Spong see here.)

It is an autobiographical account of how John S grappled with death, notions of death, what (if anything) happens after death and what the Christian religion (and, by implication, other beliefs) would have followers believe.  He charts the development of his thinking from his earliest contact with death, (the goldfish going belly up and being flushed) through to the passing of acquaintances, wider family, his father, his officiating at numerous funerals and eventually the contemplation of his own approaching demise.  Intermingled with this, is his journey through Christianity, from naive young believer to fundamentalist, to critically questioning and finally discarding the overtly superstitious beliefs that Christianity was burdened with from its earlier days.  Beliefs such as the virgin birth, Jesus as literal son of God, Jesus as God-man, miracles, the resurrection and the like.  As the sub-title of the book suggests, he has moved beyond religion, beyond theism and beyond heaven and hell. 

He concludes that most of our notions of God have been invented by man and most of religion exists for the purpose… “to manipulate the external supernatural deity so that this deity will bring divine power to bear in the service of frightened human beings.”  Ouch!  No wonder John S has become a hated and reviled figure for much of traditional Christianity. 

He expounds a new (for Christianity anyway) vision of God (though he was not necessarily the originator of this view.)  I quote from p.156:  “God is not an external being apart from us, to which we must relate as powerless ones to the all-powerful one.  “God” is more a glimpse into the meaning of the totality of human experiences, where we recognize that we are part of an ultimate grasping after a universal consciousness with which we are one and in which we are whole.  This universal consciousness was, however, hidden from us until we exhausted the possibilities of religion in which God was always perceived as other.”  If I am understanding him correctly here, he is talking of the evolution of human spirituality and suggesting that primitive and superstition notions were a necessary stage which we have now begun to outgrow. 

The above gives an indication of his final conclusions as to eternal life – the book’s title.  Escaping the barriers of time and space – eternity is within us.  I can’t do his conclusions justice in a few short sentences, you will need to read the book yourself for this, but my opinion is, it is well worth the effort. 

I am not a Christian.  Never will be.  But I have a fascination for how the dominant belief system of our culture came into being, consolidated it’s power, sustained it’s existence, how it is grappling with it’s decline and whether indeed it has a future.

For me, John S (and others – eg John Hick, Richard Holloway) represent a step forward in the evolutionary development of spirituality.  A step away from superstitious nonsense, a step towards universalism, a step into rational spirituality.  And, I think, it is the path that Christianity must take in order to survive long-term.  (I am struck by how some of the ideas presented in this book parallel those of (original) Buddhism in which the ultimate goal of liberation was a state of  nothingness.  Not the nothingness of annihilation, but rather no-thingness  the absence of any attachment to any thing – a state of pure being.)

I would like to own this book and will eventually hunt down a copy through Amazon or some-such.    For more books by John Spong, see here.

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This is a good book and very inspiring, but frustrating too in places.

The subject is a bit of a mouth-full – Neuroplasticity.  Not it’s not about how plastics affect your brain, it is about the ability of the human brain to reorganise itself by forming new neural connections throughout the life-span of the individual.  Neuroplasticity can allow neurons (brain cells) to compensate for injury, or for harmful brain conditions and adjust their activities in response to new situations and changes of environment.  And, what’s more, these changes can occur quite quickly in response to changes in the way we think.

Only a short time ago, this was considered impossible.  It was thought that by the time an individual had reached adulthood, their brain was a “fixed entity” not able to grow further, or to compensate for injury, or to change its functional structure to any significant degree.  Whilst this remains true to some degree (we can’t grow new bits of brain if we lose them) we have discovered that the brain is much more changeable than we ever considered possible.

Jeffrey S, working with people who suffer from Obsessive Compulsive Disorder, became dis-satisfied with the traditional approaches to therapy, namely Behaviour Therapy, Cognitive Behaviour Therapy and Response Prevention.  Sometimes these treatments can be perceived by the client as demeaning, shaming and aversive.

Using mindfulness approaches, he discovered that by having people focus attention away from unhelpful, negative thoughts and urges and towards positive things, that they could make enduring changes to their own brain pathways.  He devised a four-part strategy – the four R’s:

Relabel – “This is a bothersome thought to do with a brain wiring problem.”

Reattribute:  “This is a brain glitch from an overactive brain area.”

Refocus:  Direct positive attention elsewhere.

Re-evaluate:  “The thoughts and symptoms are not worthy of attention.”

Using these strategies, he found that clients had better “buy in” to therapy and achieved good lasting outcomes.  What is more, brain scans were able to show changes in neuronal pathways.

All very fascinating, however he then goes on to give an extended account of the development of research on neuroplasticity and the struggle to have the ideas accepted.  This is not everyone’s cup of tea, especially the bits that cover the rather gruesome aspects of animal research.  Some reviewers have complained that this part of the book is extremely repetitive.  Well, yes it is, but it gives an account of the research development from a number of different perspectives and angles and it does actually have some fascinating and inspiring parts, if you can plough through it all.

There follows another lengthy discussion relating neuroplasticity to quantum mechanics, free will and the like, which I would imagine many people would find about as exciting as watching paint dry.  Again, philosophically fascinating if you have an interest and knowledge of the area, but I suspect most readers would prefer this to be much shorter.

I would have preferred to see much more discussion of the ideas in actual therapy and more case study examples.  These criticisms aside, the book has been well worth the price I paid for it and I am taking every opportunity to put the principles into practice.  I have heard that the mindfulness/refocusing approach also works well for the management of depression and anxiety.

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This is an excellent book on addiction and should be read by professionals working in the field, as well as those who are seeking recovery.

Richard S is a psychiatrist who has worked (in the US) for more than 25 years with those who suffer from addictions, both to alcohol and to various drugs, both legal and illicit.  In this book, he tackles some of the big questions:  Is addiction a disease? Why me?  Does treatment work? Is a spiritual awakening necessary for recovery?

He provides one of the best discussions I have come across on the “voluntary” nature of addiction.  Addicts of various types are often regarded with scant sympathy, even by medical professionals, when compared, for example, with cancer sufferers or accident victims.  “A self-inflicted condition” is a commonly heard expression.  Yet whilst the taking of a drug is a choice (in initial stages anyway,) the condition of addiction is not.  No-one chooses to be addicted – this is a neurological condition (or perhaps neuro-psychological.)  Doing something about the condition of addiction is, however a choice and this book provides good insights into how to make this choice and to maintain sobriety. 

There are excellent discussions of topics such as risk factors for developing addiction, problems of diagnosis, measuring treatment outcomes, goals of treatment, medications and why medical science can’t “cure” addiction.

Richard S also tackles the topic of spirituality in recovery from addiction, which few other authors do – not well anyway.  He covers the meaning of spirituality and endeavours to separate out this concept from denominational religion.  Topics include addiction as a metaphor for human suffering, thinking about a higher power, are science and spirituality compatible.  Unfortunately the medical and psychological professions do their best to pretend that spirituality does not exist – or is at best irrelevant and the whole concept does get badly confused with religion, particularly “traditional” Christianity and this, understandably puts many people off.

My only criticisms are that the author tends to regard 12 step programmes as the only effective treatment option.  There are other approaches which have good success rates for those who remain with them in treatment.  In the final chapter, discussing spirituality, he also puts forward some notions that are based on some rather questionable concepts and I think he would lay himself open to being shot down by those of a skeptical orientation.

These relatively small points aside, this is an excellent book and is well worth owning.

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This is a wonderful book, though rather harrowing to read and I will purchase my own copy, if the NZ dollar pulls out of its nosedive sometime soon.

Bruce Perry is a US child psychiatrist and the book is an account of a succession of his cases, illustrating various forms of severe trauma suffered by children and his subsequent treatment of them.

There is the case from which the title of the book is derived – a boy who was raised in a dog cage; the Branch Davidian children (the Waco disaster); children who were sexually abused, children who were isolated and neglected and more.  Horrible achingly sad accounts of inhumane, cruel and neglectful treatment.  Not for the squeamish.

But for each of these cases, Bruce P. gives an account of how treatment made a difference, bringing hope and healing to shattered lives.  He provides a wealth of information, much of which goes against the grain of established opinion on such matters.  What perked my interest particularly, was the discussion on how neglect and abuse adversely affected these children neurologically.  To put it simply, abuse and neglect cause significant brain impairment in the growing child.

But, turn this information around (and Bruce P. Does) and we know that child neurological development is enhanced by love, loving touch, comfort,  stimulation, richness of environment, consistency, caring positive parenting.  All the things that my daughter (and I)  have been emphasising in positive parenting posts.

The accounts in this book are those for which these was success, (at least partly.)  Sadly, for every success story, there are many more whose lives continue to plummet into disaster.  Books like this, however provide a light, particularly for those of us who are working to help undo the damage.

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Author: Dr Kim McGregor.  Subtitle: Self-help for survivors of childhood sexual abuse.

Published 2008.

This is excellent, though it makes rather grim reading.

Dr Kim McGregor has worked in New Zealand as a therapist with survivors of sexual abuse for more than 20 years, she is currently the director of Rape Prevention Education and is an active member of several other organizations dedicated to the prevention of sexual violence and/or the support of survivors of sexual violence.

The book is organised under three main section headings:  Surviving; Moving On and For Others.

Part 1, Surviving, has chapters on child sexual abuse, the child, consequences of sexual abuse and the offender.

Part 2, comprises 14 chapters on topics such as preparations for a healing journey, dealing with the abuse, dealing with feelings and emotions, expressing anger, getting rid of self-blame, confronting the offender, finding a therapist and the like. 

Part 3, has advice on caregivers of survivors and living with a survivor.  There are extensive appendices on keeping children safe, normal sexual development, notes for counsellors and a message to offenders.

Each chapter is interspersed with the accounts of those (male and female) who suffered sexual abuse in childhood and it is this that makes harrowing reading.  Harrowing not only for the accounts of abuse, which are dreadful enough, but also for the reactions, actions, inactions of others, many, if not most of whom should have known better.  There are accounts of shattered childhoods, children who grew into severely psychologically impaired adults, self-loathing, drug abuse, promiscuity, self-harm, isolation, damaged relationships.  There are accounts of the disbelief of others when the abuse was revealed, the denials, accusations, assaults, allegations of lying, shunning.  There are accounts of how the offenders operated, the grooming, the lies, assaults, rationalisations, splitting of families, denial.

There are also accounts of how survivors found help, moved on, constructed better lives for themselves and their families and, for some, used their experiences as a base of strength to help others.

Dr McGregor is a New Zealander and the accounts contained in the book have a New Zealand setting.  The content and the principles are, however, universal and I can see that the advice here could apply just about anywhere.  The advice is sound and matter-of-fact, there is an absence of gender politics and political correctness.

This book is intended as a self-help publication for the survivors of childhood sexual abuse, but it would also be a very valuable resource for therapists, for agencies such as community mental health services, for parents and families of children who have been abused, for those working with abusers and for the general public.

Over the years I have engaged in therapy with a substantial number of people, male and female, who have been sexually abused.  I continue to do so.  (I have also worked on “the other side” and spent several years running a prison unit providing a treatment programme for sexual offenders against children.) Sexual abuse in childhood inevitably raises a number of questions for the person abused, such as:

Why me?  Why did the abuser pick me?  Was I carrying a sign saying: Here – abuse me? (Even more so if there were a number of abusers over time.)

What does the abuse mean about me?  What sort of person was I? What sort of person could I have been?  What sort of person can I now be?

What does the abuse mean for me?  What life can I have? Relationships? Children? Sexuality? Who can I tell?  Who can I trust? 

Often enough, victims continue to perceive their abusers as having a hold on them down through the years, sometimes even from beyond the grave.  It is the task of therapy to break that hold and transform a victim into a survivor, who can see their abuse as a strength for them, rather than a weakness.  This book will go a long way towards assisting in this process.

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