Re: observing intercourse

[John M Price PhD <jmprice@xxxxxxxxxx>]

On Tue, 14 Nov 2000, Steven Kairys wrote:

> Can you explain why harm may be present in clinical studies but not when more
> general survey work is done?
> 
> Is harm not really there are at all, and what is wrong with the clinical study
> if it shows there is harm?

Actually, it is quite simple.  Take the case of all the studies reviewed
by Rind et al on the two occasions (1997?, and 1998).  Both looked at the
general population of folk who had had sexual contacts with adults as
minors.  A vastly different view of the results is obtained than that
promulgated by clinical studies.  There are at least three issues here
that can affect and effect results.  

The first issue is simple size. Larger samples have more power to detect
effects.  They are probably more reliable, i.e. other studies will find
similar results.  They are also more systematic in their approach to the
subjects (usually).

A second issue is the sample itself.  You cannot generalize to the whole
population from only those that are harmed by any event.  For instance,
with the tire blowout issue, you skew the data badly when you collect
those data on blowouts by only looking at the obituaries.  Another example
might be general health.  One does not get a picture of the healthiness of
a Phoenician, for instance, by looking at all the hospitals in
Phoenix.  That is simply silly.  And that is what the clinical studies
actually do.  This sample bias is the most important part.

A third would be simply injecting the beliefs of the clinical researcher
into the study.  There is a tendency for confirmation bias as well, for
instance, through a post hoc ergo propter hoc error.  All neuroses are not
caused by sexual issues, indeed my bet is people come with them from the
start, and no real 'cause' in their personal history is definitively
'it'.  However, a clinician with a bias in sexual direction (and I'd like
to see any psychodynamic clinician who does not have a hint of that), then
discussions of past unwanted sexual encounters or primal scenes will be
given the attribution - whether or not they deserve it.

The 'temperment aspect', I allude to above can be seen even in PTSD.  The
OK City Bombing caused lots of stress, grief, etc. in its victims, however
looking at the table of data the paper studying those people
(JAMA. 1999;282:755-762) indicates that a previous psychiatric issue was
very important in determining if one develoed PTSD.

> If there is a discrepancy between clinical measures of harm and more general
> surveys in this topic then what about other topics?

As to the measures of harm, those should be the same in both areas.  They
are psychometric instruments after all.  However the effect of the events,
and indeed this (primal scene, illicit sex, bombs, crimes against persons,
etc.) is an event - not a syndrome, disease, or mental disorder.  The
clinician should not assume that these things will hurt everyone to the
degree that they see in the people who actually are so hurt.  That makes
no sense.

WRT the Rind stuff, a reasonable discussion of the issues of effect size
and I think generalizability is found in their talk in the Netherlands.  I
have a copy at:

ftp://ftp.calweb.com/users/j/jmprice/w7.pdf

Any good research design text will help as well.  Ask at your local
university's psych department what they are using, and aybe get one at the
used book cost.

In terms of clinicians attitudes toward child sexual abuse, and a nice
short paper with references to lots of the more research oriented studies
on that topic, see:

http://www.csulb.edu/~asc/child.html

which is a paper in the journal Sexuality & Culture by Tom Oellerich.  I
think this applies to the third point I mentioned.  It also discusses teh
issue of iatrogenic harm when clinicians believe what they do so strongly
as to impose those beliefs on their clients.  With kids, this is indeed
most important to keep in mind at all times.  If a kid is asymptomatic,
then maybe the clinicians should leave well enough alone, rather than hold
fast to the belief, and the real research seems to be pointing to the fact
that it is only a belief, that 'harm' must have been done, so treatment
must be given.  As Oellerich mentions, you would not go to an ER for a
'bicycle accident' event - unless there were symptoms such as a broken
arm.


> 
> Brian Morgan
> 
> Jim Christopherson wrote:
> 
> > Paul Okami had written a number of articles, published in the Journal of Sex
> > Research, reviewing the literature on this
> > topic, the general conclusion of which is that it is only in Western culture
> > with a Freudian tradition that the "primal scene" is regarded as a problem.
> > The reference for one of these articles is:
> >
> > Okami, P. (1995) ‘Chjldhood exposure to parental nudity, parent-child
> > co-sleeping and primal scenes: a review of clinical opinion and empirical
> > evidence’ Journal of Sex Research, 32, 1, pp51-64.
> >
> > In cultures where the whole family sleeps in one room, no-one would see it
> > as an issue. The evidence of harm comes from clinical studies. More general
> > survey research does not reach that conclusion.
> > Jim Christopherson,
> > Centre for Social Work,
> > University of Nottingham UK
> > -----Original Message-----
> > From: Benjamin E Saunders <saunders@musc.edu>
> > To: Child Maltreatment Researchers
> > <CHILD-MALTREATMENT-RESEARCH-L@cornell.edu>
> > Date: 23 November 1999 22:28
> > Subject: observing intercourse
> >
> > >Colleagues,
> > >
> > >I am looking for help with two issues.  First, is anyone aware of any
> > >published research examining the impact, if any, of children inadvertantly
> > >observing adults having sexual intercourse.  The prototypical example of
> > >this situation would be parents having sex with the door open and the
> > >child observing the sexual behavior without the child's knowledge.  I am
> > >not interested in intentional situations, i.e., a sexual offender has a
> > >child watch while he or she has sex with a partner in order to increase
> > >sexual gratification. Any references would be greatly appreciated.  This
> > >situation is increasingly being identified as "abuse" or neglect in some
> > >areas and I was wondering if we know anything about the impact of
> > >observing sexual activity between adults on children.
> > >
> > >Second, I am also looking for published research that examines the impact,
> > >if any, of sexual assault in childhood on victims' adult work life.  What
> > >is the impact of childhood sexual assault on occupational achievement,
> > >income achievement, work life expectancy (i.e., years of productive work),
> > >promotions and career progression, etc. Do adults assaulted as children
> > >change jobs more often?  Do they use more sick days?  Do they ultimately
> > >make less money over their work life compared to what they would have made
> > >had they not been assaulted?  Is there any evidence that there are certain
> > >jobs that CSA victims cannot do as adults because of their victimization
> > >or limitations on their work that prevent them from being able to be
> > >employed in certain jobs.
> > >
> > >Any help with any of these issues would be greatly appreciated.
> > >
> > >Thanks, Ben
> > >~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> > >Benjamin E. Saunders, Ph.D.
> > >Associate Professor and Director, Family and Child Program
> > >National Crime Victims Research and Treatment Center
> > >Medical University of South Carolina
> > >165 Cannon Street, Box 250852  (843)792-2945
> > >telephone Charleston, SC 29425 (843)792-3388 fax
> > >
> > >Visit our website at:   http://www.musc.edu/cvc/
> > >~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> > >
> > >
> 

-- 
John M. Price, PhD                                     jmprice@calweb.com
Life: Chemistry, but with feeling!      |      PGP Key on request or FTP!
Comoderator: sci.psychology.psychotherapy.moderated          Atheist# 683