Child Abuse & Neglect, Vol. 19, No. 12, pp. 1423-1429, 1995 Copyright © 1995 Elsevier Science Ltd Printed in the USA. All rights reserved 0145-2134/95 $950 + .00 Pergamon 0145-2134(95)000105-0 M O T H E R H O O D A M O N G INCEST SURVIVORS TAMAR COHEN Meital-Israel Center for Treatment of Child Sexual Abuse, Jerusalem, Israel Abstract--This is a preliminary report of an investigation of the maternal functioning of woman survivors of child sexual abuse. One possible long-range consequence of child sexual abuse is its effect on the victim's future ideas about parenting, as well as her functioning in this role. Clinicians have observed a multigenerational "transmission" of this abuse, yet most empirical findings are insufficient in substantiating this notion. A study group of 26 mothers who are adult survivors was compared with a control group of 28 mothers with no such abuse in their background. Seven areas of parenting skills were investigated: role-image, objectivity, expectations, rapport, communication, limitsetting, and role-support. Significant differences were found on all seven scales, characterized by a tendency of the study group to be less skillful in the maternal functioning than the control group. Particularly high differences were found on the scales of role-support, communication, and role-image. Secrecy, shame, and self blame, so often associated with this abuse, are offered as partial explanation of the study group's general undeveloped social skills. However, other factors, such as age of onset and termination of the abuse, its severity as well as family dynamics and relationship, may contribute to these results. Further research in this area is therefore needed. Meanwhile, therapists should pay more attention to the maternal functioning of CSA survivors who are under their care. Key Words---Child sexual abuse, Incest victims, Motherhood. STUDIES OF THE future impact of child incestuous abuse show that women who were victims experience a variety of difficulties. Among them are sexual dysfunctions and difficulties in heterosexual relationships, low self-esteem, a propensity toward repeated victimization in various forms, various psychiatric disorders including PTSS and dissociative disorder, and antisocial behavior such as prostitution, delinquency, alcohol and drug abuse (Baisden & Baisden, 1979; Gelinas, 1983; Herman, 1981; Meiselman, 1980; Silbert & Pines, 198l; Tsai, Feldman-Summers, & Edgar, 1979). One possible sequelae of childhood incest is its contribution to the victim's ideas about parenthood, and consequently to the survivors' function in this role. The paucity of a systematic inquiry into this area is indeed surprising since most professionals tend to accept the probability that this form of child abuse effects a sizable segment of the female population. Such an inquiry assumes even greater social importance when we consider that in our society women still have almost exclusive responsibility for raising children. Mothering might indeed prove to be a problematic consequence for the adult woman who was a victim during their childhood, as can be inferred or surmised from the few existing empirical studies. For example, reports on exposed cases of incest describe families in which one or both parents were themselves victims of this abuse in their childhood. These reports give the impression that incest may "pass" in families from one generation to the next, and while intergenerational transmission of incest is not inevitable, a few clinicians attempted to postulate a model of continuity of this abuse (Cohen, 1983; Gelinas, 1983; Kaufman, Peck, & Presented at the 10th Congress of the International Society for the Prevention of Child Abuse and Neglect, Kuala Lumpur, Malaysia, September 1994. Received for publication February !, 1995; final revision received May 30, 1995; accepted June 1, 1995. Reprint requests should be addressed to Tamar Cohen, Ed.D., 14 lbn Gabirol Street, Jerusalem, Israel, 92430. 1423 1424 T. Cohen Tagniri, 1954; Lustig, Dresser, Spellman, & Murray, 1966). In addition, an incestuous background was found in mothers who exhibited other forms of child maltreatment or were at risk of doing so (Cole & Wooleger, 1989; Cole, Wooleger, Power, & Smith, 1992; Egeland, Jacobovitz, & Papatola, 1987; Goodwin, McCarthy, & Divasto, 1981; Newberger, Gremy, Waternaux, & Newberger, 1993). Accumulated clinical observations of mothers who were victims of incest and sexual abuse point to several areas of difficulties in their maternal role: Gelinas observed that those mothers find it difficult to provide an organizing dally structure for their children, and to sustain a reasonable balance of discipline and affection (Gelinas, 1983). Herman reports that these mothers show an inability to derive satisfaction from the maternal role and relates it to their unrealistic standards and expectations (Herman, 1981). A heightened sense of responsibility, hypervigilance, and inability to use support systems was observed as well (Cohen, 1987). Clinicians suggest that these difficulties may tax the mother emotionally, thus hinder her ability to cope with the " n o r m a l " demands of her children. These reports hold a general difficulty that stems from their use of clinical observations, or the utilization of small samples drawn from reported cases of child maltreatment. In both cases, the generalizability of the reported findings to all mothers who were incest victims is questionable. This preliminary investigation of mothers who were incest victims is an attempt to fill the gap of knowledge and contribute to the understanding of the problem by addressing both the issue of the sample base as well as that of objective, quantitative inquiry. Sample The subjects for this study consisted of 54 mothers. The focal group (N = 26) was drawn from the total caseload at Meital Israeli Center for Treatment of Child Sexual Abuse. Meital offers clinical therapeutic services to children an adolescents who were victims and their families as well as to adult survivors, and operates regional activities in the three largest cities in Israel. About half of its caseload (53% in 1993; 52% in 1992) are adult survivors, of which 73% were female. Twenty-eight clients at the middle stage of therapy were contacted, of which 26 agreed to participate. A control group was drawn from among professionals in the community who attended lectures on child sexual abuse. From the 30 willing to participate in the study, we collected demographic information. Information about the possible existence of CSA among the control group was collected as well, and revealed that of the 30 participants, 2 had experienced this form of abuse. The two questionnaires were therefore excluded from the control group. We have thus reached a control group consisting of 28 mothers with no incestuous background. The data on the past sexual abuse among the focal group reveals that of the 26 mothers, 16 (61.5%) reported on consummated intercourse, sodomy, and oral sex. Nine of them (34.6%) experienced various forms of molestation or simulation of sexual intercourse, and one woman (3.9%) reported voyeurism and sexual exhibitionism. The average age at onset of sexual abuse was 7 years and average age if its cessation was 14 years. The average age in the focal group was 37.3 years and in the control group 42.4 years (standard deviation for the two groups was 7.3 and 9.5, respectively). There was no difference in educational background between the two groups: 39% of the mothers in the focal group held academic degrees, 54% graduated from high school, and 7% had elementary education. Among the mothers in the control group, 52% had academic education and 43% completed high school. Marital status was quite similar in both groups: In the focal group, 81% were married and in the control group, 96% were married. Similarly, no differences were found between the two groups in the socioeconomic status of the families of origin, or their parents' education. Motherhood among incest survivors 1425 Measures A. The measure used to determine maternal functioning was the Parenting Skills Inventory (PSI). The PSI is a known tool developed by Nash (Nash & Morrison, 1984) for assessing ordinary parenting skills. The questionnaire consists of 86 agree-disagree items that measure self-reported feelings, attitudes, and behaviors descriptive of parenting skills. It is used for assessment of parenting skills in seven areas: I. Role Support (11 items): explores parental cohesiveness--agreement versus lack of agreement between parents concerning the children, joint effort, cooperation, mutual support and assistance versus rigid role expectations, noncooperation, cross-purpose, and lack of shared responsibility. 2. Role Image (10 items): explores positive, self-assured, confident and enthusiastic perception of self as a parent, versus negative, insecure-unsure, overwhelmed or exhausted perception, colored by feelings of inadequacy, incompetence, failure, guilt and defensiveness. 3. Objectivity (11 items): measures balanced, "cool-headed," encouraging and reassuring attitude versus fearful, over-involved, intrusive and overprotective approach to the child; thus it explores the existence of a balanced perspective on the part of the parent toward the child, which enables the child's independent problem solving an autonomy. 4. Expectations (11 items): This scale explores realistic, reasonable, fair, and democratic expectations versus unrealistic, unreasonable, rigid-inflexible and autocratic expectations for the child's age and level of development. 5. Rapport (14 items): This category explores the existence of mutual acceptance, warmth and closeness between parent and child versus rejecting, unaccepting attitudes on the part of the parent and the lack of rapport or closeness in the parent-child relationship. 6. Communication (10 items): This scale explores communication skills--the ability of the parent to communicate in an open and direct manner, share positive or negative feelings, listen with empathy and facilitate resolution of conflicts and problems versus an inability or reluctance to share feelings, a tendency to be indirect and manipulative, poor listening skills and alienating behavior. 7. Limit-Setting (19 items): This category explores the parent ability to set logical, influential, consistent and effective limits and to structure appropriate consequences for "out of bound" behavior versus an inability to secure the child's world by means of rules and limits and an inability to follow through when the child "misbehaves." These seven scales are relatively independent of each other and yield high internal reliability scores. The questionnaire was translated from English to Hebrew by two independent professionals, then back to English by a third one. B. Additional information was collected about both focal and control groups. This information, also in the form of a questionnaire, included family background, present socioeconomic status, as well as past existence of family violence, sexual, physical, or emotional abuse or neglect. We have also collected specific information from the focal group about their past sexual abuse. Administration Clinical social workers, experienced in the field of child sexual abuse, administered the PSI to the focal group, and collected the additional data. Information about the past sexual abuse was obtained through a questionnaire and a structured interview. The average time for each interview was two hours. A student in a graduate social work program administered the PSI to the control group. Collection the data was spread over several months during 1992/1993. 1426 T. Cohen Table 1. PSI Scales: Internal Reliability Coefficients: Means and Standard Deviations Mothers with Incest Background Control Group Eta PSI Scale KR-20 N Mean Score SD N Mean Score SD T Square Role Support Role Image Objectivity Expectations Rapport Communication Limit Setting 0.87 0.68 0.54 0.53 0.54 0.74 0.76 23 26 26 26 26 26 26 5.8 6.0 6.9 6.8 10.8 5.7 13.0 3.3 2.2 2.2 2.2 2.2 2.7 3.9 27 28 28 28 28 28 28 8.8 7.4 8.0 7.7 12.0 7.8 15.0 2.7 2.1 1.5 1.5 2.4 2.0 3.0 -3.6* -2.4* -2.1 * - 1.7* -I.8" -3.2* -2.1 * 21.3 9.9 8.0 5.3 5.9 16.6 8.1 *p < 0.05 (one-tailed test). Statistical Analysis A l l answers to the PSI questionnaire were c o d e d (value o f " 1 " was given to answers expressing high, positive response and " 0 " to low level response). Internal reliability score for each o f the seven scales was calculated, using KR-20. The averages and SD o f each o f the seven scales was calculated for both the focal and control group. A T-test for independent samples was then applied to each one o f the scales, in order to determine t h e statistical significance o f the differences b e t w e e n the means o f the two groups. Next, effect size o f the g r o u p ' s means for each scale was calculated using Eta Square. In addition, and in order to establish that the results were not due to the age difference found between the two groups, an A N C O V A was calculated for each scale. Finally, a Discriminant A n a l y s i s was carried out in order to estimate the j o i n t contribution o f all PSI scales to the differentiation b e t w e e n the two groups, as well as to estimate the unique contribution o f each one o f the scales. RESULTS The c o m p a r i s o n o f parenting skills show that mothers who were incest victims generally function on a l o w e r level than mothers w h o d i d not experience this c h i l d h o o d trauma. The m e a n scores o f PSI scales for both groups are presented in Table 1. A s can be seen from this table, the m e a n score on each o f the seven scales a m o n g mothers w h o were victims was l o w e r than that o f the control group, and these differences are statistically significant. Large differences were found b e t w e e n the means o f the two groups on the scales o f Role S u p p o r t and C o m m u n i c a t i o n . H o w e v e r one should be cautious in concluding that Table 2. Standardized Discriminant Function Coefficients of PSI Scales PSI Scale S.D.F. Coefficient Role Support Communication Role Image Rapport Expectation Limit Setting Objectivity 0.68 0.64 0.42 -0.34 -0.13 -0. I 0 -0.09 Motherhood among incest survivors 1427 these two areas are affected more severely by the past trauma, than other areas, as this unusual result may be partially due to differences in reliability of these seven scales (see Table 1: KR20 column). Since there was a difference in the average age between the two groups, ANCOVA was calculated on all seven scales, controlling the variable of mothers' age, but essentially the same findings were obtained. In light of these reported results, we wished to examine the contribution of PSI joint scores to differentiate between the two groups. This was carried out by calculating Discriminate Analysis (n = 50). The results of this calculation yields a Canoninal Correlation Coefficient of .59 with statistical significance; X2 = 18.5; df = 7; p < .05. Further calculation of the relative contribution of each PSI scale (Table 2) yields the following: These results reaffirm the finding concerning the possible connection between past incestuous abuse and future mothering skills. An unusual finding worth mentioning is the high and negative direction found on the scale of Rapport. A possible explanation is that mothers who were incest victims have intuitive sensitivities and identifications with their child's feelings and needs. DISCUSSION The unfolding picture of this study suggests that mothers who were incest victims function generally on a lower level than mothers who were not exposed to this trauma in their childhood. It thus substantiates clinical reports, and adds to the few existing empirical studies. Of special interest are the differential results obtained from the seven PSI scales: As can be seen from Table 1, lower differences were found on the scales of Objectivity, Expectation from Children, and Limit Setting. One may ponder that the parenting skills measured by these three scales are more clearly defined by community standards and social expectations, thus given to easier learning and internalization than the skills measured by the other PSI scales. Indeed the general plight of women who were incest victims, and the specific difficulties they experience as mothers may well be linked to the past abuse. Incest and child sexual abuse is above all a betrayal of the child's trust, and as such it nlay hinder the victim's developing ability to trust others. In addition, these mothers may experience a constant fear that their children may also become victims, a fear which contributes to their seclusion. The past abuse may thus inhibit the victims from enlisting the support of husbands and friends in sharing child care responsibilities, leaving them overburdened and overextended with the unavoidable result of physical as well as emotional depletion. Future difficulties in the mothers' perceived role image which was evident in this study, can also be traced to past sexual abuse and the family dynamics. Motherhood is, after all, not only a biological act, but a socially learned role, the capacity for which is psychologically developed through relational transaction within the family. (Benedek, 1959; Chodorow, 1978; Welldon, 1988). Past parentification and especially mother-daughter role reversal and alienation so prevalent among incestuous families, may contribute to a general distortion of the psychological capacities for mothering, and also to future unrealistic perception and expectations regarding this role. Communication skills may be adversely affected by the past sexual abuse and specifically linked to its secretive nature: The ensuing subjective experiences of the child victim are ones of isolation, inadequacy and guilt over the past abuse, and the grown woman may continue to feel responsible for its past occurrence--as well as its continuation long after its cessation. The resulting reluctance, shame and fear to share her past abuse, coupled with "learned submissiveness" in her family of origin, may well interfere with her developing ability to 1428 T. Cohen communicate freely and openly, thus constrict her capacity in general, and eventually hinder open and spontaneous expression of feelings towards her children. Critic and Implication This study addressed the question o f the relationship o f present motherhood to past incestuous abuse. The findings which were presented are very preliminary indeed, yet suggest that the effects of this abuse may hinder the victim's future capacities for motherhood, and that the long range consequences o f incest and child sexual abuse may thus prove to last 1 0 - 1 5 years. H o w e v e r the results which are reported should be considered with some caution: First, the sample base of the focal group consisted o f w o m e n who sought therapeutic help regarding their past abuse. A comparison of mothering among clinical group with a nonclinical group of mothers who were incest victims is necessary. An even better design would be a nonclinical sample drawn randomly from the community where those women with abuse histories were compared with w o m e n without abuse in their past. Another possible control group might be a clinical group with no history o f abuse. We may be seeing an effect due solely to the women feeling insecure about their mothering due to mental health issues independent of abuse histories. Secondly, a more refined PSI tool, with higher reliability score is needed to validate the findings. O f special importance is an inquiry and a careful analysis of the differential effects and contribution of the various elements o f the past abuse to future maternal functioning. Other mediating variables should be studied as well. Mothers who were incestuously abused are nonetheless concerned and extremely sensitive to the needs and feelings o f their children. The deficiency in their parental skills requires the development o f specific programs: A cognitive guidance program that emphasizes children's normative stages o f development seems appropriate. Such a program should also include learning of acceptable parental responses to the child and techniques that will strengthen mother-child relationship. REFERENCES Baisden, M. J., & Baisden, J. (1979). A profile of women who seek counseling for sexual dysfunction. American Journal of Family Therapy, 7, 68-76. Benedek, T. (1959). Parenthood as a developmental phase. Journal of American Psychoanalytic Association, 7, 389417. Chodorow, N. (1978). The reproduction of mothering: Psychoanalysis and the sociology of gender. Berkeley, CA: University of California Press. Cohen, T. (1983). The incestuous family revisited. Social Casework, 64, 154-161. Cohen, T. (1987). Experiences of motherhood among women who were victims of childhood incest. Doctoral Dissertation, University of Michigan, Ann Arbor, MI. Cole, P. M., & Wooleger, C. (1989). Incest survivors: The relation of their perceptions of their parents and their own parenting attitudes. Child Abuse & Neglect, 13, 409-416. Cole, P. M., Wooleger, C., Power, T. G., & Smith, K. D. (1992). Parenting difficulties among adult survivors of father-daughter incest. Child Abuse & Neglect, 16, 239-249. Egeland, B., Jacobovitz, D., & Papatola, K. (1987). Intergenerational continuity of abuse. In J. Lancaster & R. Gelles (Eds.), Biosocial aspects of child abuse. New York: Jossey-Bass. Gelinas, D. J. (1983). The persisting negative effects of incest. Psychiatry, 46, 312-332. Goodwin, J., McCarthy, T., & Divasto, P. (1981). Prior incest in mothers of abused children. Child Abuse & Neglect, 5, 87-95. Herman, J. (1981). Father-daughter incest. Cambridge, MA: Harvard University Press. Kaufman, I., Peck, A. L., & Tagniri, C. K. (1954). Family constellation and overt incestuous relation between father and daughter. American Journal of Orthopsychiatry, XXIV, 266-277. Lustig, N., Dresser, J. W., Spellrnan, S. W., & Murray, T. B. (1966). Incest: A family group survival pattern. Archives of General Psychiatry, 14, 31-40. Motherhood among incest survivors 1429 Meiselman, K. C. (1980). Personality characteristics of incest history in psychotherapy patients: A research note. Archives of Sexual Behavior, 9(3), 195-197. Nash, L., & Morrison, W. L. (1984). Manual for the parenting skills inventory. Seattle, WA: Parenting Press. Newberger, C. M., Gremy, I. M., Waternaux, C. M., & Newberger, E. H. (1993). Mothers of sexually abused children: Trauma and repair in longitudinal perspective. American Journal of Orthopsychiatry, 63(1), 92-102. Silbert, M. H., & Pines, A. M. (1981). Sexual child abuse as an antecedent to prostitution. Child Abuse & Neglect, 5, 407-411. Tsai, M., Feldman-Summers, S., & Edgar, M. (1979). Childhood molestation: Variables related to differential impacts on psychosexual functioning in adult women. Journal of Abnormal Psychology, 88(4), 407-419. Welldon, E. V. (1988). Mother, Madonna, whore: The idealization and denigration of motherhood. New York: Guilford Press. R6sum6----Cet article donne un rapport pr61iminaire sur une enqu~te aupr~s de femmes agress6es sexuellement durant leur enfance, afin de voir comment elles fonctionnent aujourd'hui dans ieur r61e maternel. On estime qu'h long terme, ces agressions affectent la faqon dont les victimes envisagent leur r61e maternel et leurs capacitEs en ce sens. Les cliniciens ont observe que ces agressions semblent se transmettre de gEn6ration en gEnEration pourtant les constats empiriques n'appuient pas cette notion. L'Etude a compar6 28 m~res non abus6es et 26 m~res survivantes d'agressions sexuelles en enfance, selon sept aspects de la comp&ence maternelle : I'image que les m~res se font du ce r61e, l'objectivitE, les attentes, la capacitE d'Etablir une relation, la communication, la capacitE de poser des limites l'enfant, et l'appui du r61e. Pour chacun de ces aspects, on a remarquE des differences importantes, h savoir que les m~res agress6es Etaient moins dou6es en temps que parents, principalement Iorsqu'il s'agissait du support dans le r61e, de la communication et de l'image du r61e. Ceci peut s'expliquer en partie par certaines conditions entourant les agressions, soit son aspect secret, la honte et le bl~rne de soi--traits typiques du phEnom~ne des agressions sexuelles. Toutefois, d'autres facteurs pourraient jouer : I'~ge o/l les agressions ont commence, l'age ou elles se sont terminEes, leur gravit6, la dynamique familiale et la qualit6 des relations entre les membres de la famille. I1 faut davantage pousser les recherches, et entre temps, pr&er attention aux capacit6s matemelles des fammes jadis agress6es. Resumen--Este es un informe preliminar de una investigaci6n sobre el funcionamiento materno de mujeres que fueron vfctimas de abuso sexual en la infancia. Una posible consecuencia a largo plazo del abuso sexual infantil es su efecto en las futuras ideas de las vfctimas acerca de la maternidad, asf como su funcionamiento en este papel. Los clfnicos ban observado una "transmisi6n" intergeneracional de este maltrato, a pesar de que la mayoria de los hallazgos empfricos son insuficientes en la comprobaci6n de este concepto. Un grupo de estudio de 26 madres que fueron vfctimas de abuso sexual en la infancia fueron comparadas con un grupo control de 28 madres sin tal abuso sexual en su historia personal. Se investigaron siete ~treas de sus habilidades parentales: autoimagen del propio rol, objetividad, expectitivas, compenetraci6n, comunicaci6n, establecimiento de lfmites y apoyo en el rol matemo. Se hailaron diferencias significativas en las siete escalas, caracterizadas pot una tendencia de las madres del grupo de estudio a ser menos h~ibiles que las del grupo control en el funcionamiento materno. Particularmente, las diferencias mils altas se encontraron en las escalas de apoyo en el rol matemo, comunicaci6n y apoyo en el rol matemo. El secretismo, la vergtienza y la autoinculpaci6n, tan a menudo asociadas con este tipo de maltrato, son ofrecidas como explicaci6n parcial de la falta de desarrollo general de las habilidades sociales en el grupo de estudio. Sin embargo, otros factores, como la edad de aparici6n y terminaci6n del abuso, su severidad, asf como la din~imica y ias relaciones familiares, pueden contribuir a estos resultados. Pot tanto, se necesita investigaci6n adicional en este :imbito. Entretanto, los terapeutas deben asignar m~is atenci6n al funcionamiento materao de las vfctimas de abuso sexual infantil que se encuentren bajo su atenci6n.
