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Abuse and the power to help

The Protector's Handbook: Reducing the Risk of Child Sexual Abuse and Helping Children Recover. By Gerrilyn Smith. Women's Press #163;6.99. - 0 7043 4417 3

Gerrilyn Smith has written a most clear and informative book. It provides a practical guide for all adults who, first, want to be able to help reduce the risk to children of sexual abuse and, second, need information on how to help children who have been abused.

This is reflected in the book's two sections, "Reducing Risk" and "Facilitating Recovery". These two sections are so important to the structure of the book, and to helping readers find their way round it, that it is a pity that the chapters in the text itself run on with no indication of where the second section starts. I hope this can be corrected in any further edition of the book.

The author is a clinical psychologist who has worked in the statutory and private sectors and for some years ran the Department of Health's postgraduate training in child sexual abuse. The book's second section is informative about the professional help available but also takes the approach that often the professionals should be helping the adults in daily contact with the children to do the helping, rather than necessarily taking this role away from them.

This view is balanced by recognition that the most severely damaged children will need very skilled professional help. Gerrilyn Smith believes that the goal of treatment is to "help the child or young person and their primary care giver achieve a sense of mastery over an experience which violated them and took away their sense of control". Treatment should convey belief in the child, help the child recover self-esteem and place responsibility firmly on the abusing adult.

At various points the book helpfully undermines stereotypes. It stresses that the majority of sexual assaults are by people who know the child, not by strangers. Sexual abuse can start at any age. It almost always involves more than one episode of abuse. It is usually premeditated, not a sudden uncontrolled urge. Persuasion and grooming over time are more common than violence, although threats and bribes are not uncommon. Teaching children to say no is not enough. The main protective task rests with adults.

There is a chapter on how adults can reduce risks, for example by talking to children about different types of touching, encouraging children to tell, and even discussing a variety of hypothetical situations with them, though not necessarily focusing just on sexual abuse.I would have liked this early part of the book to be more extensive. It moves rather too quickly into what to do if a child tells you about abuse and into signs and indicators.

One of the strengths of the book is the attention it pays to aspects of gender and race. It addresses, for example, the additional issues for children who reject their racial identity because of the identity of their abuser.

I did, however, find myself querying the bald statement that the gender of the doctor carrying out a medical examination should not be the same as the perpetrator. My view is that what is most important is to give a child a choice in this matter and not make assumptions on children's and young people's behalf.

There is a great deal of very helpful advice and information for non-abusing parents, for example about who to talk to, and what they may need themselves in the way of support. The book however glosses over the difficulties many non-abusing parents have in distancing themselves from partners who are alleged perpetrators. It moves quickly to the situation of the parent who has physically distanced herself from the perpetrator, rather than exploring the ambivalence, the pain and the practical difficulties of such separations.

I welcomed the very clear chart of signs and indicators of abuse divided into three age groups and its sub-divisions into high, medium and low probability. Indeed this chart will be useful to many professionals and the book would provide an excellent introduction to professionals, including teachers, who are new to this subject. I also welcomed its statement, all too rare in the vast literature on this subject, that "sexual abuse necessarily involves emotional abuse and physical abuse".

There are other places where some changes would make a further edition even more helpful. It is not accurate to state that "the first stage in the monitoring process is usually to call a case conference". Planning and strategy meetings usually precede such a decision.

Parents need this information, especially given the Department of Health's wish to reduce the number of cases that proceed to conferences. Overall, I found this a most helpful book that will be welcomed by parents and professionals.

Clare Roskill is project manager for child care at the Central Council for Education and Training in Social Work.

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