Book Reviews

Healing the Incest Wound

by Christine A. Courtois
2nd edition
W.W. Norton. ISBN: 978-0-393-70547-8

While this 748 page book contains excellent guidance for the seasoned therapist in dealing with survivors of incest -- plus a thorough index, an amazing reference section, guide to further reading and exhaustive appendices for both incest survivors and their counsellors -- its warnings of the inherent challenges and dangers in this field would likely frighten off the novice professional.

Courtois expands the definition of incest way beyond the father-daughter or brother-sister stereotype. While the emphasis is on family incest (of various kinds including step-parents, mother-son and uncles, aunts and cousins) she includes, for example, betrayal by inadequately trained or mentally disturbed therapists as well as the now infamous priestly pedophilia.

And she cites a Boston Globe article to warn of the dangers awaiting young people on the Internet (giving an ironic unintended new meaning to the term 'social media'): "90,000 convicted sex offenders" are on MySpace and a similarly large number on Facebook.

Courtois tells us that at least 20% of women have suffered at least one instance of abuse and that the sexual abuse of boys is "greatly underestimated." No wonder a hypnotherapist colleague once told me that sexual abuse of children is so widespread that it could be considered "normal".

The reason such abuse, particularly incest, is not "normal" is not only the revulsion many of us have toward the subject but more importantly, the negative effects on the abused children -- and the cycle of intergenerational abuse so often engendered by the first perpetrator.

But not only children are at risk of incest. "Although uncomfortable to contemplate, researchers have found that some elders are sexually assaulted by younger or peer members of the family or by other caregivers."

The author warns that many victims (who internalize the shame, anger and guilt of their abusers) suffer from inadequate methods of coping with the aftermath of incest -- and become what therapists label as "personality disorders" (page 245) thus potentially creating burnout in therapists who become overwhelmed with the traumas and despair of such clients.

I found this close-to-burn-out weariness to be true one summer a few years ago when I listened to the misery of six unconnected male clients in a row each of whom had been molested by a woman, usually the mother or older sister.

That summer was capped when Magda (not her real name) described her family's reaction to her being raped at age 15 by her 17-year-old brother, "Nick". Her mother washed the bloody sheets from Magda's bed. Nothing was said about the crime for several months until one evening around the supper table Magda burst into tears after her brother made a sneery remark about her.

Not being able to contain herself any longer Magda blurted out her dismay and frustration about Nick's disgusting behaviour (by then repeated a couple of times). Silence fell. Magda's mother bowed her head. But the father stood up, strode around the table to Magda, and spat on her.

When Magda, now 19, with a history of failed relationships and a host of self-esteem issues, shamefully whispered this story to me I slammed my fist onto the desk between us and forcefully said, "YOU have nothing to be ashamed of. But your parents do and so, of course, does your brother."

Author Christine A. Courtois would perhaps claim that I overreacted, that countertransference and Magda's stunning beauty had clouded my judgement. Over-empathizing is but one of the scores of dangers that face a therapist in seeking to help the victims of incest.

In fact, Magda later told me that my dramatic expression of disgust at the parents' behaviour enabled her to acknowledge her pent-up anger and to let go of the blame-the-victim mentality endemic to her family's culture.

Courtois discusses the therapeutic treatments that can be effectively employed by the compassionate yet objective therapist:

  • Post-traumatic stress (acute, chronic and delayed) relief and dissociation;
  • cognitive-behavioral;
  • experiential, emotion-focused, or expressive-cathartic;
  • exploratory, psychodynamic or psychoanalytical;
  • sensorimotor and somatosensory;
  • systemic;
  • pharmacological.

Two research-based pages detail the role of hypnosis in helping incest victims to heal.

I have to defer to Courtois's vastly greater experience when she tells us that most familial incest begins in the child's bedroom. Most of my abused clients (Magda was an exception) began their nightmare journey in or near the bathtub. As adults they display an inordinate fear of water (such that the common tranquil beach-by-the-ocean scene as an induction into hypnosis is contra-indicated).

It is imperative for the therapist to understand the child's view of the incest.

One of the most difficult aspects of parent-child incest for us to accept is the bond that develops between the victim and the perpetrator. Courtois sheds much needed light on how this bond develops and deepens even to the point that the offending parent can rationalize that he or she was merely responding to the child's desire and unconditional love for the abusing parent.

Since many victims are disbelieved by other family members one of the major healing factors is "acceptance and validation" by the therapist whether the victim is still a child or is dealing as an adult with the childhood abuse. ". . . respect, information, connection and hope" are essential to helping the traumatized client.

Counseling psychologist Courtois co-founded the post-traumatic disorders program known as The Center. This second edition of her invaluable book is a vital asset to every therapist who seeks in-depth comprehension of ways to empower the survivors of incest.