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Not all victims of childhood sexual abuse develop sexual problems as adults. Previous authors have examined the role of self-blame in survivors who develop such problems but have not described the specific mechanism of self-blame. This article offers an explanation based on anthetic therapy (AT), which holds that the "Inner Critic" is the source of self-blame. It describes a technique for reducing self-blame and offers a clinical example that demonstrates its application with a childhood sexual abuse survivor. (Bulletin of the Menninger Clinic, 63[2], 240-253)
The prevalence of childhood sexual abuse is well documented (e.g., DeFrancis,1971; Fritz, Stoll, & Wagner,1981; Kinsey, Pomeroy, Martin, & Gebhard, 1953; Tsai & Wagner, 1978). The resulting sexual maladjustment in adults who were sexually abused as children has been reported as occurring in such areas as sexual dysphoria, sexual dysfunction, impaired sexual self-esteem, and avoidance of or abstention from sexual activity (Browne & Finkelhor, 1986).
However, a survey of the literature reveals that not all victims of childhood sexual abuse develop sexual problems as adults. In clinical research, the occurrence of sexual problems ranged from only 45% up to 87% of the sample studied (Briere, 1984; Meiselman, 1978). In a study of mostly unmarried college students, Fromuth (1986) found no correlation between childhood sexual abuse and adult sexual self-esteem, desire for intercourse, or self-ratings of sexual adjustment.
Various explanations have been offered to account for this differential impact. For example, a study by Tsai, Feldman-Summers, and Edgar (1979) found substantial differences in adult adjustment following childhood molestation and concluded that such differences may be accounted for by such mediating factors as the features of the molestation, the feelings evoked in the victim, and postmolestation experiences. Another theory is that dysfunction occurs as a result of classical conditioning; that is, the assault acts as the unconditioned stimulus that evokes negative emotions. The learned negative reaction then becomes generalized to other sexual situations (Becker & Skinner,1983). Maltz (1988) also offers a conditioning explanation, stating that the victim learns to dissociate during the abuse in order to cope with the trauma and associated feelings of guilt and shame. She holds that current sexual experiences then trigger the conditioned response of dissociation and further guilt and shame.
The posttraumatic stress disorder (PTSD) model...