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Book Review   |    
Understanding Abusive Families: An Ecological Approach to Theory and Practice • Violence and Sexual Abuse at Home: Current Issues in Spousal Battering and Child Maltreatment • Women Survivors of Childhood Sexual Abuse: Healing Through Group Work: Beyond Survival
Shoshana R. Sokoloff, M.D.
Psychiatric Services 1999; doi:
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by James Garbarino, Ph.D., and John Eckenrode, Ph.D., with the staff of the Family Life Development Center at Cornell University; San Francisco, Jossey-Bass Publishers, 1997, 273 pages, $34.95 • edited by Robert Geffner, Ph.D., Susan B. Sorenson, Ph.D., and Paula K. Lundberg-Love, Ph.D.; Binghamton, New York, Haworth Press, 1997, 371 pages, $24.95 softcover • by Judy Chew, Ph.D.; Binghamton, New York, Haworth Press, 1998, 160 pages, $39.95 hardcover, $14.95 softcover

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Understanding Abusive Families, by James Garbarino, John Eckenrode, and their associates at the Cornell Family Life Development Center, is a well-written, carefully edited book that offers a new way of conceptualizing child abuse. It is a book well suited for college courses, training programs, and practicing clinicians and should be required reading for politicians and policy makers.

Drs. Garbarino and Eckenrode and their colleagues present the history of concern about child abuse in this country; grapple with definitions of physical, emotional, and sexual abuse; and explore the current research and clinical understanding of each. They develop a theoretical perspective on "the elusive crime of psychological maltreatment" as the destruction of competence in children. They offer a thought-provoking section discussing the subtypes of adolescent maltreatment and the ways in which research findings on adolescent maltreatment differ from those on abuse of younger children.

This book's greatest contribution—and indeed the subtitle of the book—is in providing an ecological approach to theory and practice in the area of abusive families, suggesting that "we must discover how the lives of individuals, families, and societies are interdependent." The authors review statistics from the National Study of Child Abuse and Neglect demonstrating that child maltreatment of all kinds correlates most strongly with low family income; children in families with incomes less than $15,000 are at significantly greater risk in every category of maltreatment. They present studies of neighborhoods, controlling for income, showing that less cohesive neighborhoods have consistently higher levels of abuse. They argue that any sound attempt to address child maltreatment must address social and economic factors.

Understanding Abusive Families records the situation as it currently exists for many children, notes the pitfalls of the current system for dealing with abusive families, and suggests alternative approaches. The concluding chapter outlines changes in the direct provision of treatment and in society in general that would be likely to reduce the incidence of child abuse. The book's conclusion reads like a sermon, a graduation address, or—in this grim social, economic, and political climate—a fantasy.

The collection entitled Violence and Sexual Abuse at Home, edited by Robert Geffner, Susan B. Sorenson, and Paula K. Lundberg-Love, suffers from being read directly after Understanding Abusive Families. It is the first issue of the new Journal of Aggression, Maltreatment, and Trauma, and it reads like a journal. The articles are loosely connected and are often dry in presentation. However, the collection rewards the reader with interesting clinical tidbits, up-to-date statistics, ideas for future research, and the occasional compelling chapter.

Perhaps the most persistent message is that although domestic violence is a very common problem—we are told that assault by an intimate is the primary cause of injury to women in this country and that 25 to 33 percent of couples experience domestic violence, rendering domestic abuse "more prevalent than automobile accidents, muggings, and cancer deaths combined"—the theory and treatment of domestic abuse is a very young science. Almost every entry in the book ends with statements of the need for more and better research, and most serve to remind the clinician to look more carefully for the presence of family violence.

The first chapter recounts a chilling study showing that psychologists and family therapists—and one could hardly imagine that other disciplines would fare any better—are poorly trained to recognize and treat the potential dangers of family violence. In one emergency room study, a protocol for asking women about their histories of maltreatment by a partner raised the prevalence rate of domestic violence from 5.6 percent to 30 percent. The chapter on sibling sexual abuse points to a very common and often ignored type of abuse.

It is evident throughout this collection that the best treatment for families with "violence and sexual abuse at home" is interdisciplinary. A chapter on custody decisions for children of abusive men demonstrates clearly that lessons from the domestic violence literature—that spouse abuse and child abuse often occur in the same homes, and that children exposed to domestic violence show a fourfold increase in both internalizing and externalizing disorders—should inform clinicians and judges about what custody arrangement is in the best interest of the child. An interesting discussion of a biological model for aggression suggests that psychopharmacological interventions used to address impulse control, anger, and aggression should be helpful in treating abusive men.

Judy Chew's book on therapeutic group work for women survivors of childhood sexual abuse will be of great interest to clinicians who run groups for survivors of childhood sexual abuse and to therapists who refer their patients to groups. Dr. Chew draws on principles of narrative therapy and solution-oriented and Ericksonian approaches in the setting of the group as a supportive, healing community.

Any clinician not already schooled in these approaches would do well to read Chew's book with a library at hand. This book is unusual in that it is not quite a manual and is much more than a manual. There is not enough detail for it to serve as a how-to book for the first-time group leader, but the schematic prose, often relying on lists of questions and brief ideas, could well serve as a template for a longer, richer book on this important subject.

Dr. Sokoloff is assistant professor of psychiatry at the University of Massachusetts Medical School in Worcester.

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