Sibling Incest

J Fam Viol (2009) 24:531–537 DOI 10. 1007/s10896-009-9251-6 ORIGINAL ARTICLE Sibling Incest: A Model for Group Practice with Adult Female Victims of Brother–Sister Incest Kacie M. Thompson Published online: 5 June 2009 # Springer Science + Business Media, LLC 2009 Abstract Working with groups of people who have been sexually abused introduces mutual experiential themes into the process that can be beneficial and meaningful. This paper discusses brother–sister incestuous sexual abuse with implications for group work. Literature and research is reviewed concerning sexual abuse, incest, family relationships, and theories that aid in explaining incest. Themes covered include: effects of incest, coping methods, blaming, and family of the victim. Common themes are explored and implications for group work are suggested on the basis of length, detail, structure, content, and pre-group contact. Keywords Sibling incest . Group practice . Group therapy Sibling incest is widely believed by researchers and clinicians to the most common type of incest (Carlson et al. 006). Historically, the issue of father–daughter incest has been most often referred to when speaking of incest as a form of sexual abuse; and the concept of sibling incest has been ignored. Despite the high occurrence of sibling incest and its negative effects, attention to this issue by the family, researchers, and professionals has been lacking (Bass et al. 2006). In fact, violence between siblings is much more prevalent than child abus e by parents (Kiselica and MorrillRichards 2007). The purpose of this discussion is to highlight the experience of victims of sibling incest by shedding light on their feelings, thoughts, and mental and emotional issues that are a result of incestuous abuse. Based on the understanding of the sibling relationship and aspects of sibling incest, a model for group therapy is introduced K. M. Thompson (*) University of Montana, Missoula, MT, USA e-mail: [email  protected] com for adult female victims of brother–sister incest. Aspects, such as sibling elationships, effects of brother sister incest, the family, blaming, coping, and theoretical frameworks, are discussed to inform group work with victims. The Sibling Relationship & Incest Siblings share a unique relationship bound by genetics, social class, history, and family connections. The sibling relationship often outlasts many other relationships (Bass et al. 2006). The sibling relationship is unique in longevity and can be one of the most influential relationships in oneâ₠¬â„¢s life. Because of this, the impact siblings have on one another should not be underestimated (Kiselica and Morrill-Richards 2007). This unique relationship that siblings share is sometimes the reason why incidences of sibling incest are regarded as â€Å"sexual curiosity†. This view of sexual curiosity is often accepted by family members and the details of that curiosity are not fully understood (McVeigh 2003). Sibling incest is defined as sexual behavior between siblings that is not age appropriate, not transitory, and not motivated by developmentally appropriate curiosity. Sexual abuse between siblings is not limited to intercourse. It has been shown that unwanted sexual advances, sexual leers, and forcing a sibling to view pornographic material can have as much of a psychological impact on the victim as actual intercourse (Kiselica and Morrill-Richards 2007). There are many forms of sexual abuse, but the negative effect incest poses on the victim and the family cannot be ignored. The sibling relationship and the causes of sibling incest have been addressed in several ways. Some authors such as McVeigh (2003), note the importance of the power dynamic between the brother and sister, as that dynamic is caused by age difference and gender expectations. Haskins (2003) 532 J Fam Viol (2009) 24:531–537 states that incest with a younger sibling by an older sibling is motivated largely by urges to satisfy underlying emotional needs for nurture and comfort rather than a need for sexual gratification. The offender’s behavior has sometimes become an outlet to express his unconscious needs. To fully understand the victim and offender’s relationship, family contexts should be examined. Perhaps the victim feels and behaves in similar ways due to the dysfunction in the family environment and the possible need for comfort and acceptance, which will be discussed in relation to family details. Common Experiences: The Effects of Sibling Incest Reactions to incestuous sexual abuse vary from person to person, depending on the severity, duration, and family reaction to the abuse. Victims of sexual abuse experience long-term difficulties including psychological, sexual, and relationship problems (Brand and Alexander 2003). Victims of incest have many feelings, emotions, and issues to deal with in order to cope with the abuse they experienced. Victims of sibling incest exhibit a wide variety of psychological problems. Sexual sibling abuse creates fear, anger, shame, humiliation, and guilt (Kiselica and MorrillRichards 2007). Along with those feelings, victims can also have severe depression and feelings of helplessness (Martens 2007). Sometimes these feelings can lead to suicidal thoughts, and sexual promiscuity; two aspects that are very common in sexually abused women (Rudd and Herzberger 1999). In order to understand the many effects of abuse and the long-term consequences, aspects, such as blaming, coping, and forgiveness, will be addressed under the framework of issues to be addressed during group work with victims of sibling incest. Family of the Victim Family systems theory has been utilized by clinicians to aid in the understanding of sibling abuse. Family systems theory supports the understanding of the sibling relationship within the familial realm by viewing the sibling relationship as just one piece in the family puzzle. The family environment is an interactive, interdependent network in which the behavior of each individual or subsystem modifies the behavior of other individuals or subsystems. This environment is quite intimate, and if the network begins to break down, it often fosters violence. Through this, the family systems outlook shows that sibling abuse and incest cannot be considered an isolated problem but should be seen as a manifestation of family dysfunction (Haskins 2003). The importance of the family should always be examined in cases of sibling incest. Bass et al. (2006) note that each member of the family will hold a unique perspective and position on the issue of incest and sexual abuse; which in turn models how the woman involved in that abuse will react or respond to the abuse and the treatment that may follow. Sibling incest occurs in families with some common characteristics (Phillips-Green 2002). Abusive and incestuous families have high levels of personal, social, and economic stress; substance abuse; and exaggeration of patriarchal norms; and parenting skills are consumed with high levels of frustration, with punitive or harsh childrearing styles (Haskins 2003). Systems theory aids in the understanding that what one person does effects another, which effects another. The family dynamics that housed the sibling abuse can have negative effects on the victim in how she views herself and how she will parent her children based on how she was raised. Whatever the case, sibling incest is painful and damaging, whether the families are relationally connected or distant (Bass et al. 2006). Not only does the family play an important role in examining the bigger picture of the victim’s life, but it also provides insight into the individual and her treatment process. With brother–sister incest, the victim and the perpetrator are both in the family unit, and that unit can be strongly effected by disclosure of abuse. Disclosure can create emotional distress which may lead to the breakdown of the family, disclosure can also cause blaming to occur. It has been shown that blaming is often a large factor in the disclosure process. The parents and teachers often blame the victim for the abuse instead of providing support (McVeigh 2003). The victim has already endured the abuse, the shroud of secrecy, and in the moment she thinks she will begin to overcome this abuse she is often ridiculed and blamed for causing the abuse that was inflicted upon her. Cyr et al. (2002) hypothesize through their research that when blaming from the parents occurs, the mother is placed in a loyalty bind, having to choose between her daughter and her son. Depending on the type of relationship the mother has with each child, the blaming could be greatly influenced. The issue of blaming can be reciprocal, as the victim may then blame herself and her mother. Blaming Just as the victim is often blamed for the abuse she endured, blaming can occur by the use of self-blame or by motherblaming. Blaming the self for events that happened are not only damaging but are often associated with feelings of guilt relative to the abuse (Morrow and Sorell 1989). Women that have experienced brother–sister incest may also feel unsafe, and when she believes that she is the one J Fam Viol (2009) 24:531–537 533 to be held responsible for the wrongdoing, she will turn any feelings of rage and hostility away from the perpetrator or her family and place them on herself (Schlesinger 2006). Self-blame and mother-blaming are common ways to deal with feelings of guilt and anger. Mother blaming is supported by the notion that the mother is in some way responsible for the acts of the victim’s brother. Victims of incest often internalize anger, directing hatred and aggression against themselves. When these feelings become too intense, the victim copes with this by focusing her anger on her mother, which allows the victim to externalize her feelings (Jacobs 1990). Looking at family dynamics as well as the specific relationship the victim has with her mother can be useful in understanding coping methods through blaming. processing for the resolution of the trauma, as well as increase the likelihood for poor day to day adult functioning (Brand and Alexander 2003). With a deeper understanding of coping methods, there may be an enhanced opportunity for educating the individual who exhibits those behaviors, as well as other group members. Group Therapy The use of group therapy can be very effective with a variety of populations, especially those that have experienced incest. Group therapy can provide a unique opportunity for self and interpersonal learning because it allows for members to address effects of interpersonal victimization by identifying with other members who have had similar experiences (Wanlass et al. 2006). Although little is known regarding best practice measures to treat victims of sibling incest, options for treatment have been discussed based on the fact that each victim of sexual abuse will be different in the treatment process (Martens 2007). There are several characteristics of sexual abuse that can affect not only the victim, but the treatment process as well. Aspects such as duration of the abuse and the use of force should be examined. As mentioned earlier, the family dynamic should be looked at as well though the lens of how the victim’s disclosure of abuse was received. The victim will be coping with not only the abuse, but the impacts disclosure may have had on the family and the victim as well. Rudd and Herzberger (1999) note four common characteristics among victims coming to receive treatment: enforced secrecy, interpersonal power differentials, influences on sexual development, and individual aftereffects. These researchers state that abused women often felt that by tolerating the abuse and keeping it a secret was a way to hold the family together. This aspect of secrecy in the incestuous relationship is also connected to power dynamics within the relationship. These characteristics as well as sexual development and individual aftereffects can be examined including other issues discussed earlier. Focusing on building strength and resilience in group therapy has been noted by Wanlass et al. (2006) and Anderson (2006). Both authors contend that working through the abuse during the group process can be seen as â€Å"surviving† the abuse, which is an example of resiliency. The group therapy process can be structured and focused to maximize skills associated with resiliency, leading to improved treatment outcomes (Wanlass et al. 2006). Anderson (2006) discusses a change in perspective of how the victim views herself; from the victim to the survivor; which can aid in the process of forgiveness. The topic of forgiveness may be valuable to group members, depending on where each member is in her process of Coping When considering group therapy with women who have experienced sibling sexual abuse, coping mechanisms should be examined to understand what issues and problems the individuals may have due to their coping skills. The way each individual copes with the abuse can be connected to any diagnosis that they may have been given as a result of the abuse. For example, many victims of trauma, especially sexual related trauma display characteristics of Post Traumatic Stress Syndrome (Banyard and Williams 1996). In these situations, group members may need to be taught coping strategies to manage traumarelated anxiety (Foa et al. 1999). Paying close attention to the possibility of or presence of a disorder will be very helpful in group work. Coping has been examined in many ways to aid in the process of understanding how individuals respond to trauma and stress. Brand and Alexander (2003) state there are two types of coping strategies: emotionfocused coping, and problem-focused active coping. Becoming more aware of both of these style of coping will greatly influence effectiveness of group work. Emotion focused coping is rooted in the individual trying to regulate their emotions in dealing with the abuse, and problem-focused active coping is when individuals engage in behaviors in an attempt to manage the problem situation. An example of problem-focused coping is when an individual tries to manage her stress from the abuse through an eating disorder behavior. While the group facilitator learns more about the group members, behavior such as these may arise in discussion. Other coping methods that have been identified include the coping strategy of avoidance. Previous studies have stated that avoidance may be an initial way to cope with the stress of sexual abuse, but in the long term sense the avoidance strategy may increase future symptoms and cognitive 534 J Fam Viol (2009) 24:531–537 understanding the abuse she experienced. Working on forgiveness with group members may aid in the reduction of feelings that cause depression, fear, and anxiety by channeling those feelings and discussing options for positive coping though forgiveness and resiliency. Theoretical Frameworks Guiding Practice Research and information discussed thus far has roots in theory. These theories could lead to a deeper understanding and an enhanced framework for the discussion of incest as well as aid professionals in group work. Attachment theory, symbolic interaction theory, family systems theory, and feminist theory outline the theoretical framework that guides practice with female victims of incest. As mentioned earlier, much of the discussion of incest has its foundation in family systems theory and the significance of relationships family members have ith one another. Alexander and Anderson (1994) note that the family context associated with the abuse often explains more of the long-term effects than the abuse itself. Attachment theory lends itself to this notion by stating that the parent–child relationship is just as important to the child as eating and sleeping. Based on the child’s â€Å"internal working model† of relationships modeled by the parent–child relationship, that model governs how interpersonal relationships are viewed and experienced (Alexander and Anderson 1994). The goal of incorporating an attachment perspective is one of helping the client increase flexibility of though and views in interpersonal relationships beyond the parent– child relationship. This could be especially useful if there have been negative interactions as well as if blaming is occurring. Symbolic interaction theory aids in the exploration of incest by looking at aspects, such as frequency of abuse, degree of self-blame, and family disruption, in relation to how the victim will manifest her self-concept (Morrow and Sorell 1989). Through this theory, how the individual who experienced the abuse views herself is viewed as a social product constructed and developed by the social interactions around that individual. Once again, family relates to this theory and explanation of factors surrounding incest and sexual abuse, but it also reaches beyond to include other important social interactions, such as friends, classmates, etc. Understanding the social constructs present in the victim’s life can create a better understanding of what needs to be dealt with and recognized for effective group therapy to occur. The feminist framework of incest and the victim is centralized around gender and oppression, and the roles that males and females play in society. As discussed earlier, Anderson (2006) speaks of the importance of changing the viewpoint of â€Å"surviving† abuse to overcoming and resisting the abuse through resiliency. This idea of becoming resilient by resisting oppression is focused in categories found to represent resiliency in the face of oppression: being powerless, being silenced, and being isolated. Not only do all three of these aspects describe how an incest victim feels, but Anderson (2006) also argues that they correlate with oppressive resiliency. Introducing this idea of not being an incest ‘survivor’, but being a resilient person with qualities to be proud of, seems much more empowering, and is a great representation of an example of how feminist theory can be applied to group work with victims of incest. Moving past sentiments of oppressed within one’s feelings as well as within society due to one’s gender can be helpful for the victim, especially within a group setting. People can often find strength in numbers, and if other members are making the same conclusions about their lives and their experiences, positive progression can occur. Kreidler and England (1990) make an important point: â€Å"Because incest isolates victims and encourages feelings of guilt, incrimination, and shame, group experiences allow survivors to build self esteem and develop relationships in a protected environment†. Through this, the group process fosters autonomy and a sense of control in its members. Group Model Group therapy for adult female victims of sibling abuse can be approached in many ways. Group facilitators must be able to assist their clients in making sense of their trauma and work through negative emotions, as well as to teach group members healthy and adaptive coping strategies (Wanlass et al. 2006). The basics of group work will be rooted in helping group members work through their experiences while processing their emotions. Through this, connections will often be made with other members based on the shared experience of brother–sister incest. Focus should not only be on the present, but the victim should be able to make connections to the abuse and how her life has been affected. Victims of sibling incest have lifelong problems in many areas including marriage, work, and parenting (Phillips-Green 2002). Once group members begin to make those connections, the possibility for positive change may increase. Northen and Kurland (2001) emphasize the importance of thorough and thoughtful planning to the success of group work (p. 109). In order to address the topics and concerns discussed throughout this paper, the intake process should be thorough in detail and always take into account the elements of the brother–sister incest, finding out if force was used, how long the incest occurred, etc. The facilitator in charge of creating the group should be involved in the intake of members, as well as choosing the time and place J Fam Viol (2009) 24:531–537 535 where the group will meet. The length of the group sessions should be considered. Group therapy can be short term or long term, depending on the desired goals of the facilitator and the needs of group members. Sparks and Goldberg (1994) propose a short term group that is centered within re-educating victims about the dynamics of incest. Victims are often unaware of the widespread incidence of sibling incest experiences, and may feel much less alone in their feelings and issues as a result of the abuse. These authors note the sense of empowerment that women feel by telling their story to others who share similar experiences, as vocalizing the abuse sets it â€Å"free† and places it in the open, as well as helps the woman to continually break feelings of secrecy. There can be advantages and disadvantages to short-term and long-term group models. Short-term groups are more effective for creating connections between victims around a shared experience, but due to the severity and seriousness of sibling incest, the author proposes a long-term group specifically for women who have experienced brother– sister incest. Long-term groups offer more of an opportunity to address issues such as sexuality, sexual dysfunction, and other issues such as secrecy, isolation, and suicidal thoughts that victims often carry with them throughout their lives. This long-term group is a 12-week format, with meetings once per week at two hours per session. Depending on the size of the group and the characteristics of members, private individual sessions outside group meetings may also be arranged. Size can vary, but should be limited to 10 women. Northen and Kurland (2001) make the point that the smaller the group, the more demand on members to be fully involved in the group, and then there is more demand for intimacy of relationships (p. 136). Sparks and Goldberg (1994) mention the importance of realizing that many survivors will be suspicious of anyone in the counselor/professional role because they many have felt they experienced further violation and betrayal from any previous treatment. To begin to look at this, it may be helpful to ask women during intake if they have gone to any treatment previously, as well as how they felt about it. The facilitator should be aware of this prior to the first meeting. The facilitator also needs to make group members aware of the time commitment during the intake process, making sure they know that missing sessions is not encouraged. A possible therapy method that can be incorporated in group work is the use of Cognitive Processing Therapy for Sexual Abuse (CPT-SA). This treatment is an adaptation by Chard et al. 1997) of Cognitive Processing Therapy for rape victims and is intended to extend treatments for childhood sexual abuse by addressing sexual abuse responses and aspects of the abuse (Chard 2005). This 17week therapy method combines the use of individual and group therapy to maximize positive results by utilizing the benefits of group work as well as giving group members individual attention throughout the group process. Alt hough this method is not discussed at length in this paper, it may be useful to examine facets of CPT-SA for possible incorporation in group work with incest victims. The goals, strategies, and topics included in treatment will vary from therapist to therapist; and the goals and topics included in therapy typically reflect the therapists’ own assumptions of the impact of child sexual abuse (Beutler et al. 1994). This author suggests topics that should be addressed in the group are: emotions and feelings, sexuality, family history, effects of disclosure, power/feeling of powerlessness, secrecy, relationship with the offender, relationship with family members, current coping skills, and options for positive change for the future. These can be modified week to week. There really is no way to run a group in a step-bystep manner, as the group process is unique in itself as it takes shape and changes course all on its own. Topics can be presented to the group if there seems to be a lack of conversation or comfort with one another, but once the group members get to know one another topics and discussions will take shape and find their way into discussions even if there isn’t a definite â€Å"plan† for the group that day. For the use of an example, a basic proposed model for group may include: Week 1: Learning about each other What brings you here? Tell us about yourself. How do you feel about being here? Activities may be used to â€Å"break the ice†, writing exercises, etc. Week 2 & 3: The Family and Disclosure What is your relationship with your family like? Discuss dynamics of the family. What happened when you told about your abuse? Blaming may be discussed here. Week 4 & 5: Relationship with your brother Relationship changes, start and end of abuse, where the perpetrator is, how that makes you feel. Week 6 & 7: Depression, guilt, anger, sexual promiscuity. What are you dealing with now? How has the abuse effected you long term? How have you changed? Week 8 & 9: Coping strategies, positive outlets, self esteem, strength, resilience Week 10, 11, & 12: Reflection and growth, closure and celebration The topics included in this example will likely blend and flow from week to week, and should not serve as a rigid foundation for group. Through these suggestions, the facilitator can help the abused woman feel that her sense of victimization is valid, she can help the victim remove 536 J Fam Viol (2009) 24:531–537 self blame, and identify change patterns of self-abuse and self-degradation to promote growth and a higher selfesteem (Kiselica and Morrill-Richards 2007). Given the unique relationship that siblings share, this relationship may become a backdrop to the group process, as well as the family relationships that connect within the sibling subgroup. It is likely that these relationships will go through an on-going assessment and re-definition as group members discover more about themselves in regard to their behaviors, feelings, and relationships with others. Although topics outlined in the example could be introduced to the group for discussion, most of these topics will likely come up due to the nature of the experience and the common aspects that are seen frequently in sibling abused women. The author suggests that the group should be allowed to take their session in the direction they want it to go. To exemplify the power of each group member’s story, it is proposed that letting the group decide what they would like to discuss proves most effective. Sparks and Goldberg (1994) state that the group becomes a forum for humor and creativity as members take advantage of the unique opportunity to express what can not be expressed until someone who can appreciate it is willing to hear it. This creativity of the members should not be underestimated, and every moment of that process should be an empowering reminder for the group members. Most of the literature argues that the group facilitator(s) should be female. The possibility for a co-facilitator should be considered, depending on the size of the group. If the group is small, only one facilitator is needed. The facilitator (s) should have some knowledge and/or experience in crisis and group work. Age should also be taken into consideration. Group members should be 18 years of age and older, as this group is restricted to adult female victims. Commonality and shared experience are extremely important to the success of this group process, and grouping members based on age range will be helpful for members to relate to each other on more levels than one. During the intake process, the facilitator should attempt to arrange the groups based on what they conclude to be the most effective combination of members based on what was discussed with members prior to the initial meeting. The option for diversity should not be ignored, but O’Hare and Taylor (1983) make the important point that the group composition should always be considered in relation to making sure one person in the group does not stand out; for example, one African American woman, one lesbian woman, etc. Once again, thoughtful design of the group cannot be ignored. Group closure may include a celebration of connections and alliances made within the group. The format of closure and celebration should largely be decided by group members. Conclusion Group work with victims of sibling incest can be complex and challenging. It is clear that many factors influence the victim’s life other than the actual abuse. Family dynamics and overall relationships at the time of the abuse and disclosure prove to be extremely important in determining the entire picture of the victim. Once the facilitator becomes more educated about the details of incest and what to expect from group members, she will be able to design the group in the most effective manner. With the help of shared experience and shared knowledge, group members will find connections with one another that will maximize their growth and value of the group therapy experience. References Alexander, P. C. , & Anderson, C. L. (1994). An attachment approach to psychotherapy with the incest survivor. 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