Family Violence: A Clinical and Legal Guide

Abstract

SANDRA J. KAPLAN, ED.: Family Violence: A Clinical and Legal Guide. American Psychiatric Press, Washington, DC, 1996, 332 pp., $46.50, ISBN 0-89042010-6. A million children suffered from physical abuse in 1993 and 1,000 of them died. In 1986 there were at least 150,000 cases of child sexual abuse. Ten percent of American women are exposed to domestic violence and 2 million suffer injuries each year. In a Boston sample, 3 % of the elderly were physically maltreated, and it is estimated that a million elderly in the US are the victims of elder abuse. This book is a review of the many forms of family violence-ranging from child abuse (physical and sexual) to child neglect, domestic violence, and elder abuse. The editor, Dr. Sandra Kaplan, is Chair of the APA Committee on Family Violence and Sexual Abuse as well as a member of the Steering Committee of the AMA's National Advisory Council on Family Violence. Most of the chapters are written by Kaplan and/or one of the members of the APA Committee. The volume is well edited to make the chapters consistent in their format and content. Each of the topics are reviewed in terms of frequency or prevalence, the identity of abusers, the effects on the abused, the techniques of clinical assessment, and the treatment/ prevention for each condition. Each chapter includes a legal commentary as well as a wide selection of references. The chapter on the physical abuse of children reports that child abuse is a consequence of parental vulnerabilities (young age, mental illness or substance abuse), child vulnerabilities (difficult temperament), social stressors (poverty, single parenthood or minority status), and number of children in the family. Mothers are more often the abusers of younger children than fathers. The parents of abused children were found to have more psychopathology than comparison groups. Using a case example, the authors outline approaches to both parent and child treatment. The review of child and adolescent neglect (errors of omission, whereas abuse means errors of commission) cites abandonment, delay in health care, inadequate supervision, educational neglect, inadequate nurturing, and refusing psychological care. The children who are neglected have low self-esteem, are socially isolated and have a high rate of disciplinary referrals. The parents who are neglectful show depression, substance abuse, and spouse abuse. Treatment needed includes special education and therapy to deal with cognitive and behavioral impairments. Treatment may include respite care, family therapy, and therapy for individual parents. Therapists are cautioned about countertransference and confidentiality problems. In regard to the legal issues associated with child neglect, it is noted that all states have provisions for intervention and severe neglect may be a criminal offense. The review of child sexual abuse reports that girls are victims five times more often than boys and that intrafamilial sex abuse is the most common form. …