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Dewald, P.A. (1993). Adult Analysis and Childhood Sexual Abuse: Edited by Howard B. Levine. Hillsdale, NJ: Analytic Press, x + 231 pp., $29.95.. J. Amer. Psychoanal. Assn., 41:904-906.

(1993). Journal of the American Psychoanalytic Association, 41:904-906

Adult Analysis and Childhood Sexual Abuse: Edited by Howard B. Levine. Hillsdale, NJ: Analytic Press, x + 231 pp., $29.95.

Review by:
Paul A. Dewald, M.D.

The topic of overt incest and sexual abuse of children has become a subject of increasing interest. Experience in the analysis of patients with this particular trauma has demonstrated the profound as well as subtle effects on their subsequent development and maturation. In this volume, analysts with extensive experience present their findings with such patients.

The quality of the papers is uneven, and there is repetition of some of the findings and conceptual understandings by different authors. But all agree that the incest or sexual abuse must be viewed in total context of the child's environmental and developmental processes, and that it is frequently the external manifestation of a significantly disruptive family constellation of chronic deprivation and alienation. All also believe that the final effects are a function of multiple variables, including the parental versus nonfamilial abusers, the sex of the abuser, the age at which the abuse occurred, the chronicity or duration of the abuse, the nature of the actual event, and the relationship to other caretakers.

Another common theme relates to the difficulties in treatment of such patients by whom the analysis is perceived as a potential reliving of the original sexual abuse. The wish and fear of such reenactment evokes specific difficulties in establishing a therapeutic alliance and viable analytic relationship, while the pressures to reenactment activate specific defenses, resistances, and transference fantasies.

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