Aggression and Violent Behavior 10 (2005) 604 623

Treating sibling abuse families

John V. Caffaroa,*, Allison Conn-Caffaro
a

California School of Professional Psychology, Los Angeles, United States

Received 10 September 2002; received in revised form 5 May 2004; accepted 14 December 2004

Abstract Societys awareness of sibling incest and assault, and its response, has lagged behind other child abuse issues and concerns. In comparison with parentchild abuse, intersibling abuse is generally underreported by parents, teachers, mental health professionals, and the community. Child Protective Services and the legal system are reluctant to accept and respond to sibling abuse reports that are filed. This article reviews an integrative, multidimensional approach for conducting assessment and psychotherapy with children and families where sibling abuse has occurred. Clinical examples and selected research results are included to illustrate fundamentals of treating sibling incest and assault victims and their families. Treatment for sibling incest and assault requires multidisciplinary cooperation and usually, the coordination of services among several provider systems. Like child abuse treatment in general, it is complex and challenging work that requires ongoing specialized training and ability. D 2005 Elsevier Ltd. All rights reserved.
Keywords: Siblings; Abuse; Families; Children

Contents 1. 2. Healthy sibling development . . . . . . Sibling development in abusive families 2.1. About the research project . . . 2.2. Characteristics of participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605 606 607 607

* Corresponding author. 317 14th St. Suite E Del Mar, CA 92014, United States. E-mail address: jvc@caffaro.us (J.V. Caffaro). 1359-1789/$ - see front matter D 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.avb.2004.12.001

J.V. Caffaro, A. Conn-Caffaro / Aggression and Violent Behavior 10 (2005) 604623 2.3. Frequency of sibling incest and assault by category of 2.4. Sibling incest survivors . . . . . . . . . . . . . . . . 2.5. Sibling assault survivors. . . . . . . . . . . . . . . . 2.6. Sibling incest and assault survivors . . . . . . . . . . 3. Sibling assault . . . . . . . . . . . . . . . . . . . . . . . . 4. Sibling incest . . . . . . . . . . . . . . . . . . . . . . . . . 5. Sibling abuse family configurations . . . . . . . . . . . . . 5.1. Peripheral parent families . . . . . . . . . . . . . . . 5.2. Pseudo-consensual sibling incest families . . . . . . . 5.3. Pseudo-parent sibling families. . . . . . . . . . . . . 5.4. Stepsibling abuse . . . . . . . . . . . . . . . . . . . 6. Assessment and treatment considerations . . . . . . . . . . . 6.1. Traumatic effects . . . . . . . . . . . . . . . . . . . 7. Limitations of our study . . . . . . . . . . . . . . . . . . . 8. Summary and conclusions . . . . . . . . . . . . . . . . . . Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix B . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Our siblings often constitute our ongoing sense of family. Brothers and sisters provide lifes longest lasting intimate relationship for one another, generally outlasting ties with parents by 20 to 30 years. While friendships and marriage vows may begin and end, sibling connections remain. Nonetheless in assessment and intervention with abusive families, sibling relationships are often overshadowed by a too narrow focus on parentchild interactions. Researchers say, and siblings agree that there is a deep-seated sense of obligation for many brothers and sisters. There is also a shared family history. What if that shared history is filled with violence and pain? How are sibling relationships influenced by abuse and neglect? In order to provide some answers to these questions we must first explore what constitutes healthy sibling maturation.

1. Healthy sibling development The sibling bond can be obscured by adulthood. In most families, sibling ties begin in childhood with parents writing the script. Many parents inadvertently place children in comparative categories such as, one is the bsmart childQ, another the bresponsible oneQ, etc. This unidimensional labeling can result in stunted sibling growth. In longitudinal studies, Dunn (1991) discovered that preschoolers who felt that their parents were more affectionate to them than to brothers or sisters went on to have a greater sense of competence and selfworth several years later. In contrast, the child who reports being more often on the receiving end of hostility tends to have lower self-esteem later on. What we know about sibling relationships comes largely from research conducted among children and adults in nonclinical families. These studies (Adams, 1968; Cummings

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& Schneider, 1961; Dunn, 1983; McHale & Crouter, 1996; Teti, 1992) suggest the importance of family size, culture, ethnicity and gender composition with regard to sibling relationships. Siblings also have a powerful influence on each others sociocognitive development (Dunn & Munn, 1986a, 1986b) and gender identity (Sutton-Smith & Rosenberg, 1968). In addition, studies of normal siblings report that rivalry during childhood frequently sets the tone for the relationship siblings have as adults, although not in the ways that many parents expect. Children often have little or no experience with peers when they enter a sibling relationship. Sibling interaction offers the opportunity to learn how to share and how to think for yourself. Being mindful of sibling differences also helps to shape your self-esteem and forces you to consider who you are in relation to your brother or sister. The constant squabbles that siblings specialize in may actually be the tools by which brothers and sisters learn to be close as adults. Apparently, moderate conflict between siblings may assist children to develop socially. According to Kutner (1990), there are a number of explanations for this hypothesis: (a) siblings can take more risks with a brother or sister because they will not be rejected the way they might be by a friend, (b) squabbles may serve to aid differentiation between siblings in the same family and (c) conflict may serve as a release for anger and frustration that the sibling feels towards an adult in the family. There is evidence (Minuchin & Fishman, 1981; Minuchin, Lee, & Simon, 1996) that well-functioning families exhibit an openness to feedback, both internally and externally. Better functioning families also have clearer generational boundaries that allow parents to acknowledge the uniqueness of each sibling, without losing sight of his or her basic equality. While siblings in these families may develop different skills and roles from one another, their differences are not treated as deficits but rather supported and encouraged. Research interviews conducted with 73 adult survivors of sibling incest and assault, in addition to our combined clinical experience treating numerous families, led us to observe certain systemic family patterns (Caffaro & Conn-Caffaro, 1998). This review article provides preliminary descriptions of several of these family patterns along with assessment implications, clinical illustrations, and selected research results. 2. Sibling development in abusive families Clinical observation of troubled families reveals that parents frequently scapegoat one child, thus indirectly favoring another. Conflict between siblings in these situations may reflect the childs way of coping with the power imbalances brought on by parentchild coalitions. Children who are treated unequally or unfairly by their parents are more likely to fight with each other. The future adult sibling relationship may also suffer. Kahn and Lewis (1988) assert that the sibling bond exerts a formative influence upon personality. These ties may intensify when, as children or adolescents, siblings have had plentiful access to each other and have been deprived of reliable parental care. When other important relationships (i.e. parents) cannot be relied upon, extreme sibling behavior can be

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activated. It has been our experience in instances of severe parental abuse or neglect, that siblings tend to develop disordered attachments with each other which may appear as confluent unions, or as disengaged separations. 2.1. About the research project Our research included an in-depth interview study of 73 adult survivors of sibling incest and assault. Interviews lasted approximately 1 1/2 to 2 h. Volunteers were accepted from several sources including: advertisements in local professional newsletters; personal announcements of our research project and a request for participants to approximately 200 colleagues in the local and national child abuse prevention community; and permission to recruit individuals referred to the San Diego Department of Social Services (Child Protective Services) as voluntary participants in our study. The data include direct transcribed comments as well as information derived from responses to the Adult Sibling Abuse Survivor Questionnaire (see Appendix B) with 73 participants. A content analysis was conducted on the transcripts of each interview. The analysis was based on Coffey and Atkinsons (1996) concept that the narrative quality of qualitative textual data enables the researcher to consider how social actors order and share their experiences, feelings, and thoughts, hence be analyzed alongside meanings and motives. We were interested in the following questions: what family characteristics contribute to the development of abusive sibling relationships in childhood? How do various family configurations (e.g., stepfamily, single-parent, peripheral parent) affect the relationship between siblings in abusive dyads? How does sibling incest and assault in childhood affect the adult survivors ability to form adequate, sustaining intimate relationships? 2.2. Characteristics of participants Forty-nine (67%) female and twenty-four (33%) male adult survivors of either sibling incest or assault or both agreed to participate in our study. Participation was voluntary; each individual provided written informed consent. Participants ages ranged from 18 to 54 years, with a mean of 38 years (S.D.=8.44) for both men and women. Fifty-six participants (77%) identified themselves as Caucasian, ten participants (13%) as African American, and seven (10%) as Latino. 2.3. Frequency of sibling incest and assault by category of abuse Twenty-nine individuals (39%) were adult survivors of sibling incest; twenty-six (36%) met our criteria for survivors of sibling assault. In addition, 18 men and women (25%) reported themselves as survivors of combined sibling incest and assault. We also determined initial frequencies of sibling incest and assault by gender of offender and victim; this information is presented in Table 1 (see Appendix A).

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2.4. Sibling incest survivors Women sexually abused by their brothers accounted for 18 of the 29 adult survivors of sibling incest (63%) in our study, the largest number of respondents in any one category. Adult survivors of brotherbrother incest were the next largest group (20%), with six men in this category. Sisterbrother incest survivors made up the third largest group with three adults (10%), and only two women in our study (7%) self-identified as survivors of sistersister incest. 2.5. Sibling assault survivors The greatest number of respondents in this category were survivors of brotherbrother assault. Twelve men (45%) reported a history of physical assault by a brother. Eight women (30%) self-identified as adult survivors of brothersister assault. The next largest category consisted of four women (15%) who self-identified as survivors of sistersister assault, and finally we interviewed two men (10%) who reported a history of sisterbrother assault. 2.6. Sibling incest and assault survivors The second largest number of respondents in any category were 11 women (61%) selfidentified as survivors of combined sibling incest and assault by a brother. Next most numerous in this category were five men (30%) who reported a history of brotherbrother incest and assault, and two women (9%) self-identified as adult survivors of sistersister incest and assault. There were no adult survivors of sisterbrother incest and assault interviewed for our study. Consistent with the literature on family violence and gender (Graham-Bermann et al., 1994; Russell, 1986; Saunders & Azar, 1989), survivors abused by females made up the smallest numbers in our study. The number of participants in our study is relatively small, self-selected, and not necessarily representative of sibling abuse survivors in general. Nonetheless, the frequencies above are consistent with other reports for brothersister incest (Laviola, 1992) and assault (GrahamBermann et al., 1994), and for brotherbrother assault (Goodwin & Roscoe, 1990).

3. Sibling assault National surveys of family violence (Gelles & Straus, 1988; Straus, Gelles, & Steinmetz, 1980) as well as studies of school aged children (Duncan, 1999; Goodwin & Roscoe, 1990) report high prevalence rates of sibling physical aggression. In addition, research (Simonelli, Mullis, Elliot, & Pierce, 2002) examining the association between abuse by siblings and subsequent experiences of dating violence suggests a link between dating violence among males and sibling abuse. Despite such evidence, sibling violence has received relatively little attention in the child maltreatment literature. Perhaps, because sibling violence is so commonplace, it tends to be accepted as a normal characteristic of family life.

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Sibling assault can be defined as a repeated pattern of aggression directed toward a sibling with the intent to inflict harm, and motivated by an internal emotional need for power and control (Caffaro & Conn-Caffaro, 1998). When parents frequently disagree over how to resolve disputes between siblings, children may decide to reject parental authority and bfight it outQ between themselves. In addition, overt parental conflict in the family provides a model of authority for siblings to eventually emulate both within and outside of the family of origin. In Debbies family, this pattern became violent and had serious consequences: My dad would come home drunk, and my mom would be angry and slap him in the face. Shed slap him, but never more than twice. Because if you went more than twice. . .the trophies started flying, the shelves started falling, and we were hiding. When my dad came home in this kind of mood, we knew right where to go. And if you did something that day that Mom was going to tell Dad, you knew that you were really going to get it, and hed be hitting you. And then Gary, my oldest brother would treat my younger brother Mark the same way.

4. Sibling incest Sibling incest is estimated to occur three to five times as often as the most frequently cited form, fatherdaughter incest (Cole, 1982; Finkelhor, 1978; Smith & Israel, 1987). In one study of child-on-child sexual abuse (Shaw, Lewis, Loeb, Rosado, & Rodriguez, 2000), approximately half of the 51 cases were children victimized by their siblings. Paradoxically, it is also the least detected since the sibling incest taboo is fairly weak, violating neither the generational nor dependency bond deemed so vital between other family relational subsystems (Meiselman, 1978). One of the difficulties in collecting data regarding sibling incest has been the lack of universally acceptable criteria for distinguishing abusive sexual contact from normal sexual exploratory behavior. A paucity of research on the problem exists, in part, because sexual activity between children has long been thought to be harmless. One way to distinguish bnatural curiosityQ and exploration from child-on-child sexual abuse appears to be whether there was consent or coercion. There are, however, gray areas within these parameters. Sometimes incest that appears consensual is actually based on fear. Some believe that age differences between siblings are relevant for making such distinctions. One commonly supported view is that mutual sexual exploration among children within the same age range is a normal occurrence in a childs psychosexual development. The closer in age the children are, the more likely the incest will be viewed as nonproblematic (Courtois, 1988; Kahn & Lewis, 1988; Russell, 1986). Laviola (1992) however, in a study of 17 cases of older brotheryounger sister incest, found more than half the women reported the age differential to be 5 years or less. Yet they still perceived themselves to be forced or coerced into incest activity. Further, James and MacKinnons (1990) feminist critique of family systems theories of incest dynamics emphasizes the importance of the power differential between siblings of different genders regardless of age.

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According to the Canavan, Meyer, and Higgs (1992) study of female victims of sibling incest, there are several themes that move sibling incest beyond the realm of normal sexual exploration. These themes include: enforced secrecy, power differentials, influence on sexual development, and individual after-effects. Sexualized contact which is kept secret due to fear, coercion or threat cannot be considered harmless sex play. When ones first sexual experience has been with a sibling, it is difficult to disclose. Shame and guilt keep survivors and offenders quiet. To illustrate, while interviewing Leslie for our study, we were impressed by the open and straightforward manner in which she described her abuse in her family of origin. When she spoke of her role as an offender with Rhonda, her younger sister, her affect suddenly changed: I have great difficulty with the fact that I used my younger sister for a long period of time. I have never talked about this, its just something I try to work through on my own. But to be fair if Im going to say that my brothers did it to me, I have to own up to what I did to my younger sister. She and I shared a bed and I would mess around with her when she was asleep. I didnt know that she ever woke up. Leslie had previously not been able to acknowledge sexually abusing her sister. She carried a tremendous amount of shame and guilt and wondered if this was the reason that she and her sister had little contact as adults. To hear Leslie describe it, exploitation and indifference characterized her relationship with Rhonda: She lives in Los Angeles but we never see each other unless I go up there. When we were kids if she wanted me to do one of her chores she could be real sweet and if I had something she wanted I could be acknowledgedthe rest of the time I was dead to her. That is basically how she still is now. Sibling offenders who were themselves abused are in a particularly difficult dilemma regarding treatment. They may experience adverse effects from psychotherapy due to their simultaneous identification with both victim and offender roles in the family. Therapists may also be confused about how to proceed with treatment. The child maltreatment literature contains relatively little information pertinent to assessment and intervention with sibling offenders abused as children, and society seems confused about how to react to such individuals. We caution professionals to avoid making rigid assumptions or generalizations about sibling incest. It is important to inquire not only about what actually happened but also to pay attention to the individuals subjective experience of traumatic events.

5. Sibling abuse family configurations The family configurations presented here depict family structural characteristics commonly found in sibling abuse families. Together they reveal family risk patterns

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which, when coupled with an absence of protective factors, share a heightened structural vulnerability for sibling incest or assault. These family configurations describe many of the sibling abuse families we have treated. They are not bpureQ types, however. A family may resemble some combination of subtypes, or may be organized differently at various developmental stages of the life cycle. Two families may be similar in structure; yet abuse may occur in only one of these families due to differences in developmental, community, and cultural circumstances. 5.1. Peripheral parent families In peripheral parent families, one parent maintains a role exterior to the others. In many cases, he or she re-enters the family system in an authoritarian or abusive manner. (We consider this to be one family subtype, regardless of which parent resides on the periphery.) The parent who is more available in the family may be nurturing, but unable to protect him or herself and the children when the peripheral parent becomes abusive. Conversely, the nonperipheral parent may be the one who abuses the children. An absence of parental contact and support renders children vulnerable to sibling abuse for a number of reasons. Children in peripheral-parent homes may feel that there is not enough love, attention, or support for everyone. These feelings can create adversarial relationships among siblings who are attempting to meet their needs in a family with limited resources. In addition, sibling interactions often are not supervised adequately; this situation creates structural deficits, and a lack of parental authority and control. When adult caretakers are not available to facilitate problem solving, siblings are left to resolve conflicts using their own inadequate (albeit developing) skills. Thus the benefits of learning effective communication, sharing, and natural and logical consequences are not integrated readily into their abilities to resolve problems (Caffaro & Conn-Caffaro, 1998). The following clinical example illustrates sibling dynamics in an abusive peripheral family system. Excerpts are included from the treatment of two of the five siblings involved in the abuse. Twelve-year-old Trenton was the middle child. His father was an unemployed alcoholic who was frequently away from the house. When at home, dad could usually be found drinking and watching television with friends. Trentons father was often abusive to his family. He sometimes assaulted and humiliated his wife and the three oldest children in front of his friends and the rest of the family. Unfortunately Trentons mother was only marginally available to her children. She also became increasingly abusive following the incarceration of her husband for an unrelated violent act. Trenton and his siblings were sometimes left with male baby-sitters who raped and sodomized all five children in front of one another. Child protective services intervened and the children, separated by gender, were placed in foster homes. Trenton developed an abusive relationship with his 6-year-old brother. Almost immediately he began beating up Marcus in their new foster home. Trenton explained to the therapist, bI have to show him when he does wrong, and teach him to do rightQ.

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This was the same rationale his father had used to justify his abusive behavior with the children. The therapist had Trenton draw pictures of two different ways he served as a teacher to his brother; a mean way and a nice way. Following his lead, therapy began to focus on his cruelty with Marcus. As Trenton shared more openly about his mistreatment of Marcus, he saw parallels to his fathers abusive behavior. A critical point in treatment occurred when Trenton identified his own pain resulting from his fathers abuse. He was able to make an empathic identification with how his brother probably felt as a victim. Following this insight the therapist held several sibling sessions. The brothers were able to develop a stronger bond by sharing with one another their respective experience. While drawing pictures depicting abusive memories, they recalled some of the traumatic situations they were forced to confront in their family of origin. Additionally, the sibling meetings gave the boys an opportunity to work on their interpersonal relationship. They were able to address some of the things that made them angry with each other, and negotiate ways to handle conflict in the future. Follow-up a year and a half later indicated that they continued to share a nonabusive relationship with each other. When parental relationships with children are characterized by favoritism or crossgenerational coalitions, the child who is bleft outQ may become increasingly resentful and aggressive toward the preferred sibling. Parental intervention is critical. Felson and Russo (1988) report that parents were more likely to punish the more powerful sibling (older sibling or boys), which in turn stimulated more provocation on the part of the bweakerQ sibling. In well-functioning families, a structure of accepted and constructive rules guides interactions within and between family subsystems. Families with a serious problem of sibling violence lack such a rule structure. A working alliance between parents, or a consistent single parent is basic for the establishment of the family rules necessary to curb the escalation of sibling violence. 5.2. Pseudo-consensual sibling incest families Siblings subject to ongoing parental abuse or neglect may turn to each other for validation, support, protection, and nurturanceneeds normally met by adult caregivers. High access, coupled with the lack of reliable parental care, can increase sexual tension between siblings and subsequently can lead to incest. A sexually charged climate at home also has been associated with increased sexual tension between siblings who already turn to one another to meet critical emotional needs (Smith & Israel, 1987). Although many children reared in neglectful families exhibit qualities consistent with this type of family, incestuous sibling interactions seem to develop less frequently. When they do, pseudo-consensual incest often overtly resembles noncoercive sex play between children close in age, except that the incestuous behavior may be more intense, more frequent, and longer lasting. In such families, both children (victim and offender) suffer from an extreme lack of parental guidance and a high level of neglect (Caffaro & ConnCaffaro, 1998). Elena, a 6-year-old Mexican child was removed from her home by Child Protective Services and temporarily placed in a group facility for sexual bacting outQ behavior, which led to a

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suspicion that she had been molested. She was the oldest of five children. Early in treatment it was revealed that her uncle, who had lived with the family for a few months, had exposed Elena to pornographic materials. In addition, the older children had probably observed their parents having sex on more than one occasion. They lived together in a three-room cottage, where the living room also served as the parents bedroom. Elenas father was a migrant worker who was intermittently absent for weeks at a time. When he found work near home, he often worked long hours, 6 or 7 days each week. Elena had a 5-year-old brother named Julio and three younger siblings ranging in age from 3 1/2 years to 5 months. Consistent with the dynamics of pseudo-consensual cases, Elenas parents were overwhelmed by their parenting and work responsibilities. As a result, they were not reliably available for all of their children. We gathered information about the amount and quality of time that Elena and Julio spent together. A family pattern was solidly established whereby the children automatically sought each other out for comfort and soothing, and shielded their parents from many of their problems. As they grew older, Elena and Julio also used the intense sibling relationship to meet many of their needs for closeness and physical contact. Elenas parents were proud of the self-sufficiency they had taught their two oldest children. More than a year ago, they had placed them in the same bed, so that when one became afraid or needed something during the night, the other could offer assistance. After several weeks of play therapy, it was revealed that Elena and Julio had been engaging in mutual and dual masturbation for nearly a year. Their parents were not surprised by the information, and did not understand how it might harm their childrens development. It appeared that there were no other family or nonfamily victims or offenders. Elenas parents underwent a Child Protective Services investigation. The social worker acted to protect the children from additional trauma associated with their neglect, and expressed concern about the parents inability to establish clear boundaries in the home. They uncovered no additional evidence of sexual abuse. Questions remained, however, about the heightened sexualized climate in the home. A treatment challenge unique to pseudo-consensual incest cases is how to reorganize the family so that the incestuous behavior no longer occurs, without inducing shame or guilt (see Caffaro & Conn-Caffaro, 1998 for a complete report of this case). This is especially critical when the siblings involved are younger age peers, such as Elena and Julio. Further, the incest behavior evolves gradually in the interest of self-preservation, given the parents caretaking deficits. The siblings must learn other coping skills without being shamed for those that they have developed to meet critical survival needs. One must take care to avoid shaming parents as well; such care, in turn, decreases the likelihood that shameful feelings will be expressed or projected onto the children. 5.3. Pseudo-parent sibling families In pseudo-parent sibling families, neither parent is reliably available and the pseudoparent child becomes a highly relied upon family member, but simultaneously cannot

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fully join or maintain membership in either the sibling or the parental generation. When parents abdicate caretaking responsibilities to the functional oldest child, they place him or her in a unique generational position in relation to the other siblings. Brothers or sisters in this role sometimes lack the authority to create appropriate limits governing sibling behavior. The caretaking child in these families tends to be 4 to 5 years older than his or her next youngest sibling. Furthermore, it is frequently the pseudo-parent child who initiates the abuse of his or her younger sibling(s). The dynamics within the pseudo-parent sibling family (dual and single parent) are somewhat alike. The primary difference is that the parentified child in the single parent family assumes caretaking responsibility for both his or her younger siblings and the single parent. This child is actually drawn into the spousal subsystem as more of an equal, and therefore has influence with regard to younger siblings. Parentchild incest, commonly reported with the parentified child in pseudo-parent sibling families, complicates this process. The btraumatic sexualizationQ of the pseudo-parent child in this circumstance may lead to the development of sexual feelings and attitudes in a dysfunctional manner (Finkelhor & Browne, 1985). This can result in early sexual awareness and eroticization; the victim may then relate to younger siblings in sexualized ways. 5.4. Stepsibling abuse With the number of remarried families on the rise, more clinicians have begun to recognize the ambiguity of step-relations, and the lack of universally agreed upon norms which govern them. Conflict among sibling groups is frequently cited as a significant family problem in the remarried family. Furthermore, fluid boundaries and uncertainty surrounding the incest taboo in remarried families may make negotiating sexual issues between stepsiblings challenging. Yet, family practitioners devote scant attention to the stepsibling subgroup, and there is little available information on how to conduct psychotherapy with this important family subsystem (Rosenberg, 1980). Stepsibling relationships are characterized by a number of important factors; some of these may be related to the development of abusive interactions. First, stepsibling relationships are often formed instantaneously, so that children have no time to adapt and accommodate to each other. Further, because of the lack of a shared family history, stepsiblings espouse different values, customs, and family styles, all of which require increased tolerance and accommodation. Stepsiblings have in common the loss of their original families: often they struggle with feelings about the past, both real and idealized. Each childs experience of loss is unique, however, and must be addressed according to the individuals current subjective and objective needs (Caffaro & ConnCaffaro, 1998). Carl, a research participant, was 2 years old when his parents divorced. He and his twin brother Ken went to live with their dad. When Carl was 10, his father remarried a woman with one son and four daughters. Alice was about Carls age and they became very close.

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Their parents spent all their free time in bars, so Carl and his stepsister basically ran the house: Alice and I, we sort of took over like the parents and she and I were always close. In fact, I think our parents thought that she and I might be getting romantically involved when we got a little older.

6. Assessment and treatment considerations An integrative theoretical approach allows one to view more explicitly the interdependence of the sibling bond. Each of us is a composite of interpersonal relationships. Those learned as children in our families are among the most enduring and influential. When early development is traumatic, at-risk children remain bstuckQ, or regress under stress to less unified stages of development. The permanence and rigidity of these levels of functioning, especially in relation to ones siblings, provides us with important assessment information. As family clinicians, we have treated many clients experiencing distress over sibling relationships. Our perspective has allowed us access to the cognitive and affective elements of an individuals sibling relationships. We have found that working through sibling abuse issues generally involves some combination of individual, sibling, family and group sessions. As a result we have developed a psychosocial assessment tool, the Sibling Abuse Interview1 to enhance our evaluation and intervention with sibling abuse families. The SAI explores the history and current status of sibling relationships through a series of questions presented to each member of the family and the relevant subsystem over a series of meetings (Caffaro & Conn-Caffaro, 1998). Areas of inquiry are arranged in developmental sequence and address the effects of abuse trauma on individual, subsystem, and family system functioning. The SAI also highlights sibling strengths in order to evaluate safety concerns and sources of individual and family resilience. In addition, we are mindful that each family relationship is set in a particular cultural context. Differing cultural expectations influence the developmental course of relationships between parents and children, as well as between siblings. The ability to recognize these differences is important when assessing and intervening in sibling incest and assault dyads. And because abuse trauma is likely to involve multiple areas of functioning, sibling assessment must be an ongoing part of treatment rather than a static process that precedes therapy (Caffaro & Conn-Caffaro, 1998). The unique circumstances of sibling abuse treatment frequently require a modification of traditional systemic approaches. In treating victims or perpetrators of sibling violence, safety and accountability are front and center issues for the clinician. We concur with Larson and Maddock (1986) that family treatment is not always possible or acceptable. Family-based
1

The Sibling Abuse Interview may be obtained directly from the authors.

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therapy may be one aspect of a multidimensional approach to treatment that includes individual, group, and family intervention. The patients readiness is a prime criterion for determining the wisdom of family involvement. Treatment considerations must take into account the developmental stage and breadinessQ of the incest survivor and treatment must be coordinated with the needs and capacities of the client. There is a clear danger inherent in rigid approaches, which expect all families to fit the same theories of causation and methods of treatment. 6.1. Traumatic effects Studies comparing victims of brothersister and fatherdaughter incest (Cyr, Wright, McDuff, & Perron, 2002; McVeigh, 2003; Rudd & Herzberger, 1999) conclude that the harmful consequences of sibling incest are of equal seriousness to those of fatherdaughter incest. Shaw et al. (2000) reporting on a culturally diverse sample also concluded that children sexually victimized by other children manifested elevated levels of emotional and behavioral problems and were not significantly different from those who had been sexually abused by adults. One of the more consistent research findings is that future adult relationships also suffer negative effects as a result of coercive sexual contact between siblings. Earlier studies (Alpert, 1991; Rudd & Herzberger, 1999) found that about half of the victims of brother sister incest more than 25 years of age never married. This was the highest nonmarriage rate reported by any of the incest survivor groups. Our research appears to confirm that the victims ability or desire to marry is affected. Sixty four percent of the sibling incest survivors in our study over the age of 25 reported never marrying. Reports from our participants suggest that sibling incest and assault leaves lasting effects on the relationship. For example, Cicirelli (1982) estimates that only 3% of siblings reared in healthy families ever permanently sever emotional ties with one another. However, 25 of our research participants (34%) in response to a question asking them to describe the nature of their current and previous contact with the brother or sister who abused you said they had no contact with this sibling; practicing an bemotional cutoffQ pattern with at least one adult brother or sister. Coined by Murray Bowen (1978), emotional cutoff is defined as emotional distancing from the family-of-origin, accomplished either through physical distance or internal mechanisms. However the cutoff is established, its hallmark is the denial of the unresolved attachment to the family-of-origin. People who cut off are likely to repeat in their marriages the problematic patterns of their family-of-origin (Bowen, 1978; Framo, 1981; Keer & Bowen, 1988). In one study (McCollum, 1986), subjects who were emotionally cutoff reported less satisfaction with nuclear family relationships. In a study by Weiner (1990), subjects with higher levels of emotional cutoff were more depressed and more likely to be the marriage partner who initiated a divorce. Additionally, emotional cutoffs from family members in adulthood have been linked to lower adaptability to stress and greater levels of anxiety (Bray, Williamson, & Malone, 1984).

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Although emotional cutoff has been theorized as occurring in all relationships to some degree (Keer & Bowen, 1988) and has been recognized clinically as occurring between siblings (Benswanger, 1987), sibling cutoffs have received relatively little attention in the literature. Most research into sibling relationships has ignored current relationships, concentrating instead on the effects of childhood sibling relationships. Another consistent theme raised by our sibling incest survivors is the failure of family members to acknowledge the incest. Family members reluctance to validate and support survivors increases the likelihood of impaired adult sibling relationships. Furthermore, relationships between sibling victims in the same family may be fractured by sibling incest. One research participant recalled that a sadistic older brother had tortured her while sexually abusing her. During the interview, she reluctantly acknowledged sending her younger sisters to him as her only defense. After that, he was less harsh with her. She still wakes up during the night plagued by guilt and feeling like an evil person for putting her sisters in harms way in order to lessen her own trauma. She describes her adult relationships with each of her sisters with significant dissatisfaction. One has moved to another country and maintains no contact with her; she depicts the other as lost and dependent, with considerable mental health problems, so that their infrequent visits usually end poorly. Other important themes from our research consistent with the literature (Rudd & Herzberger, 1999) include the fact that a significant number of our research participants had not sought treatment and had not shared their stories of sibling incest with anyone before. Thirteen out of twenty-nine (45%) sibling incest survivors had not disclosed the incest to anyone before our interview. Those who were in therapy often remarked to us about how their therapists had not focused on their abusive relationships with siblings. We believe that for some, the difficulty of disclosing incidents of sibling abuse and the shame connected with the experience may be even greater than that associated with parentchild abuse. Some participants in our study minimized the effects of sibling abuse. For example, one initially told us she did not think the sibling incest was important. After the research interview she changed her mind. A female survivor of sibling incest shared with us that she had many other issues that were competing for her attention and the abusive sibling relationship just took a back seat. Some expressed the fear that their therapist would judge them harshly upon hearing their secret. Clinical experience suggests another explanation for why an individual with a history of sibling incest may be less inclined to reveal his or her experience: societys ambiguous taboo against sexual expression between siblings and the frequent lack of significant age difference may lead victims to assume that they were willing participants. This faulty misconception exacerbates their confusion and shame. Intrafamilial abuse is the product of complex factors and interactions involving the victim, the offender, and the environment. Sibling abuse is also multidetermined by systems characteristics. Parental absence is suggested to play a significant role in intensifying the mutual dependency and sexual curiosity of brothers and sisters, and loose boundaries promote abusive relationships (Bank & Kahn, 1982; Smith & Israel, 1987).

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7. Limitations of our study This is a qualitative glimpse at the experience of victims and survivors of sibling incest and assault, and their families. The interviews were not a random sampling of sibling abuse victims or survivors; the participants were mostly white and middle class. In addition, we obtained our information from adults, who were a more convenient and more accessible group of participants than children. Interviewing children in their families might not have yielded complete information or provided us with a view of long term effects of abuse. Nor would interviews with parents have been likely to provide complete information because research on other types of abuse, such as parentchild incest, tells us that children have difficulty in reporting their victimization while they live in the abusive family situation. With greater autonomy and distance from the family-of-origin, survivors might be better able to reflect on their experiences. Our research protocol, however, is also limited by its retrospective design. Survivors may not have recalled details of their childhood abuse experiences exactly as they occurred (Alexander, 1992; Beutler & Hill, 1992). Furthermore, the number of participants in our study is relatively small, self-selected, and most had undergone some psychotherapy treatment. Therefore, they may not be representative of the sibling abuse survivor population.

8. Summary and conclusions Sibling abuse is not a violation of generational boundary but rather a significant interpersonal boundary violation with potentially devastating long term effects. We question the concept of sexual contact between siblings as a mutually consensual experience. A great deal of sibling incest and assault may not be coming to the attention of courts or social service agencies due to: lack of disclosure, the misconception that most sibling sexual behavior is normal sex play, and the tendency to accept sibling violence as a normal characteristic of family life. Adult siblings have traditionally inhabited an ambiguous place in family relationships. They have no roles, no rituals, and no clear-cut patterns of behavior to guide them. Certain changes in our modern world have simultaneously placed brothers and sisters in a position of greater accessibility to each other. Traumatic events within the family may greatly impact the nature of the already confusing adult sibling relationship. The implications for the helping professions are important. As clinicians, we are generally taught that siblings are, at best, minor actors on the stage of human development. However, research indicates that the bonds between siblings may be as influential as the parentchild relationship in shaping personality differences (Bank & Kahn, 1982; Plomin & Dunn, 1991). Despite this evidence, little is known about the particular effects of trauma and abuse on sibling relationships. In addition, few resources exist for siblings to address their unique issues. We believe the need exists for a specialized focus on the sibling relationship in abusive families. In such families it is often the parents who, either physically or psychologically, abandon their children. Under these conditions a child may often depend on an older sibling even when that dependency is fraught with pain, anxiety and further maltreatment. We hope that

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our observations inspire further thought, inquiry, and prevention efforts so that various forms of family violence, including intersibling incest and assault, are more effectively evaluated, treated, and ultimately prevented from occurring whenever possible.

Appendix A.
Table 1A Frequency of sibling incest and assault by category of abuse (n =29) 39% Sibling incest B/S B/B S/B S/S 18 6 3 2 (63%) (20%) (10%) (7%) (n =26) 36% Sibling assault 8 12 2 4 (30%) (45%) (10%) (15%) (n =18) 25% Incest and assault 11 (61%) 5 (30%) 2 (9%)

! ! ! !

B/S=brother/sister, B/B=brother/brother, S/B=sister/brother, S/S=sister/sister.

Appendix B Adult Sibling Abuse Survivor Questionnaire 1. Describe your parents relationship to one another as you were growing up. 2. Describe your parents relationship to each of your siblings and yourself as you were growing up. 3. What was your birth position? What effect, if any, do you believe this and the positions of your sisters and brothers had on your relationships while you were growing up? 4. What is your earliest memory of each of your sisters and brothers? 5. If you have a younger sibling, can you remember how you felt when he or she was born? 6. What different parental messages did you and your brothers or sisters receive about what you could be or do when you grew up? 7. Please describe the closest or happiest you have ever felt with each of your siblings. 8. Describe the angriest or most distant you have ever felt with each of your brothers or sisters. 9. If you have brothers and sisters, how were your relationships with your brothers different than those with your sisters? Tell stories to illustrate. 10. What are some of the messages you received about your siblings regarding their conception, pregnancy, delivery, early months, etc.? Were there concerns related to temperament or personality? Use stories to illustrate whenever possible.

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11. How did your parents influence your relationships with your siblings? 12. What were the messages your parents communicated to you and your siblings about your bodies, roughhousing, touching, or cuddling with parents and siblings? 13. What different parental messages about sexuality did you and your siblings receive while growing up? Were sexual roles clearly defined in your family? 14. When you began to go through puberty, what changes did you notice within your sibling relationships? How did your parents behavior toward you change at that time and what effect did this have on your relationship with your siblings? 15. Did you perceive your parents to use overly harsh discipline with you or any of your siblings as you were growing up? Choose one: (a) all the time, (b) frequently, (c) some of the time, (d) rarely. (Define harsh discipline: includes severe restrictions on behavior, humiliation and shaming, threatening, shouting, corporal punishment, and/or other forms of cruelty.) 16. Did you perceive any physical abuse occurring between a parent or other adult and child in your family as you were growing up? (Define physical abuse: causing nonaccidental physical harm or injury to a child. Includes hitting, shoving, striking with an object, and kicking.) 17. Did you perceive any sexual abuse occurring between a parent or other adult and child in your family as you were growing up? (Define sexual abuse: any sexual contact between an adult and a child including sexualized touch, masturbation, forcing a child to touch an adult, viewing pornography, sexualized conversation, or intercourse.) If yes, then: 18. How did any physical or sexual abuse inflicted by a parent on you or your siblings affect your relationship with your brothers and sisters? How does it affect your relationship now? 19. Were any of your sisters or brothers protected from parental abuse? If so, how? By whom, and why? How did this affect the sibling relationships in your family? 20. Describe your relationship with each of your siblings while you were growing up? 21. Did you feel picked on a lot by one sibling in particular while you were growing up? (a) Did you perceive a higher level of conflict with a particular childhood sibling in the home than with others? (b) Would you characterize a brother or sisters interaction with you as physically or emotionally abusive? (Define sibling assault: sibling causing physical harm or injury to a brother or sister. Includes pushing, hitting, kicking, biting, terrorizing, humiliating, exposing to violence or danger.) 22. Were you or any of your siblings sexually abused by any of your brothers or sisters while growing up? (Define sibling incest: sexual behavior between siblings that is not age appropriate, transitory sexual exploration between developmental equals. May or may not include use of force or coercion, bribes, threats, mutual or dual masturbation, asking sibling to touch another sexually, forcing a sibling to witness masturbation, viewing pornography, fondling, sexualized conversation, oral copulation, or intercourse.) If yes, then: 23. How would the incest typically happen? Where, when? 24. How did the physical or sexual abuse affect your relationship with the sibling offender?

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25. How is your relationship now with the brother or sister who abused you? Describe the nature of your current and previous contact? 26. Did someone in the family acknowledge the abuse? Who? Did either parent try to protect you? Who knows about the abuse? 27. If you now have children of your own, how do you see the sibling abuse affecting your relationship with them? 28. If you could say anything you want to your brother or sister regarding the abuse that occurred in your family, what would it be? 29. Is there anything you would like to add to this interview that I have not asked? References
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