National Survey of Psychologists' Sexual and Physical Abuse History and Their Evaluation of Training and Competence in These Areas*
NOTE: This link leads to a follow-up study in Journal of Consulting and Clinical Psychology.
ABSTRACT: A national survey of 250 female and 250 male clinical and counseling psychologists (return rate was 58%) showed that over two thirds (69.93%) of the women and one third (32.85%) of the men had experienced some form of physical or sexual abuse. Participants gave low ratings to their graduate training programs and internships with regard to addressing abuse issues, although more recent graduates gave higher ratings. Participants rated themselves as being moderately competent to provide services related to victims of abuse, although women perceived themselves to be more competent than men. Practical and theoretical implications are discussed.
In the past 20 years or so, there has been a growing awareness that the sexual and nonsexual abuse of children and adults may be more widespread than had been stated in standard texts (e.g., 1 or 2 per million; for examples of this literature, please see the first paragraph and following under the section "Acknowledging the Scope of the Problem" in a related article) and may in some cases be associated with serious psychological harm.
Unfortunately, psychologists know little about how--or if--training in clinical and counseling psychology has responded to this awareness. Although there have not been systematic, detailed investigations to determine the extent to which graduate programs have included curriculum in the area of abuse, the professional literature suggests that graduate training programs have largely ignored abuse as a specific content area. Alpert (1990), for example, noted that there is "relatively little formal education and training in child sexual abuse" (p. 324). Thoughtful articles on the structure and content of formal training in this area - emphasizing the lack of prior attention - have just begun to appear (Alpert & Paulson, 1990).
We also know little about the abuse histories of clinical and counseling psychologists. It is possible that such histories are relevant to an interest in helping others who have been abused or to competence in providing that help. To our knowledge, the only published research that might be related in some way to this issue is in the area of sexual involvement between therapists-in-training and their educators. Pope, Levenson, and Schover (1979) found that 17% of the female respondents and 3% of the male respondents reported sexual contact with at least one of their educators; however, Pope et al. did not obtain any information about whether those contacts were experienced as abusive. Such relationships were, for female students, related to later conduct as a practitioner.
For women, engaging in sexual contact as students with educators was statistically related to later sexual contact as professionals. Of those women who had sex as a student, 23% reported sex as a professional, compared with only 6% of those who, while students, had no sex with their educators. Pope et al., 1979, p. 686)
A subsequent survey of female psychologists also showed that student-teacher sexual contact was quite common (17%) and that, in hindsight, women believed that they were negatively affected by such contact (Glaser & Thorpe, 1986). These reports of negative effects, particularly when viewed in the context of ethics and coercion, raise questions of whether such intimacies may in some cases constitute abuse. Most participants believed that student-educator sexual contact was unethical regardless of whether it occurred during (96.2%) or outside (72.8%) of the working relationship. Only 2.5% of the participants believed that such involvements were not at all coercive if they occurred in the working relationship; only 17% believed involvements were not at all coercive if they occurred outside of the working relationship. Finally, a national survey of clinical and counseling psychologists indicated that only 15% believed that their training to provide help to patients who had experienced therapist-patient sexual involvement had been adequate (Pope & Vetter, 1991).
Our study surveyed a national sample of clinical and counseling psychologists (a) to determine the proportion of practitioners who reported having been sexually or physically abused; (b) to assess the degree to which practitioners believed that their graduate and internship training in the area of abuse was adequate; (c) to assess the degree to which practitioners believed that they were competent to provide services to those who had experienced various forms of abuse; and (d) to explore the degree to which gender, the year the highest degree was earned, reported history of abuse, reported adequacy of training, and perceived competence might be interrelated.
Sample Selection and Survey Procedure
A sample of 500 psychologists (250 men and 250 women) who were members of at least one of three of the American Psychological Association's (APA's) divisions was randomly selected from the Directory of the American Psychological Association. The three divisions were 12 (Clinical Psychology), 29 (Psychotherapy), and 42 (Independent Practice). Each person was sent a cover letter, the 1-page survey form described later, and a stamped, addressed envelope for returning the form.
The questionnaire contained four sections. The introductory section asked only the participant's gender, highest degree earned, and the year that his or her highest degree was awarded. No other identifying information was requested so that participants would feel secure in their anonymity.
In the second section (personal history), participants checked any of the following incidents that they had experienced during childhood or adolescence: sexual abuse by a relative; sexual abuse by a teacher; sexual abuse by a physician; sexual abuse by a therapist or counselor; sexual abuse by a nonrelative (other than a teacher, physician, therapist, or counselor); and nonsexual physical abuse. Participants were also asked to check any of the following incidents that they had experienced during adulthood: sexual harassment, attempted rape, acquaintance rape, stranger rape, nonsexual physical violence by a spouse or spouselike partner, nonsexual physical violence by an acquaintance, nonsexual violence by a stranger, sexual involvement with a therapist or counselor, and sexual involvement with their physician.
In the third section(graduate training and internship), participants rated their graduate program and then their internship training in seven areas: childhood or adolescent sexual abuse, childhood or adolescent nonsexual physical violence, sexual harassment, actual or attempted rape, nonsexual violence against an adult, therapist-(adult) patient sexual involvement, and physician-(adult) patient sexual involvement. All ratings were made on a 5-point scale ranging from 1 (very poor; e.g., little or no attention devoted to the topic) to 5 (very good; e.g., much attention devoted to the topic).
In the fourth section (current competence or expertise) , participants rated their current competence in providing professional services to individuals whose needs were related to each of the seven types of experiences listed in the second section (i.e., childhood or adolescent sexual abuse, childhood or adolescent nonsexual physical abuse, etc.). These ratings were made on a 5-point scale ranging from 1 (little or no competence) to 5 ( high level of expertise).
Although 296 questionnaires were returned, 6 did not indicate the participant's gender and were excluded from the analyses. Consequently, the effective return rate was 58%.
Gender and Highest Degree of Participants
One hundred and fifty-three women participated. All but 8 reported a PhD as the highest degree earned. The other degrees were EdD ( n = 6) , PsyD (n = 1) , and MA ( n = 1) One hundred and thirty-seven men participated; all but 10 reported a PhD as the highest degree earned. The other degrees were EdD n = 6), PsyD ( n = 1), MA ( n = 2), and BA ( n = 1). Women obtained their highest degree at a significantly later date than did men, t (288) 2.80 ( p < .0054).
A χ2 analysis revealed that gender was not significantly related to the return rate (i.e., the proportion of men was not significantly different from the proportion of women who responded to this survey).
Personal History Childhood and adolescence.
Approximately one third (33.1%) of the participants reported having experienced some form of sexual or physical abuse as a child or adolescent. The most frequently reported types of abuse were sexual abuse by a relative (13.8%); sexual abuse by a nonrelative other than a teacher, physician, therapist, or counselor (13.1%); and physical abuse (11.0%). In all categories but one, women were more likely than men to report having been abused as a child. The exception was physical abuse (i.e., 13.1% of the men reported physical abuse compared with 9.1% of the women).
Table 1 presents the percentages of men and women reporting each type of childhood or adolescent abuse. χ2 analyses revealed only one significant gender difference at the level of an individual category: Significantly more women than men reported childhood or adolescent sexual abuse by a relative, χ2 (1, N = 290) = 13.98 (p < .0005.)
|Type of abuse||Men||Women|
|Sexual abuse by relative||5.84||21.05|
|Sexual abuse by teacher||0.73||1.96|
|Sexual abuse by physician||0.0||1.96|
|Sexual abuse by therapist||0.0||0.0|
|Sexual abuse by nonrelative (other than those previously listed)||9.49||16.34|
|Nonsexual physical abuse||13.14||9.15|
|At least one of the above||26.28||39.22|
A χ2 analysis also revealed that women were more likely than men to check at least one of the abuse categories, χ2 (1, N = 289) = 5.46 p < .02 . Moreover, the average number of abuse categories checked by women (.50) was significantly greater than the average number checked by men (.29), t (288) 2.87( p < .005).
Slightly over one third (36.6%) of the participants reported some form of abuse during adulthood. The most frequently reported types of abuse were sexual harassment (20.69%) and nonsexual physical abuse by a spouse (9.66%).
Table 2 presents the percentages of men and women reporting such abuse. χ2 analyses showed that women were significantly more likely than men to report sexual harassment, χ2 (1, N = 290) = 58.52 (p < .0005), attempted rape, χ2 (1, N = 290) = 16.39 (p < .0005), and acquaintance rape, χ2 (1, N = 290) = 9.27 (p < .002). Consistent with these findings at the individual-item level, χ2 analysis revealed that women were more likely than men to check at least one of the abuse categories, χ2 (1, N = 290) = 57.61 (p < .0005). Likewise, the average number of abuse categories checked by women (.88) was significantly greater than the average number checked by men (.16), t (288) = 8.03 (p < .00005).
|Type of abuse||Men||Women|
|Nonsexual physical abuse by a spouse or partner||6.57||12.42|
|Nonsexual physical abuse by an acquaintance||0.0||2.61|
|Nonsexual physical abuse by a stranger||4.38||7.19|
|Sexual involvement with a therapist||2.19||4.58|
|Sexual involvement with a physician||0.0||1.96|
|At least one of the above||13.87||56.86|
About one third (32.85%) of the men reported at least one episode of abuse before or during adulthood. Twenty-three percent reported one form of abuse, 8% reported two forms, 1% reported three forms, none reported four, and 1% reported five.
Over two thirds (69.93%) of the women reported at least one episode of abuse before or during adulthood. Twenty-nine percent reported one form of abuse, 23% reported two forms, 12% reported three forms, 2% reported four forms, 2% reported five forms, and 1% reported six forms.
A χ2 analysis comparing men and women in terms of whether they reported at least one episode of abuse during childhood, adolescence, or adulthood revealed a significant difference, χ2 (1, N = 290) = (39.56 p < .0001): Women were more likely than men to report at least one episode of abuse.
Graduate Program and Internship Graduate program.
As Table 3 illustrates, the perceived quality of graduate training in sexual and nonsexual abuse was low for both men and women. A regression analysis conducted to explore the possibility that these ratings of graduate training programs might be systematically related to gender, abuse history, or the year of highest degree yielded positive findings (R 2 = .11, adjusted R2 = .10, p < .0001). However, only the year of highest degree was statistically associated with rating of the graduate program (p < .0004): The more recent the year of the highest degree, the higher the rating of the graduate program tended to be (see Table 4).
|Type of abuse||Men||Women||Men||Women||Men||Women||Men||Women|
|Childhood or adolescent sexual abuse||1.66||1.68||0.86||1.01||1.0||1.0||1.0||1.0|
|Childhood or adolescent physical abuse||1.96||1.91||0.94||1.08||2.0||2.0||1.0||1.0|
|Rape or attempted rape||1.84||1.68||0.92||1.00||2.0||1.0||1.0||1.0|
|Nonsexual violence against adults||2.18||1.80||1.05||0.98||2.0||1.0||2.0||1.0|
|Therapist-patient sexual involement||2.18||2.10||1.24||1.30||2.0||2.0||1.0||1.0|
|Physician-patient sexual involvement||1.76||1.49||1.05||0.97||1.0||1.0||1.0||1.0|
|All scores combined||1.87||1.73||1.02||1.05||2.0||1.0||1.0||1.0|
Note: Ratings ranged from 1 (very poor; e.g., little or no attention devoted to the topic) to 5 (very good).
|Year of degree||n||M||SD||Mdn||Mode|
|Prior to 1960||21||1.51||0.79||1.00||1.00|
Note: Ratings ranged from 1 (very poor; e.g., little or no attention devoted to the topic) to 5 (very good).
As Table 5 illustrates, the perceived quality of internship training in sexual and nonsexual abuse was also low for both men and women. A regression analysis conducted to explore the possibility that ratings of internships might be systematically related to gender, abuse history, or the year of the highest degree yielded positive findings (R 2 = .12 , adjusted R 2 = .11, p < .0001). Again, only the year of the highest degree was statistically associated with the rating of the graduate program (p < .0001) : The more recent the year of the highest degree, the higher the rating of the internship tended to be (see Table 6).
|Type of abuse||Men||Women||Men||Women||Men||Women||Men||Women|
|Childhood or adolescent sexual abuse||2.12||2.24||1.21||1.30||2.0||2.0||1.0||1.0|
|Childhood or adolescent physical abuse||2.38||2.44||1.19||1.31||2.0||2.0||1.0||1.0|
|Rape or attempted rape||2.13||1.96||1.10||1.18||2.0||1.5||1.0||1.0|
|Nonsexual violence against adults||2.46||1.97||1.19||1.12||2.0||2.0||2.0||1.0|
|Therapist-patient sexual involvement||2.26||2.06||1.27||1.29||2.0||2.0||1.0||1.0|
|Physician-patient sexual involement||1.92||1.52||1.17||1.00||1.0||1.0||1.0||1.0|
|All scores combined||2.14||1.97||1.18||1.21||2.0||1.0||1.0||1.0|
Note: Ratings ranged from 1 (very poor; e.g., little or no attention devoted to the topic) to 5 (very good).
|Year of degree||n||M||SD||Mdn||Mode|
|Prior to 1960||21||1.67||1.00||1.00||1.00|
Current Competence or Expertise
As shown in Table 7, participants generally tended to report that they possessed moderate competence or expertise in providing services to clients who had experienced the designated forms of abuse. Multiple regression analyses were conducted to explore the possibility that reported competence in each of the content areas (e.g., childhood or adolescent sexual abuse, childhood or adolescent physical abuse) might be systematically related to gender, the year of the highest degree (see Table 8), the overall rating of the graduate program, and the overall rating of the internship training. Significant multiple correlations were obtained only for reported competence in providing service for sexual harassment (R 2 = .098, adjusted R 2 = .085, p < .0001), rape (R 2 = .096, adjusted R 2 = .083, p < .0001), sexual involvement with a therapist (R 2 = .064 ,adjusted R 2 = .051 , p < .001), and sexual involvement with a physician (R 2 = .052, adjusted R 2 = .039, p < .005). Neither rating of the graduate program nor the rating of internship was systematically related to reported competence.
|Type of abuse||Men||Women||Men||Women||Men||Women||Men||Women|
|Childhood or adolescent sexual abuse||3.23||3.57||1.09||1.15||3.0||4.0||3.0||4.0|
|Childhood or adolescent physical abuse||3.38||3.53||1.04||1.12||3.0||4.0||4.0||4.0|
|Rape or attempted rape||3.17||3.72||1.12||1.13||3.0||4.0||3.0||4.0|
|Nonsexual violence against adults||3.59||3.56||0.92||1.07||4.0||4.0||4.0||4.0|
|Therapist-patient sexual involvement||3.42||3.76||1.11||1.15||3.0||4.0||3.0||5.0|
|Physician-patient sexual involvement||3.21||3.48||1.11||1.24||3.0||4.0||3.0||4.0|
|All scores combined||3.31||3.61||1.08||1.13||3.0||4.0||3.0||4.0|
Note: Ratings ranged from 1 (little or no competence) to 5 (high level of expertise).
|Year of degree||n||M||SD||Mdn||Mode|
|Prior to 1960||21||3.43||1.08||4.00||4.00|
A multiple regression analysis exploring the possibility that the overall level of competence might be systematically related to gender, abuse history, or the year of the highest degree yielded positive findings (R2 = .04 , adjusted R2 = .03, p < .019): Women perceived themselves to be more competent than men in treating clients with abuse histories.
Several major findings emerged: (a) A relatively high proportion of participants reported a history of physical or sexual abuse; (b) participants generally found their graduate programs and internships to be deficient in training them to address abuse issues, although later graduates rated their training more positively than did earlier graduates; and (c) participants generally believed that they were moderately competent to provide services to abuse victims, with female practitioners reporting a higher level of perceived competence than male practitioners.
History of Abuse
A substantial proportion of the participants reported some form of abuse, either during childhood or adolescence or more recently during adulthood. Whether the percentages reported here reflect the percentages of men and women in the general population who have experienced abuse is difficult to determine. Because the scope, sampling procedures, content, format, and wording of our survey differed from prior surveys, meaningful comparisons could not be made.
Not withstanding the limitations just noted, our findings seem consistent with the general trends suggested by other surveys: A substantial minority of people reported abuse as children or adults, and women are more likely than men to have suffered abuse. For example, Finkelhor's (1979) study of 796 college students indicated that 19% of the women and 9% of the men had experienced some form of sexual abuse as children. In Russell's (1984) study of 930 women, 56% reported experiencing rape (defined as intercourse obtained by threat or actual force) or attempted rape, and 24% reported actual rape. Koss, Gidycz, and Wisniewski (1987) found that 27.5% of 3,187 college women reported experiencing at least one rape since age 14. Examining the incidence of sexual coercion in dating situations, Muehlenhard and Linton (1987) found that 14.7% of the female college students reported experiencing unwanted sexual intercourse. A survey of federal employees showed that 42% of the women and 15% of the men reported some form of harassment (United States Merit Systems Protection Board, 198); a follow-up survey indicated strikingly similar (42% of the women; 14% of the men) results (United States Merit Systems Protection Board, 1988). A more general study conducted for Time and Cable News Network by Yankelovich Clancy Shulman asked individuals whether they had ever experienced what they regarded as sexual harassment at work (Gibbs, 1991). About one third (34%) answered yes.
In a study of sexual harassment in which 287 randomly selected female APA members participated, 9% reported that others tried to seduce them while they were employees and 5% reported sexual involvement as employees (Robinson & Reid, 1985). Therapist-patient sexual abuse is an area in which estimates of victimized patients have tended to be indirect (Pope, 1990b). A study of licensed California psychologists showed that about 45% reported working with at least one patient who had been sexually involved with a prior therapist; about 90% of these sexually abused patients were women (Bouhoutsos, Holroyd, Lerman, Forer, & Greenberg, 1983).
A subsequent national study obtained similar results: Half of the therapists reported working with at least one patient who had been sexually involved with a prior therapist; approximately 87% of these 958 sexually abused patients were women (Pope & Vetter, 1991)
Such statistics provide only a small sample of the large and growing body of work that addresses issues of abuse. For more detailed and comprehensive information regarding the types of abuse studied in this survey, representative research reports, reviews of issues and findings, and discussions of implications are provided by Briere (1991); Brodsky (1989); L. S. Brown (1988); G. R. Brown and Anderson (1991); Council on Ethical and Judicial Affairs, American Medical Association (1991); Council on Women in Psychology (1989); Courtois (1988); Estrich (1987); Feldman-Summers (1989); Feldman-Summers and Jones (1984); Finkelhor (1984); Fitzgerald (1991); Fitzgerald and Ormerod (1991); Fitzgerald et al. (1988) ; Frieze (1986); Gartrell, Herman, Olarte, Feldstein, and Localio (1989) ; Gechtman (1989); Gutek (1985, in press); Herman (1981); Holroyd and Brodsky (1977); Koss and Harvey (1991); Pope (1990a, 1990b); Pope and Feldman-Summers; Rubin and Borgers (1990); Russell (1986); Sell, Gottlieb, and Schoenfeld (1986); Shopland and VandeCreek (1991); Sonne (1987, 1989); Sonne, Meyer, Borys, and Marshall (1985); Surrey, Swett, Michaels, and Levin (1990); Swett, Surrey, and Cohen (1990); Vasquez (1991); Walker, Bonner, and Kaufman (1988); Walker (1979, 1988, 1989); and Wolleat (1991).
It cannot be determined with certainty whether the results of our study generalize to the population of clinical and counseling psychologists as a whole. From the earliest self-report studies of this type, researchers have examined the issue of representativeness (for a discussion, see Pope, 1990a, 1990b; Tavris, 1987) and emphasized the need for caution in interpreting results.
Arguments can, of course, be made that those with abuse histories will be more or less eager to respond. However, even if it is assumed that those with abuse histories would be more likely to respond, the findings indicate that there are a substantial number of clinical and counseling psychologists who have suffered abuse. In qualifying these results, it is also important to note that although the population we sampled was composed predominantly of practitioners, some members of Divisions 12, 29, and 42 functioned, either part- or full-time, in other roles such as teaching, administration, and research.
Acknowledging that clinical and counseling psychologists may themselves have suffered abuse raises a number of questions. For example, to what extent, if at all, does a history of abuse influence practitioners to have a greater interest in providing services to abuse victims? Some practitioners, of course, may experience the opposite response: An experience of a particular kind of abuse in their personal lives might have been so devastatingly painful and disruptive that they seek to avoid working with clients who have encountered similar abuse.
Another question raised by this research is, To what extent, if at all, does a history of abuse influence practitioners to be more sensitive to the impacts of abuse on the victim? Is there a way in which the knowledge and sensitivity that may be gained by a personal history of abuse can be imparted to others, for example, in graduate training programs? On the other hand, can a history of abuse, if insufficiently acknowledged, examined, and resolved, render practitioners less able to help a client suffering from a similar form of abuse?
Questions such as these are necessarily left unanswered by the current research. However, the substantial numbers of practitioners reporting abuse suggest that such questions deserve attention. It must be kept in mind that a practitioner's history of abuse was not found to be related to evaluations of graduate or internship programs or to perceived competence. If a relation exists, it is probably complex and involves factors such as severity of abuse, type of abuse, developmental stage at which the abuse occurred, whether treatment was received, and so forth.
Perceived Quality of Graduate Training and Internship
It is remarkable that for both male and female participants, "very poor" was the rating most frequently given to graduate training in every area of abuse but one, namely, nonsexual violence against adults. When mean scores were considered, the results were similar (i.e., in almost all abuse categories, the average ratings were less than 2.0) From any standpoint, these participants found that graduate training related to childhood and adult abuse was woefully lacking. Arguably, one can take some solace in the finding that ratings tended to be higher for more recent graduates. However, even for the most recent graduates, ratings of their programs with respect to coverage of abuse issues were extremely low (i.e., the mode was "very poor" for all graduation year periods, with mean scores barely exceeding 2.0 for the two most recent graduation year periods) In short, recent graduate program improvements were slight, at least from the perspective of these respondents. Although marginally higher, the ratings of internship training also reflected dissatisfaction with training in the abuse areas studied here.
These findings suggest that graduate training programs have generally focused little, if any, attention on sexual or physical abuse. Moreover, if graduate training mirrors the volume of published research in a given topic area, it would not be surprising if graduate training in various areas of abuse has been generally weak because published research in these areas has been sparse up until the past decade or so (see Pope, 1990a). These respondents may be aware that a substantial body of literature exists in sexual abuse areas (e.g., childhood molestation, rape, therapist-patient sexual involvement) and believe that the theoretical and empirical advances in these areas deserve explicit attention in graduate training programs. These respondents may also be aware of the legal issues associated with these various abuse areas and believe that these issues are of such direct importance to the practitioners as to require courses that focus specifically on such areas. Significant changes in graduate programs (and internships) are needed if they are to be regarded as being any better than "very poor" in training in the abuse areas in the eyes of practitioners.
Borys and Pope (1989) suggested a set of 10 specific steps that graduate training programs, internships, and other formal teaching programs might take to address issues related to therapist-patient sexual abuse and related forms of behavior. Such steps included (a) ensuring that topics related to abuse are reflected in virtually all clinical coursework, supervision, and other forms of education rather than "limited to a specialized lecture or course and neglected in the rest of the curriculum" (Borys & Pope, 1989, p. 291); (b) presenting the research-based literature as well as works of advocacy (including those that offer arguments that seek to deny, minimize, or justify various forms of abuse) so that students can "confront and evaluate the full range of such arguments" (Borys & Pope, 1989, p. 291); and (c) ensuring that students and faculty work together in an environment in which they are safe from abuse (e.g., sexual harassment of students by professors) and in which it is safe to discuss issues related to abuse (see also Pope, Keith-Spiegel, & Tabachnick, 1986; Pope, Sonne, & Holroyd, 1993; Pope & Vasquez, 1998).
This latter issue of safety is of great importance from at least four major perspectives. First, simply addressing issues of abuse (e.g., in a classroom discussion) may be a terrifying or otherwise uncomfortable experience for some students whose lives have been directly or indirectly (e.g., the abuse of a family member, life partner, or close friend) touched by abuse. Sensitivity to the potential impact of course content that may be personally immediate for students is essential.
Second, rendering clinical or counseling services to people who have been abused can elicit a variety of disturbing feelings for which interns and other human service providers-in-training need a genuinely safe training environment. For example, trainees may experience erotic reactions when working with victims or survivors of certain kinds of abuse (e.g., Ganzarain & Buchele, 1986, 1988; Pope, 1994; Pope, Sonne, & Holroyd, 1993; Sonne & Pope, 1991) Such trainees may feel that discussion of their own erotic reactions in supervision or other training settings may place them at risk for exploitation or harassment by educators Pope et al., 1986).
Third, educational institutions must avoid subjecting students to not only the forms of abuse that are the focus of this article (e.g., sexual harassment) but to any form of abuse. Those responsible for graduate training programs, internships, and other training settings must be alert to the diverse ways in which the members of their communities may encounter abuse in forms such as exploitation, prejudice, or invidious discrimination based on factors such as race, ethnicity, gender, sexual orientation, or special physical needs (e.g., L. S. Brown, 1991; Bruyere & Pollard, 1991; Diaz, 1990; Erlich, Pincus, & Morton, 1987; Fox & Barclay, 1989; Guthrie, 1976; Herek, 1986, 1989; Jones, 1985; Peterson, 1990; Pollard, 1991; Pope & Vasquez, 1998; Santiago-Negron, 1990; Tabachnick, Keith-Spiegel, & Pope, 1991). When a training setting exposes students to abuse, students may not only react negatively to the setting itself and the educational experience but also experience a variety of acute and more lasting harmful effects (e.g., Baldwin, Daugherty, & Eckenfels, 1991; Richman, Flaherty, Rospenda, & Christensen, 1992; Sheehan, Sheehan, White, Leibowitz, & Baldwin, 1990).
Fourth, safety and the sense of safety involve maintaining suitable boundaries of privacy. When graduate programs, internships, and other training programs address forms of abuse that many students and faculty might have personally experienced, it is especially important that all individuals' appropriate rights to privacy be adequately respected and protected.
It is encouraging that practitioners feel moderately qualified to treat victims of abuse, despite what they perceive as poor training in the area. The sources of practitioners' perceived competence cannot be determined from our study. Although later graduates rated their graduate and intern training programs as more adequate than earlier graduates, there were no differences between earlier and later graduates' perceived competence to treat victims of abuse. Compared with their younger colleagues, earlier graduates' lengthier clinical experience might have compensated for their poorer training. It is worth noting that several participants commented that they had supplemented their formal education with workshops and readings on their own time.
That women's ratings of competence were on the whole higher than men's ratings in abuse areas studied here has several possible explanations. First, it is possible that because women are more likely than men to have been abused at some time in their lives, they may find it easier to empathize with their clients; consequently, they feel more competent. It is also possible that female practitioners have had more experience treating survivors of the kinds of abuse described in this study and as a result feel more competent. Finally, it is possible that female participants, on the whole, took more steps to prepare themselves to treat abuse victims, perhaps because of their interest in this client population or their own histories of victimization. Unfortunately, why female practitioners felt more competent than male practitioners in the areas in question cannot be answered with the data gathered here.
In many respects, these findings raise more questions than they answer. Yet, it is apparent that practitioners must address these questions if they are to be responsive to the needs of the larger community. Childhood and adult abuse are events that may in some instances be associated with later events, conditions, or behaviors that are signficantly negative. Practitioners need to know exactly how and why their training programs are seen as inadequate in these areas and how, in light of this perceived inadequacy, practitioners acquire the knowledge they need to treat victims.
- Survey of Psychologists' "Forgetting" Child Abuse (follow-up study)
- Ethics in Psychotherapy and Counseling, Second Edition
[NOTE: Some references have been updated since the original publication of this article.]
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FOOTNOTE 1: In light of the multiple statistical analyses, findings throughout this article were considered statistically significant only if the probability was less than .02.