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1/” WM“

THE EFFECTS OF CHILDHOOD SEXUAL ABUSE ON PARENTING:
THE ROLES OF SOCIAL SUPPORT, COPIN G, AND RESOLUTION

By

Linda Ellen Burke

A DISSERTATION
Submitted to
Michigan State University

in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Psychology

1998

ABSTRACT

THE EFFECTS OF CHILDHOOD SEXUAL ABUSE ON PARENTING:
THE ROLES OF SOCIAL SUPPORT, COPING, AND RESOLUTION

By

Linda Ellen Burke

The long-term effects of childhood sexual abuse have been widely documented.
However, only more recently have the roles of potential moderating and mediating
variables been examined. The current study sought to expand upon previous research by
examining the potential buffering effects of social support on attenuating the negative
effects of a history of sexual abuse on maternal confidence, warmth, control, and self-
reported levels of depression. The mediational roles of coping and resolution of abuse-
related issues were also tested to determine their relative impacts upon associations
between sexual abuse, parenting outcomes, and depression. Results of regression
analyses indicated direct effects of social support on psychological well-being and
parenting confidence; however, no buffering effects were found. Severity of sexual abuse
was directly related to greater maternal control. None of the coping variables or
resolution mediated the effects of abuse. However, lack of resolution directly predicted
depression. Severity of abuse predicted lack of resolution regarding abuse-related issues.
Parental reappraisal coping predicted maternal confidence and maternal warmth and less

maternal control. The implications of these findings are discussed.

ACKNOWLEDGMENTS

I would like to thank my committee, Dr. G. Anne Bogat, Dr. Richard DeShon, Dr.
Cris Sullivan, and Dr. Robert Caldwell for their support, helpful feedback and
encouragement throughout this process. I would particularly like to thank Dr. Bogat, who
has remained an invaluable mentor and friend for many years and who provided
encouragement and motivation when my own was flagging.

I would also like to thank all those family members and fi'iends who remained
patient and supportive over the years as I finished my "big paper." A special thanks to
those friends at The Children's Health Council who provided me with a compassionate
car when I was discouraged, practical advice when I was stymied and, most importantly,
humor when I risked taking everything a bit too seriously.

Above all, I would like to thank the women who participated in this study. These
women opened their lives and often their homes, many with the hope that their
participation would be helpful to other survivors. I hope that this project has in some way
fulfilled those hopes.

Finally, thanks and love to my mom and dad.

iii

TABLE OF CONTENTS

LIST OF TABLES ...................................................................... viii
LIST OF FIGURES ..................................................................... ix
CHAPTER I: INTRODUCTION
Overview and Purpose of Study .............................................. 1
Child Sexual Abuse
Effects of CSA ........................................................ 7
Effects of CSA on parenting ........................................ 9
Abuse-related factors ................................................ 10

The Deficit Model: Why We Focus on the "Damaged"

Woman"
The intergenerational transmission of abuse ..................... 12
Is there a "cycle of victimization"? ................................. l3

CSA and the Stress/Social Support/Coping Model: A
Theoretical Formulation of the Effects of CSA on

Parenting ....................................................................... 15
Stress: The First Portion of the Model ..................................... 15
Social Support
Definition of social support ........................................ 17
Social support and parenting ....................................... 18

iv

Direct vs. buffering effects of social support .................. 19

Social support and CSA ......................................... 21

The conceptualized role of social support in

the present study .................................................. 23
Coping

Definition and relevant research ................................ 23

Coping strategies and CSA ...................................... 26

Resolution of abuse-related issues .............................. 28

Maternal Depression: A Variable with Connections to

CSA and Parenting ........................................................ 30
Summary and Rationale for the Present Study ......................... 32
Hypotheses ................................................................. 34

Hypothesis 2 ...................................................... 34

Hypothesis 3 ...................................................... 34

Hypothesis 4 ...................................................... 34

Hypothesis 5 ...................................................... 35
CHAPTER 11: METHOD

Research Part1c1pants 36
Measures .................................................................. 36
Demographics ................................................... 36

Child sexual abuse 36

Stress ............................................................. 40
Social support 40
Coprng 41
Lack ofresolution ofabuse................. . .. . . . . . . . . . . . . . . . . 42
Maternal depression............................ 42
Measures ofparenting ......................................... 43
Maternal confidence and control ............................. 43
Maternal warmth ............................................... 44

Procedures ............................................................... 44

CHAPTER III: RESULTS

Descriptive Analyses ................................................... 49

Intercorrelation of Study Variables ................................... 53

Effects of Abuse-Related and Demographic Variables ............ 55

Testing the Research Hypotheses .................................... 56

Hypothesis 1: Testing the Stress-Buffering Hypothesis

with a CSA Population ................................................ 56

Hypothesis 2: Sexual Abuse as Stressor ............................. 56

Hypothesis 3: The Effects of Abuse on Parenting

Outcomes ............................................................... 57

The Mediational Role of Coping and Lack of

Resolution .............................................................. 6O

Hypothesis 4: Mediators Related to Maternal

Depression ............................................................. 61

vi

Hypothesis 5: Mediators Related to Parenting

Outcomes ............................................................. 63
CHAPTER IV: DISCUSSION .............................................. 68
A LIST OF REFERENCES .................................................... 84
APPENDICES
APPENDIX A: Demographic Questionnaire .................... 96
APPENDDC B: CSA Questionnaire ............................... 98
APPENDD( C: Hassles Scale ..................................... 104
APPENDIX D: Social Provisions Scale ......................... 109
APPENDIX E: Ways of Coping .................................. 111
APPENDD( F: Resolution Questionnaire ........................ 115
APPENDD( G: CBS-D ............................................. 1 17
APPENDD{ H: Parenting Questionnaire ......................... 119
APPENDIX 1: Relationship with Child ........................... 121
APPENDD( J: Consent for Participation in Research .......... 122
APPENDD( K: Recruitment Flyer ................................ 123

vii

Table 1:

Table 2:

Table 3:

Table 4:

Table 5:

Table 6:

Table 7:

Table 8:

LIST OF TABLES

Demographics of Sample ........................................... 37
Internal Consistency of Measures ................................. 38
Number of Perpetrators Reported by Women ................... 50
Number of Women Reporting Abuse Types

(Primary Perpetrator) ................................................ 51
Relationship of Woman to Primary Perpetrator ................. 52
Intercorrelations of Study Variables .............................. 54

Social Support as a Buffer of Stress and
Abuse Predicting Depression ...................................... 58

Social Support as a Buffer of Abuse
Predicting Parenting Outcomes ................................... S9

viii

LIST OF FIGURES

Figure 1: Buffering Hypothesis for Stress/Social Support
and Depression ..................................................... 3

Figure 2a: Stress-Buffering Effects Model for Abuse/ Social
Support and Depression .......................................... 4

Figure 2b: Direct Effects Model for Abuse/ Social Support and
Depression .......................................................... 4

Figure 3: Direct Effects Model for Abuse/Social Support and
Parenting Outcomes ............................................... 5

Figure 4: Proposed Mediational Effects of Coping and Lack of
Resolution on Parenting Outcomes .............................. 6

Figure 5: Coping and Lack of Resolution as Mediators of the Effects
of Abuse on Level of Depression ................................ 62

Figure 6: Coping and Lack of Resolution as Mediators of the Effects
of Abuse on Maternal Confidence ............................... 64

Figure 7: Coping and Lack of Resolution as Mediators of the Effects
of Abuse on Maternal Warmth .................................. 66

Figure 8: Coping and Lack of Resolution as Mediators of the Effects
of Abuse on Maternal Control ................................... 67

ix

CHAPTER I
INTRODUCTION
Overview ind Purpose of Study

Over the past 25 years, a considerable amount of research has been devoted to the
exploration of the etiology and effects of childhood sexual abuse on women. Researchers
have clearly established that the experience of childhood sexual abuse (CSA) results in
both short— as well as long-term negative effects. Two recent reviews (Beitchman,
Zucker, Hood, DaCosta, Akrnan, & Cassavia, 1992; Kendall-Tackett, Meyer Williams, &
F inkelhor, 1993) identified well over 50 studies published within the past 15 years that
focused specifically on the effects of sexual abuse on children and adults. However, the
majority of research focuses on the negative clinical effects of CSA on victim's
psychological well-being (e.g., sexual dysfunction, mood disorders) and neglects other
life areas that do not fall under the umbrella of this clinical deficit model.

This study attempted to avoid adhering solely to the deficit model by assessing not
only the negative effects of sexual abuse, but also the psychological strengths that may
mediate the association between abuse and outcome variables. In addition, various
aspects of parenting, rather than psychopathology alone, were included as outcome
variables in this study. With the exception of the work of Cole and her colleagues (1989;
1992), this association has gone relatively unexplored. Given that it has been estimated
that nearly 1 in 4 girls will experience sexual assault at some point in their lives

(F inkelhor, 1984), it is important to explore the impact of sexual abuse on what is

2
arguably one of the most critical relationships in the woman's life.

To further refine these empirical questions, this study sought to explore the
effects of sexual abuse within the context of assessing the associations between stress,
social support, and c0ping. Studies addressing the effects of CSA often lack a viable
theoretical framework; they also typically assume a direct pathway between abuse and
later outcomes. For example, studies tend not to explore the role of moderating or
mediating variables that may buffer or exacerbate the effects of abuse. In this study, the
stress-buffering hypothesis was tested to determine whether social support moderates the
relationship between stress and depression with this particular population (See Figure 1).
Other studies have found mixed results depending, in part, on the population to which it
is applied (V aux, 1985).

In a separate set of analyses, sexual abuse was substituted for stress and the
buffering hypothesis was again tested to determine whether social support buffers the
effects of sexual abuse (similar to the manner in which it does for daily stress (Figure 2a))
when predicting depression, or whether the effects are direct (Figure 2b). The buffering
versus direct effects of social support were then tested with three different parenting
outcomes: parenting confidence, maternal warmth, and maternal control (Figure 3).

Finally, five variables were hypothesized to mediate the relationship between
sexual abuse and both psychological and parenting outcomes (Figure 4): reappraisal and
avoidant coping styles (associated with parenting and abuse-related stress, respectively)
and lack of resolution of abuse issues.

This approach was considered the initial step in developing a more precise model

Social Support

 

 

StreSs * Depression

Figure]

Buffering Hypothesis for Stress/Social Support and Depression

Social Support

 

AbuSe >Depression

Figure 2a

Stress-Buffering Effects Model for Abuse/Social Support and Depression

Social Supp rt

 

Abuse >Depression

Figure 2b

Direct Effects Model for Abuse/Social Support and Depression

 

 

 

Social Support
+
Abuse Maternal
_ Confidence
Social Support
+
Abuse >Matemal
_ Warmth
Social Support
Abuse > Maternal
+ Control

Figure 3

Direct Effects Model for Abuse/Social Support and Parenting Outcomes

Abuse Avoidant

Abuse Reappraisal

 

Abuse ’ Parental Avoidant \-\> Parenting

/ Outcomes
Parental Reappraisal/v
Lack of Resolution

Figure 4

Proposed Mediational Effects of Coping and Lack of Resolution

7

for understanding the effects of childhood sexual abuse on parenting.
Child Sexual Abuse

Effects of CSA. Anna Freud (1981) stated that "where the chances of banning a
child's normal developmental grth are concerned, sexual abuse ranks higher than
abandonment, neglect, physical maltreatment or any other form of abuse" (p. 34). There
is considerable research which assesses the nature and effects of childhood sexual abuse.
The following review focuses on those studies which involved survivors of abuse
perpetrated by either a member of her immediate farrrily, a close relative, or a family
acquaintance.

Among the short-term effects of CSA are the inability to trust others, especially
those in authority (Gagliano, 1987; Hazzard, King, & Webb, 1986; Lindberg & Distad,
1985; Porter, Blick, & Sgroi, 1982; Sgroi, Blick, & Porter, 1982). Gagliano (1987)
suggests that this is due to the fact that if the most important authority figure in the child
victim's life is also his or her abuser, it becomes nearly impossible to either respect or
trust others in positions of authority. Another primary effect is low self-esteem
(Gagliano, 1987; Oates, Forrest, & Peacock, 1985; Porter et al., 1982). Researchers and
therapists have also noted that intense shame and guilt (e. g., as a result of feeling
responsible for abuse, disclosing the abuse and "causing" a disruption in the family;
Damon, Todd, & Macfarlane, 1987; Hazzard et al., 1986; Lindberg & Distad, 1985),
depression (Anderson et al., 1981; Hazzard et al., 1986), inappropriate sexual behavior
(Friedrich, Urquiza, & Beilke, 1986; Tufts, 1984), and overwhelming anger (Anderson,

Bach, & Griffith, 1981; Hazzard, King, & Webb, 1986; Tufts, 1984) are also negative

effects suffered by victims of CSA.

Several long-term outcomes, which are most often assessed in adult populations
with histories of CSA, have been identified by both researchers and clinicians. Empirical
and anecdotal evidence has tended to focus on the clinical symptoms associated with
abuse. These most commonly include symptoms associated with Post-Traumatic Stress
Disorder, such as intrusive daytime imagery, insomnia, depression, anger, guilt, mistrust,
substance abuse, feelings of worthlessness, suicide attempts, isolation, and emotional
numbing (Bagley & Ramsey, 1985; Briere, 1984; Courtois, 1979; Herman, 1981; Jehu,
Gazan, & Klassen, 1985; Lindberg & Distad, 1985; Meiselman, 1978; Peters, 1984).
Further examples of continued effects of childhood sexual abuse include anxiety and
depression (Bagley & Ramsay, 1985; Briere, 1984; Luster & Small, 1997; Sedney &
Brooks, 1984), impaired self-esteem (Bagley & Ramsay, 1985; Herman, 1981; J ehu et al.,
1985), and sexual dysfunction (Herman, 1981; Jehu et al., 1985; Steele & Alexander,
1981). A history of child sexual abuse has also been associated with high frequencies of
eating disorders (Palmer, Chaloner, & Oppenheimer, 1992; Waller & Ruddock, 1993).
Compared to the effects of other types of child abuse, there is also some evidence that
sexual abuse is more strongly associated with suicidal behavior in adolescent girls
(Kosky, Silbum, & Zubrick, 1990; van der Kolk, Perry, & Herman, 1991; Shaunesey,
Cohen, Plummer, & Berman, 1993).

One of the most detrimental effects adult survivors continually report is difficulty
trusting others, especially those closest to them. Levay & Kagle (1977) reported that

women who had been sexually abused were more successfirl with impersonal

9

relationships but experienced considerable intimacy dysfunction when relationships
moved toward deeper levels. Courtois (1988), drawing from her clinical interactions with
female survivors of childhood sexual abuse, noted that they tended to "experience
relationships as threatening instead of gratifying" (p. 112), and they often felt "trapped"
and "unable to move past a certain point (of intimate involvement)" in close relationships.
In another clinical study, nearly 75% of the clients indicated a fear of intimate
relationships with men (J ehu et al., 1985). As a result, these women tended to engage in
a pattern of shorter, more superficial relationships. These results were consistent with
earlier findings (Lukianowicz, 1972; Meisehnan, 1978). Jehu and his colleagues suggest
that avoiding deep, long-term relationships arises from fears of recreating the earlier
abusive relationship as well as from the experience of betrayal and exploitation.

Effects of CSA on parenting, In general, the research indicates that, as a result of
CSA, survivors' interpersonal relationships may be significantly affected because they
experience difficulty trusting others, maintaining long-term relationships, and resolving
conflict. It is therefore surprising that only a limited number of studies have explored the
effects of CSA on the mother-child relationship.

Findings that do address this link suggest that mothers with histories of sexual
abuse are more focused on their own needs rather than their children's needs (including
relying on their children for emotional support) and engage in more belittling and less
affirming interactions with their children than women without abusive histories (Burkett,
1991). In addition, sexually abused women tend to describe motherhood either in terms

of its rewards or drawbacks, rather than relating experiences that were both positive and

10

negative (Burkett, 1991; Herzog, Gara, & Rosenberg, 1992). The results of two other
studies revealed that women survivors' perceptions of their own parents and experiences
of abuse predicted certain aspects of their own parenting. Survivors who held strongly
negative perceptions of both parents were the most likely to report less nurturing and
more controlling attitudes toward their children than non-victims. In addition, survivors
reported less consistency, less organization, and fewer maturity demands from their
children as well as lower levels of parenting confidence and control than non-victims
(Cole & Woolger, 1989; Cole, Woolger, Power, & Smith, 1992).

There is also limited anecdotal evidence that a history of sexual abuse negatively
impacts women's parenting. In particular, many clinicians have noted that women
survivors experience considerable difficulty when their own children reach the age at
which they themselves were first molested (Green, 1982). It is hypothesized that seeing
and experiencing their children at this age triggers these women's own memories of
abuse, thereby creating considerable stress, which in turn affects their parenting
experience. In addition, clinicians have noted that women who are survivors often
express fear that they will be poor mothers (Courtois, 1988; Herman, 1981); however, as
Herman points out, these women ofien do a much better job of taking care of their
children than they do taking care of themselves.

AbrLse-related factors. A first step in developing a more refined understanding of
the impact of CSA has been identifying and assessing the role of variables related to the
nature of the abuse and the contextual situation within which it occms. Although the

findings are somewhat mixed, overall, researchers have found that the closer the relation

1 1
of the perpetrator to the child (Anderson et al., 1981; Friedrich, Urquiza, & Beilke, 1986;
Wyall & Newcomb, 1990), the more deleterious the effects, particularly if the perpetrator
is a father or step-father (Browne & F inkelhor, 1986). Longer duration (Bagley &
Ramsay, 1985; Russell, 1986) and severity of the abuse (Bagley & Ramsay, 1985;
Finkelhor, 1979; Mullen, Romans-Clarkson, Walton, & Herbison, 1988; Russell, 1986;
Tufts study, 1984) have also been associated with more devastating consequences for the
victim. For example, CSA involving force and violence is associated with more severe
psychopathology (Mullen et al., 1988). However, the results of many of these studies are
difficult to compare due to differences in how severity or the exact nature of the abuse
itself were operationalized.

In addition, the responses a child encounters when she discloses the abuse may
greatly affect her immediate, and possibly later, adjustment. Specifically, the more
negative and ultimately unprotective response the child receives when the abuse is
disclosed, the more negative the psychological outcome for the victim (Anderson et al.,
1981; Davenport, Browne, & Palmer, 1994; Herman, 1981; Tufts study, 1984).

The Deficit Model: Why We Focus on the "Damaged" Woman

While it is expected that women's previous experiences of abuse will have created
obstacles to their parenting, it is also considered important to determine how women
survivors have succeeded in the face of their abusive experiences. In the past, research
studies have either tended to utilize the clinical anecdotes of therapists who have worked
with survivors or surveyed non-clinical populations using only measures which assess

pathological outcomes. The tendency to assess pathology rather than health is a common

12

theme in psychology. Two examples, which are related to the current study, will help to
put this phenomenon in context: the theory of intergenerational transmission of abuse and
the theory of a cycle of victimization. Both these theories relate to abuse, and they also
have been used more ofien to assess women's, rather than men's, roles (e. g., research
involving the intergenerational transmission of abuse more often assesses maternal
abuse).

The intergenerational transmission of abuse. Although more often associated with
the occurrence of physical or emotional abuse rather than sexual abuse, the
intergenerational transmission of abuse hypothesis contends that parents' own experiences
of physical and/or emotional abuse and neglect may be associated with subsequent abuse
of his or her own children (e.g., Herrenkohl, Herrenkohl, & Toedtler, 1983; MacEwen,
1994; Main & Goldwyn, 1984; Quinton, Rutter, & Liddle, 1984; Steele & Pollock, 1968).
One possible explanation for this phenomenon is that rejected children become adults
who are cautious of and unresponsive to intimate relationships and these adults are also
more likely to become rejecting parents (Kempe & Kempe, 1978; Rohner & Rohner,
1980)

Despite evidence supporting this theory, several researchers have pointed out
methodological limitations within this body of research (Altemeier, O'Connor, Vietze,
Sandler, & Sherrod, 1982; Gelles & Cornell, 1985). For example, Ciccheti & Carlson
(1989) compared multiple studies testing the intergenerational hypothesis and found that
the rate of transmission varied from 18 to 70%, in part depending upon the methodology

utilized. Ciccheti & Carlson estimated that the actual rate of transmission was closer to

13

30% i 5%. Clearly, while a history of parental abuse may put some persons at increased
risk of abusing their own children, the pathway is far from direct or simple.

With regard to sexual abuse, the intergenerational transmission hypothesis
warrants even closer scrutiny. Zuravin and her colleagues (1996) recently explored
whether parents who were physically, emotionally or sexually abused as children were
more likely to abuse their own children. Findings suggested that mothers who
experienced severe sexual abuse (i.e., intercourse vs. non-intercourse types of abuse)
were more likely to have a maltreated child. However, the mother was rarely identified as
the perpetrator; rather, the authors suggest that the mother's presumed lack of emotional
availability secondary to having been abuse may have put the child at greater risk for
abuse by other adults (e. g., sexual abuse by an adult male). While these findings are
compelling, they do not provide information regarding the presence of variables that may
moderate or mediate the association between abuse history and outcomes.

Is there a "cycle of victimization"? Another example of the deficit focus is the
"cycle of victimization" theory, which supports the notion that certain women are
repeatedly victimized. This belief has emerged from a concurrent belief in the existence
of a "victim" personality, which has its origins in the Freudian and neoanalytic
conceptualizations of the female "masochistic" and "hysterical" personalities. There is
considerable argument over the viability of such conceptualizations; for example,
feminist theorists contend that such diagnoses serve only to oppress and disempower
women further because often the "symptoms" are actually the pathologizing of feminine

characteristics (Chesler, 1972; Greenspan, 1983; Lerner, 1986).

14

In addition, there is controversy as to whether a true pattern of repeat
victimization actually exists. Mandoki & Burkhart (1989) found that women who were
victimized as children were no more likely to be victimized later in life than women who
reported no childhood abuse. Furthermore, no predictive relationship was found between
selected personality variables (e. g., assertiveness, self-esteem, dependency, and
attributional style) and occurrence of victimization. However, the findings did indicate
that, as the degree of child victimization increased, so did the number of adult consensual
partners. Because the number of sexual partners also predicted victimization during
adolescence, these findings suggest that an indirect relationship between early and later
victimization may exist. The authors also point out that prior studies that show a
correlation between childhood sexual assault and later victimization are actually
reflecting the high base rate of victimization of women in general rather than a pattern of
repeated abuse, per se.

Both the criticisms of and developments within these two theoretical domains
highlight the need to focus on the positive, not only the pathological. Interestingly, the
burgeoning self-help literature has addressed strengths as well as weaknesses in survivors
of CSA (Bass & Davis, 1988; Poston & Lison, 1989). There is also some empirical
evidence that survivors of CSA experience feelings of power, autonomy, and
independence, and an increased sensitivity towards others as a result of their abuse
(Brunngraber, 1986). However, these findings lack a theoretical context as well as an
adequate explanation as to the potential mechanisms which may be driving the emergence

of these positive outcomes.

1 5

CSA and the Stress/Social Support/Coping Model: A Theoreticflormulation of the
Efiecm CSA on FM

The intergenerational transmission of abuse theory has been criticized for being
too simplistic. Mediating factors such as social support (Egeland & J acobvitz, 1984;
Herrenkohl et al., 1983; Hunter & Kilstrom, 1979), acknowledgement of and resolution
not to repeat abuse (Egeland & J acobvitz, 1984), and economic security (Straus, 1979)
are just a few of the factors that predict the parenting behaviors of previously abused
persons. These factors fit within a larger, ecological model of abuse developed by Belsky
(1980), which extended and drew from prior models of abuse and development
(Bronfenbrenner, 1977, 1979; Garbarino, 1977; Tinbergen, 1951). In addition, these
ecological models resemble more general stress/social support/coping models. However,
these more ecologically-based models have not been empirically tested as an explanation
for the effects of childhood sexual abuse.
Stress: The First Portion of the Model

Definition and relev‘amreseaLh. The associations among stress, social support,
and c0ping have experienced considerable attention over the past twenty or so years.
Emerging from the work of Selye (1956) and others involving the effect of external
stressors on animal and human physiology, the impact of stressors on psychological
adjustment became a focus of much research during the 19608. Selye identified the
General Adaptation Syndrome (GAS), the physical effects and adaptation that occur when
a living organism is exposed to an external stressor. Subsequently, social epidemiologists

explored the psychosocial effects of exposure to stressors, and this area of research has

16

experienced substantial growth and expansion since the 19608 and 19703.

Within the psychological and sociological realms, stress has been defined in a
variety of ways; in general, a stressful event is defined as one that demands a degree of
individual adaptation that is beyond the resources (tangible, emotional and/or physical) of
the individual at that time (Dowrenwend & Dowrenwend, 1974).

The early work of Holmes & Rahe (e. g., 1967, 1979) explored the effects of
recent major life events (e.g., loss of a loved one) on an individual's psychological well-
being. This approach was widely used throughout the 1970s and 1980s and their
measure, the Scale of Life Events (Holmes & Rahe, 1967), was utilized as an assessment
tool in numerous studies. This scale involves the respondent marking off items on a
stressful life events checklist, and an overall "stress" score is attained by tallying the
number of events a person reports within a determined period of time. This manner of
indicating stress is based on the notion that the number of events a person experiences is
directly proportional to the extent of disequilibrium that is created, and, thus, the degree
of adjustment that is required (Holmes & Rahe, 1967).

Although quite popular for a time, the technique of identifying discrete and often
rare events has more recently given way to the measurement of daily "hassles," which
Lazarus and his colleagues have defined as the "irritating, frustrating, distressing demands
and troubled relationships that plague us day in and day out" (Lazarus & Delongis, 1983,
p. 247). These "daily hassles" are more strongly related to psychological distress than the
singular life events described by Holmes and Rahe (Kanner et al., 1981); therefore,

measures of daily hassles, although criticized by some as being confounded with

17

measures of adaptational outcome (Dohrenwend & Shrout, 1985), continue to be a
popular assessment strategy of choice in studies exploring the effects of personal stress.
In addition, the hassles assessment approach has considerably more response variance
compared to the life events approach (i.e., it's unlikely that most respondents will have
experienced a recent major life event; however, many respondents will have experienced
numerous, recent daily hassles).

However measured, the resultant effects of stress on individual physical and
psychological conditions is well documented. Such findings have indicated that both
stressful life events (e.g., job disruption, loss of a loved one, etc.) and chronic stress (e.g.,
"hassles" such as financial problems) can be associated with depression (Anderson,
Noyes, & Hartford, 1977; Pearlin, Menaghan, Lieberman, & Mullan, 1981) and physical
illnesses (Holmes & Masuda, 1974).

Taking the above description of the stress process, a woman's experience of
childhood sexual abuse would seem to clearly fit the definition of "stressor." This is true
not only during the course of the abuse, but also in regards to the long-term, chronic stress
that is associated with issues such as mistrust in relationships, and feelings of anxiety,
guilt, and anger.

Social Support

Definition of social support. In general, social support is defined as "actual or
perceived" social interactions that "provide instrumental and/or expressive functions"
(Dean, 1986, p.9). More specifically, Thoits and others have identified two distinct and

equally important aspects of social support: structural (e.g., number of persons in support

18

network, accessibility, frequency of contact, etc.) and functional (e. g., perceived amount
of support and relative satisfaction with the amount and type of support received). In
addition, most operationalized definitions of functional support include areas such as
emotional support (e. g., empathic responses), instrumental or tangible support (e. g.,
financial assistance), and informational support or guidance/advice (e.g., provision of
information regarding child development to a new mother) (House, 1981; Lin, Dean &
Ensel, 1981; Russell & Cutrona, 1985; Wolf, 1981).

m1 support and parenting= One aspect of the present study, the relationship
between social support and parenting, is well-documented within the extant literature. In
general, the research suggests that social support is associated with maternal confidence
in parenting, greater maternal nurturance, and successful mother-child interactions
(Barrett, 1978; Pascoe, Loda, J effiies, & Earp, 1981; Tetzloff & Barrera, 1987). Greater
social contacts have also predicted better parenting adjustment for single-mothers, while
more tangible forms of support (e.g., household help) have been found to benefit mothers
in two-parent homes (D'Ercole, 1988; Weinraub & Wolf, 1983).

Applied research in this area has sought to evaluate specific intervention programs
that provide mothers with various forms of support. In general, these programs tend to
provide informational (e.g., regarding diet, infant care) and emotional support and have
also expanded the mother's social support network (Barrera, Rosenbaum, & Cunningham,
1986; Booth, Barnard, Mitchell, & Spieker, 1987; Dawson, vanDoominck, & Robinson,
1989; Olds, Henderson, Charnberlin, & Tatelbaum, 1986). In general, the findings

suggest that these interventions not only improve the mother's reported levels of social

19

support, but also improve the quality of the mother-infant relationship.

Direct vs. bufferingeffects of sogal support. The literature reflects an overall
consensus that social support is associated with positive outcomes for individuals.
However, the mechanism by which this association is realized has provoked debate. The
focus of this argument has been whether social support has a direct beneficial effect on
psychosocial adjustment, regardless of stress level, or whether this link only exists in the
presence of high levels of stress, thereby "buffering" the individual from the effects of
stress (Cohen & Wills, 1985).

Reviews of individual studies (see Cohen & Wills, 1985; Ensel & Lin, 1991;
Levay, 1983; Vaux, 1985 for reviews of the literature) suggest that the direct vs. buffering
effects of social support may vary across populations and may also be dependent upon the
manner in which support is measured. For example, Vaux (1985) noted that women tend
to experience greater social support than men and there is some indication that social
support may play a more salient role in women's reactions to stressful situations. In their
oft-cited review, Cohen & Wills (1985) argued that when specific, functional (i.e., the
quality, rather than the amount, of social support) support scales are utilized to assess
social support, buffering effects are more likely to be found; when the measure of social
support involves assessment of one's social network, main effects are found.

Evidence for the direct effects hypothesis suggests that social support directly
reduced reported intensity of depressive symptomatology in men and women (Miller &
lngham, 1976; Paykel et al., 1980; Surtees, 1980). In non-clinical samples of urban

Americans, social support negatively correlated with psychological distress (Beigel et al.,

2 O
1980; Lin et al., 1979). In addition, Andrews et a1. (1978) found that direct crisis support
significantly differentiated between psychologically distressed and non-distressed
individuals. The findings of the Lin et al. and Andrews et a1. studies, both of which
tested for the stress-buffering effect but found none, suggest that social support and stress
independently affect outcomes.

Conversely, other researchers have argued that social support acts as a buffer
between stress and outcome, and does not affect outcome independent of stress level.
Both of the proposed mechanisms as well as the outcomes for this model have varied.
Evidence in support of the buffering hypothesis has indicated that adequate levels of
social support may attenuate the psychosomatic effects brought on by stressful events (de
Araujo, Van Arsdel, Hohnes, & Dudley, 1973; Nuckolis, Cassel, & Kaplan, 1972) such
that, in conditions of high stress, those individuals reporting low levels of social support
also report the highest degrees of psychosomatic distress. Additional evidence, has
demonstrated the buffering effect with college undergraduates (Cutrona, 1986).
Undergraduates who reported a greater frequency of received "helping behaviors" (e.g.,
advice, expressed worry or concern) reported lower levels of depressive affect following a
stressful event than those students who indicated fewer indicators of social support.
However, in a sample of new mothers (assessed during pregnancy, and at 2-,8-, and 52-
week follow-ups), Cutrona (1984) reported no support for the buffering hypothesis.
Specifically, the results of this study indicated that, at high levels of stress, social support
did not alleviate reported levels of depression, but social support did positively impact

outcomes at lower levels of stress. These findings suggest that, for this population, social

2 1
support imparts a positive effect only up to a certain point, which is in the opposite
direction than is typically expected within the context of the buffering hypothesis.

Social suppprt and CSA. There is relatively little research that determines the
effects of specific aspects of social support (e.g., quality of support, type of support, etc.)
on how a survivor copes with CSA. As mentioned earlier, there is considerable evidence
that the reaction of those around her at the time of disclosure may have short-term and
long-term impact. One study found that the amount of social support available, along
with the existence of a close, positive relationship with an adult and the existence/absence
of pathological family interactions were important predictors of children's level of distress
immediately following disclosure of the abuse (Conte, 1987). Utilizing a somewhat
different approach, another study found that the occurrence of sexual abuse negatively
predicted the size of the survivors' current social support network, but did not
significantly predict their level of perceived social support (Edwards & Alexander, 1992).
This suggests that the experience of CSA may impact the extent of one's network, but
may not interfere with one's perception of support.

Another body of related research addresses the impact of social support in helping
an individual manage the outcome of sexual victimization (e. g., rape) rather than the
effects of ongoing childhood sexual abuse per se. The majority of studies have found that
social support, in a variety of forms ranging from groups to a sympathetic and validating
ear, subsequently help women to deal with the crisis of rape (Golding, Siegle, Sorenson,
& Burnam, 1989; Resick, 1993; Shanna, 1986). These findings suggest that social

support is an important construct to consider within the context of adjustment to sexual

2 2
abuse and assault.

A relevant question for the current study is whether social support will directly
predict outcome variables or whether it will buffer the effects of sexual abuse on
outcomes. As noted above, findings in support of the buffering hypothesis have been
mixed. In part to help explain these inconsistencies, Cohen and McKay (1984) proposed
the "specificity hypothesis", which contends that specific types of support must be
matched to the demands put forth by the particular stressor. Therefore, commonly used
global measures of stress and support would create mixed findings and reflect a need for a
more refined approach. With respect to the current study, the specific stressor, intensity
level of sexual abuse, has not previously been assessed within the context of the buffering
hypothesis. However, the nature of both this stressor as well as the target outcomes
(parenting), helps provide a rationale for predicting a direct effects rather than a stress-
buffering model.

First, much of the prior research supporting the buffering hypothesis assess the
absence or presence of current, discrete stressors (i.e., daily hassles). Sexual abuse, in
contrast, may be considered a potential source of chronic stress. Furthermore, all of the
women in the current study experienced sexual abuse and outcomes are based on intensity
of abuse rather than absence or presence of the experience. While it is beyond the scope
of the cru'rent study, it is likely that the differences in stress (and associated outcomes)
between a survivor of abuse and a person who did not experience this trauma is greater
than the relative differences in stress between survivors. Therefore, while it is believed

that intensity of abuse will be directly related to different levels of outcomes, it is not

23

believed that the presence of social support will significantly interact with different levels
of abuse intensity. That is, the fact that a woman experienced abuse at all is an extreme
stressor and while the buffering effects of social support may emerge in the presence of a
non-abused control group, it is not expected here.

Secondly, the results of several studies testing the buffering hypothesis in
predicting parenting outcomes have supported the direct but not buffering effects of
social support (Cutrona, 1984; Tetzloff & Barrera, 1987). Given that the primary
outcome variables in this study involve self-reported aspects of parenting, a direct effects
model for social support is predicted.

The conceptflzed role of social support in the present study. The present study
will test whether social support buffers the effects of stress and CSA on survivors'
reported levels of depression and parenting experiences. Since the existence of a
buffering effect is to be tested, a measure of functional social support (vs. structural) was
included. Specifically, social support was measured using the Social Provisions Scale,
based on Weiss' (1974) theory of social provisions, which includes the presence of social
support that provides any or all of the following: attachment, social integration,
opportunity for nurturance, reassurance of worth, reliable alliance, and guidance.
921mg

Definition and relevant research. The role of individual coping strategies has
emerged as a central factor in regards to how stress affects specific individuals. Lazarus
(1966, 1984) and his colleagues identified the range of cognitive appraisal and coping

strategies as reflections of the individual differences that emerged within the link between

24

stress and outcome.

Coping has been defined as the "person's constantly changing cognitive or
behavioral efforts to manage specific external and/or intemal demands that are appraised
as taxing or exceeding the person's resources" (Lazarus & Folkman, 1984, p. 1984).
Within Lazarus' stress and coping paradigm, the first process that an individual
encounters upon facing a potentially "stressful" event is appraisal (F olkrnan etal., 1986).
Initially, the individual determines what is at stake as a result of the stress (i.e., primary
appraisal) and whether he/she will be able to avoid or overcome the stressful encounter
(secondary appraisal).

Coping styles are often operationalized in terms of "emotion-focused" (e. g.,
managing stressful emotions) and "problem-focused" (e. g., actively working to change
the stress inducing situation)(Dunkel-Schetter, Folkman, & Lazarus, 1987; Folkman &
Lazarus, 1980; Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Owen, 1986; Lazarus
& Folkman, 1984). In general, emotion-focused coping involves strategies that do not
directly affect or change the external stressful situation, but rather involve internal
processes that allow the person more easily to fit the stressful situation within his or her
cognitive and emotional understanding. Examples of this process may include, but are
not limited to, cognitive reframing, minimization of the stress, behavioral interventions
(e. g., relaxation, exercise, etc.), and escape through the use of drugs or alcohol.

Problem-focused coping, in contrast, directly seeks to affect a change in the
stressful situation through strategies such as conflict resolution, information gathering,

and advice seeking. In general, the latter strategies are most often utilized when an

25

individual perceives the situation to be changeable.

These two categories were empirically derived from a factor analysis of the eight
scales of the Ways of Coping questionnaire, which was based on Lazarus' transactional
model of stress (Aldwin, Folkman, Shaefer, Coyne, & Lazarus, 1980). These widely used
scales include: Confrontive, Distancing, Self-Controlling, Seeking Social Support,
Accepting Responsibility, Escape-Avoidance, Planful Problem-Solving, and Positive
Reappraisal strategies for coping (Folkrnan et al., 1986). Others have measured coping in
terms of changing the situation, managing emotional distress, and reinterpreting the
meaning of the event (Pearlin & Schooler, 1978), as well as in terms of more specific
behaviors, such as prayer, distraction, and seeking social support (Stone & Neal, 1984).

With regard to the effects of stress appraisal and coping on individual outcomes,
Lazarus and others have found that certain coping strategies are associated with positive
and negative outcomes. For example, individuals who used confrontive and distancing
coping strategies reported less satisfactory outcomes (e. g., situation remained unresolved
or worsened), whereas people who employed more problem- focused strategies or
indicated that the situation provided them with personal growth, reported more
satisfactory outcomes (e.g., situation resolved or improved) (F olkrnan et al., 1986).
However, these findings are not conclusive; other researchers have shown that, in a
relatively uncontrollable situation, problem-focused coping may lead to frustration and
exhaustion (Cohen, Evans, Stokols, & Krantz, 1986). Furthermore, certain appraisal
strategies have been associated with specific patterns of coping (Folkrnan et al., 1986).

For example, individuals who appraised the initial situation as highly threatening to their

26

self-esteem were more likely to engage in self-controlling, confrontive, escape/avoidance,
and self-responsibility coping strategies as compared to when they did not perceive their
self-esteem to be threatened. Certain personality characteristics have also been related to
both outcome and coping style in stressfirl situations (e. g., self-esteem, level of personal
trust, discomfort with receiving help; Dunkel-Schetter, Folkman, & Lazarus, 1987).
While there is clearly a strong conceptual and empirical foundation for the stress
and coping paradigm, research also suggests the need for further exploration of the
situational determinants of coping effectiveness (Wethington & Kessler, 1991). For
example, although there is some evidence that stressor characteristics are associated with
the relative efficacy of specific coping strategies, more research of this type is necessary
(Folkrnan et al., 1986). Therefore, it would be useful not only to explore the role of
coping in situations of chronic stress (e.g., the prolonged effects of child sexual abuse in
adulthood), but also to determine whether certain aspects of the event (e. g., severity of the
abuse) are associated with certain coping strategies that are more successful than others.
Coping strategies and CSA. The extant literature indicates that survivors of CSA
utilize a variety of coping strategies. For example, researchers have found that girls are
more likely to seek help through disclosure than are boys (DeYoung, 1982; F inkelhor,
Hotaling, Lewis, & Smith, 1990). One form of coping that is common in both young
girls and women who are sexually victimized is dissociation and repression of the assault
(Bagley & Ramsay, 1985; Courtois, 1979; Peters, 1984). Often, this type of coping is
adaptive during childhood, and women will begin to recover memories of the abuse when

they are older and have developed skills and resources that will better allow them to

2 7
process the trauma.

Investigating other long-term coping strategies, Crockett (1984) found that women
who were physically and sexually abused as children and who adopted active coping
strategies as adults (e. g., helping others, work, reaching out, etc.) reported more positive
adjustment than women who engaged in more avoidant types of coping (e.g., emotional
withdrawal). Similarly, avoidant coping strategies have consistently been shown to be
associated with more negative outcomes such as anxiety, depression, likelihood for re-
victimization, and global distress (Holohan & Moos, 19985; Proulx, Koverola,
Fedorowicz, & Kral, 1995; Vollrath & Angst, 1993).

In studies of women's coping reactions to more general forms of sexual trauma
(e.g., rape and other forms of sexual exploitation, not limited to CSA), short-term coping
strategies tended to involve more self-destructive behaviors (e. g., alcohol use), whereas
more proactive, long-term strategies tended to be more constructive (e.g., seeking
information, learning how to avoid future exploitation) (Mims, 1982). This research
suggests that women survivors of CSA may be able to access their inner strengths more
readily (e.g., possibly within the context of their parenting) if they are able to employ
coping strategies that are focused on accessing resources and taking positive action (both
intrapsychic and external).

The present study examined the mediational effects of avoidant coping and
reappraisal coping (as defined and measured by Folkman & Lazarus' Ways of Coping
Checklist) on the associations between sexual abuse, parenting, and psychological well-

being (i.e., depression). Spiccarelli's (1994) transactional model of abuse argues for

28

considering coping as a mediator of the effects of sexual abuse. For example, Spiccarelli
argues that negative cognitive appraisals (e.g., self-blame) and maladaptive coping
strategies (e.g., avoidance) related to molestation are directly related to increases in
clinical symptomatology. Furthermore, Proulx, Koverola, F edorowicz, & Kral (1995)
highlighted the need for determining differences in coping specific to and depending upon
the problem presented. That is, coping strategies utilized by an individual across a variety
of problems are not necessarily constant.

In the present study, the role of coping as a mediator of the effects of childhood
sexual abuse on parenting and psychological well-being were assessed. Specifically, the
relative importance of coping with stress related to parenting and stress related to a
stressful abuse-related experience were explored with respect to maternal confidence,
warmth and control and maternal depression.

Resolution of pbuse-related:issues. Many researchers and theorists have explored
the necessity of an individual's motivation to "search for meaning" when he/she is
confronted by a stressful or undesirable situation (Frankl, 1963; Moos & Tsu, 1977).
More recently, researchers have explored the applicability of this notion to the process of
coping with sexual abuse (Bulrnan & Wortrnan, 197 7 ; Silver, Boon, & Stones, 1983). In
one study (Silver, Boon, & Stones, 1983), the majority of women surveyed reported that
they continued to search for some sort of reason for their abuse even though, for many of
the women, the abuse had ended over 20 years earlier. Furthermore, women who
reported high levels of such searching also reported higher levels of current psychosocial

stress, more abuse-related intrusive thoughts, lower self-esteem, and less resolution of the

2 9
experience, although these associations were correlational rather than predictive. The
authors posit that women who were unable to identify any meaning for their abuse were
caught in a kind of psychological limbo consisting of the interplay between their
memories of the abuse and their active "searching" for meaning. Women who were able
to identify some meaning for their abuse (e.g., labeling discord between their parents as a
precipitating factor, empathizing with their perpetrators misdirected need for love)
reported more positive adjustment.

With regard to the current study, the extent to which women continue to deal with
the unfinished business associated with their abuse may affect their experiences as
parents. "Lack of resolution", which is defined within this study as the extent to which
survivors of sexual abuse continue to be hindered in their daily lives by thoughts and
emotional stress related to their abuse, is a concept unique to this study and hypothesized
to mediate the association between sexual abuse and outcome variables. Hirnelen &
McElrath (1996) found that women who had been sexually abused as children and
reported not "having dealt with the abuse" generally reported lower levels of
psychological adjustment than survivors who had developed some way of understanding
the abuse. However, these findings were based on qualitative and anecdotal data. The
present study seeks to operationalize the concept of abuse resolution and test the extent of
its role as a mediator.

It is hypothesized that if a woman has achieved some measure of peace in regards
to their experiences, she will be more likely to devote her energies and internal resources

to the here and now rather than to the past. Drawing from the work of Silver et al.

30

(1983), among others, the current study explored the extent to which women report that
negative thoughts or feelings related to the abuse intrude upon their daily lives and the
extent to which they have resolved their relationships with both the perpetrator and the
non-abusive parent(s). In her work with women survivors of sexual abuse, Herman
(1982) noted that these women expressed feelings of intense anger and sadness towards
their mothers, whom they believed to have betrayed and abandoned them through their
inaction and silence during the abuse. From her interviews with women survivors of
sexual abuse, Herman (1981) found that, for survivors,

...the legacy of their childhood was a feeling of

having been profoundly betrayed by both parents.

As a result, they came to expect abuse and

disappointment in all intimate relationships: to be

abandoned, as they felt their mothers had abandoned

them, or to be exploited, as their fathers had

exploited them. Given these possibilities, most

women opted for exploitation. (pp. 99-100)
Maternal Depression: A Va_pi_z_1ble with Connection_s to CSAind Pgnting

Extensive evidence has linked CSA with later depression (e. g, Bagley & Ramsay,
1985; Peters, 1984). In addition, research suggests that depression is a common outcome
of general stress, and this linkage may, in turn, be partially moderated by the effects of
social support and coping (Brown & Harris, 1978; Slater & Depue, 1981). Finally,
maternal depression has been associated with certain problematic parenting and child
outcomes (e.g., Hammen et a1. 1987; Seligrnan et al., 1984). These points argue for

assessing the survivor's current level of depression in order to determine the extent to

which it plays a role in the current conceptualization separate from other variables.

3 1

In general, the preponderance of available research has focused on the effects of
maternal depression on the behaviors and psychosocial adj ustment of children ranging
from infancy through latency years. The age (or range of age) during which the child is
exposed to maternal depression may differentially determine the extent and nature of the
effects on the child (Puckering, 1989). In addition, the time at which the depression
occurs in the mother's life (e. g., before vs. after the birth of her child) also effects the
severity of the problematic child behaviors (Murray, 1988).

Babies whose mothers are depressed tend to accommodate to their mothers'
moods, appearing less responsive and more avoidant of their mothers, as well as less
adaptive in other social situations, such as in the presence of a stranger (Field et al., 1988;
Schaffer, 1984). Another study has demonstrated that infants of depressed mothers have
more marked sleep disturbance (Zuckerman, Stevenson, & Bailey, 1987). However, this
association is likely more complex, as there is some evidence that social support may
attenuate mothers' experiences of post-partum depression (Cutrona, 1984).

Prolonged effects of maternal depression on the child have also been noted. In
particular, children whose mothers were depressed when they were infants displayed
some developmental delay several years later (Coghill, Caplan, Alexander, Robson, &
Kumar, 1986). In addition, children whose mothers were depressed when they were
younger may suffer continued sleep problems, greater behavioral problems (e.g., temper
tantrums), and some reading and cognitive problem solving difficulties (Mills &
Meadows, 1987; Richman & Stevenson, 1982; Zuckerman et al., 1987).

Several studies have also linked maternal depression with conduct disorder (Griest

32

et al., 1980; Webster-Stratton, 1988). However, the extent to which depressed mothers'
perceptions and reports of their children as behaviorally difficult is confounded by their
own depression (i.e., depressed mothers perceive their children more negatively) has
become another research question (Brody & Forehand, 1986; Dumas et al., 1989;
Webster-Stratton & Hammond, 1988).

The current study explored the association between sexual abuse and maternal
depression. In addition, depression was entered in those analyses that included parenting
variables significantly associated with depression. This was done to help disentangle the
independent effects of abuse on parenting.

Summg and Rationale for the Present Study

In conclusion, the current study sought to broaden the existing research regarding
the long-term effects of childhood sexual abuse. Specifically, the effects of CSA on
women's parenting and level of depression were explored to provide information on both
psychological well-being and an equally important, but less deficit-focused, area of
women's lives. Given the associations between depression, sexual abuse, and parenting,
the effects of CSA on depression were examined and depression was also controlled for
(where relevant) in analyses examining whether various coping variables mediated the
association between CSA and outcome variables.

In order to provide a first step in developing a more refined empirical model, the
effects of CSA were also examined within the context of social support and coping. The
role of social support in attenuating the negative psychological effects of stress has been

well-established in the extant literature (Cohen & Wills, 1985). In particular, studies

33

assessing the stress-buffering effects (i.e., dependent on stress level) versus direct effects
of social support on psychological well-being suggest that these effects may vary
according to the population (Cohen & Wills, 1985; Cutrona, 1984; Ensel & Lin, 1991;
Vaux, 1985). In the present study, the stress-buffering hypothesis was tested with a
population of women who are survivors of sexual abuse. Stress was measured both in a
conventional manner (i.e., stress defined in terms of "daily hassles") and when stress is
defined as severity of sexual abuse.

With regard to coping styles, coping has been shown to mediate the association
between traumatic events and psychological sequelae. In particular, avoidant coping
strategies have consistently been associated with more negative outcomes such as anxiety,
depression, likelihood for re-victimization, and global distress (Holohan & Moos, 19985;
Proulx, Koverola, F edorowicz, & Kral, 1995; Vollrath & Angst, 1993). Spiccarelli's
(1994) transactional model of abuse argues for considering coping as a mediator of the
effects of sexual abuse. The present study examined the mediational effects of avoidant
coping and reappraisal coping (with both parenting and abuse-related stressors) on the
association between sexual abuse and depression/parenting outcomes. In addition, lack of
resolution, which was defined within this study as the extent to which survivors of sexual
abuse continue to be hindered in their daily lives by thoughts and emotional stress related
to their abuse, was hypothesized to mediate the association between sexual abuse and
outcome variables. Specifically, the relative importance of coping with stress related to
parenting and stress related to a history of childhood sexual abuse were be explored with

respect to maternal confidence, warmth, and control. Cole and her colleagues have

34

assessed parenting confidence and control in prior studies. For example, maternal control
(or "overprotectiveness") is considered to be a potentially relevant issue for survivors, for
whom protecting their own children (particularly daughters) from similar violations may
be paramount. Maternal control may also reflect the survivor's feelings of profound
mistrust of others, which may make it difficulty to afford her own child the opportunity to
engage in developmentally appropriate movements towards separation and greater
responsibility.

Hypotheses

Hypothesis 1. Social support will buffer the effects of general daily stress on
women's psychological well-being (level of depression). That is, at high levels of
reported stress, women with high levels of social support will report lower levels of
depression than women who have little or no social support.

Hypothesis 2. With stress defined in terms of a history of sexual abuse, social
support will directly predict lower levels of depression and sexual abuse severity will be
directly related to high levels of depression.

Hypothesis 3. Controlling for the effects of maternal depression where relevant,
sexual abuse will be related to low maternal confidence, higher levels of maternal control
and lower levels of maternal warmth. Social support will directly predict maternal
confidence, warmth, and low levels of control.

Hypothesis 4. Coping with abuse and resolution of abuse issues will mediate the
relationship between sexual abuse and depression such that avoidant coping and lack of

resolution will be related to higher levels of depression and reappraisal coping will be

35

associated with less depression.

Hypothesis 5. Controlling for level of depression where relevant, coping with
abuse and parenting stressors and resolution of abuse issues will mediate the relationship
between sexual abuse and parenting variables. Specifically, avoidant coping and lack of
resolution will be associated with less parenting confidence and warmth and more
controlling mother-daughter relationships. Reappraisal will be associated with greater

confidence and warmth and lower levels of controlling behaviors.

CHAPTER 11
METHOD
Research Participants

Fifty women living in Michigan and Califomia participated in this study. All
women were survivors of sexual abuse and were also the parent of a daughter.

The majority (84%) of women were Caucasian. Age of participants ranged from
21 to 54 with a median of 41 and most had at least a high school education. Twenty-eight
percent of the women interviewed had one child, 34% had 2 children, and 38% of the
women had 3 or more children. All questions pertaining to mother-child relationships
pertained to the woman's eldest daughter. The age of participants' eldest daughters ranged
from 1 to 34, with a median daughter age of 15 years. (See Table 1)

Measures

Table 2 summarizes internal consistency values and the range of corrected item-
total correlations for the questionnaire scales administered to subjects.

Demoggphics. A variety of demographic characteristics were assessed (e.g., age,
race, education, relationship status, income) using a questionnaire developed for this
study (Appendix A).

Child sexual abuse. Participants were asked specific information regarding the
duration, frequency, type of abuse, and perceived distress related to each type of abuse
(Appendix B). Abuse items were taken from Russell's (1986) Severity of Sexual Abuse
Questionnaire, which identifies a variety of different sexual abuse events ranging in

severity (e. g., "Forcible genital intercourse", "Nonforcible sexual kissing, intentional

36

Table 1
Demographics of Sample

Age
20-30
3 1-40
41-50
5 1—60
Race/Etlmicity
Caucasian
African American
Asian/RI.
Native American
Latina
Mexican American
Current Income
<$10,000
10—20k
21-30k
31-40k
>40k
Education
High School
2 years post HS.
4 years post H.S.
Graduate/Professional
Relationship Status
Single and dating
Single and not dating
Involved with:
same sex partner
opposite sex partner
Living with:
same sex partner
opposite sex partner
Missing Data
Number of Children
1
2
3+
Age of eldest daughter
<10 years old
11-20
21-30
>30

37

l2

94;

18
32

oo
N-bNNO‘h

24
16
14
34

18
28
26
28

10
20

28
34
38

38
36
18

3 8
Table 2

Internal Consistency of Measures

Measure Cronbach's alpha (Range of Corrected
Item-Total
Correlations)
CSA Questionnaire .88 .37 - .81
Daily Hassles Checklist .92 .00 - 60
Social Provisions Scale .90 .00 - .82
Ways of Coping
Parenting-related stress
Reappraisal Coping .73 .06 - .66
Avoidant Coping .49 .18 - .48
Abuse-related stress
Reappraisal Coping .78 .40 - .77
Avoidant Coping .62 .28 - .45
Resolution Questionnaire .79 .26 - .58
CES-D .92 .34 - .77

Family Experiences Questionnaire

Maternal Confidence .92 .11 - .82
Maternal Control .76 .15 - .64

Parental Relatedness Inventory

Maternal Warmth .81 .44 - .74

3 9
sexual touching of buttocks, thigh, leg, or clothed breasts or genitals"). This measure was
adapted for the current study. First, the wording was changed to make it more
understandable to the general public (e.g., fellatio, cumrilingus, anilingus was changed to
"oral sex"). In addition, the "Yes/No" format was changed to a 4-point Likert type scale
(1=1-2 times per year or less, 2=Several times per year, 3=Several times per month,
4=Several times per week) in order to provide a more exact assessment of the woman's
experience. Finally, given the ambiguity of "forcible" vs. "non-forcible," this distinction
was removed and a 4-point rating of distress was added to gain the women's subjective
experience of distress for each abusive event (1=Not very distressing to 4=Very
distressing). The final questionnaire contained 11 types of sexual abuse experienced with
each perpetrator, frequency of the abuse, and the woman's rating of how distressing it was
for her at the time. Additional questions included age at which the abuse started,
woman’s relationship to each perpetrator, whether the abuse was disclosed and, if so, the
reaction to the disclosure. These variables were not included in the final abuse severity
score; however, subsequent analyses were conducted to determine the extent to which
each were related to outcome variables.

A total abuse score was calculated for subsequent analyses by multiplying the
frequency of each item for each perpetrator by its rated level of distress. In addition,
types of abuse were weighted according to level of severity. The weighting values for
each example of sexual abuse was as follows: sexual kissing (1), the perpetrator fondled
the child over her clothes or the perpetrator forced the child fondle him over his clothes

(2), the perpetrator fondled the child under her clothes or the perpetrator forced the child

4 0
fondle him under his clothes (3), penetration (not intercourse) or oral sex demanded or
perpetrated by abuser (4), vaginal intercourse (5), and anal intercourse (6). For example,
if a woman had two perpetrators who both fondled her genitals, one on one occasion
(frequency rating of l) and the other perpetrator several times per week (frequency rating
of 4), the score for that item would be 3*1*distress rating + 3*4*distress rating. Total
item scores were added and the calculated mean was the final abuse score for that subject.
The internal consistency score for this sample was .88 (Cronbach's alpha).

_Str_es; The Daily Hassles Checklist (Kanner et al., 1981) assessed the woman's
current experiences of chronic, routine irritations in her day—to-day life (e.g., job stress,
having enough money for necessities)(Appendix C). This 117-item questionnaire
measures stress with a 3-point Likert-type scale. Participants are first asked to check each
item that they have experienced in the past month; they are then instructed to rate the
level of stress for each checked item.

Two scores can be tabulated: frequency (a count of all the items checked) and
intensity (the mean severity reported for all the items checked). This is a widely-used
questionnaire that has established test-retest reliabilities of r =.48 (for adjacent month-to-
month ratings of intensity taken over a 9-month period) and E- 79 (for adjacent month-to-
month ratings of frequency taken over a 9-month period) (DeLongis et al., 1982). The
internal consistency score for the current sample, based on intensity of stress reported by
women, was .92 (Cronbach's alpha).

Social support. The 24-item Socipl Provisionp questionnaire (Russell & Cutrona,

1985), based on Weiss' theory of social provisions, assesses the extent to which persons

4 1
are receiving functional social support (Appendix D). A 4-point Likert type scale
determines the extent to which the item is descriptive of the participant's current
relationships (e.g., "There are people I can depend on to help me if I really need it"). For
the present study, all 24 items were totaled and the mean score was used in subsequent
analyses.

Scores on the SPS have been shown to account for significance variance on a
scale of loneliness (Cutrona, 1982), and have been negatively correlated with measures of
negative affect across a variety of populations (Cutrona, 1984; Cutrona, Russell, & Rose,
1986; Russell, Altrnaier, & Van Velzen, 1985). The internal consistency score for the
entire social support measure with the current sample was .90 (Cronbach's alpha).

Qppipg, The Ways of Coping Checklist (Folkrnan & Lazarus, 1980) is a 67-item
measure that assesses the extent to which the individual uses specific strategies in order to
cope with stressful events (Appendix E). The entire measure contains 8 scales, 2 of
which were used in the present study: escape/avoidance (6 items; e.g., "I refused to
believe it had happened) and positive reappraisal (6 items; e. g., "I came out of the
experience better than when I went in"). These particular scales were chosen for
theoretical relevance and relatively strong internal consistency scores within the current
population. Participants were first asked to describe a recent problem they encountered
and then to rate on a 4-point Likert type scale the extent to which they engaged in each of
the coping strategies. Prior research has found reliability alphas for each scale that range
from .61 to .79 (Dunkel-Schetter, Folkman, & Lazarus, 1987).

For the current study, participants completed this questionnaire twice; first, in

4 2
regard to a parenting problem, and again in regard to a problem related to their abuse.
For this sample, internal consistency reliabilities for the positive reappraisal and
avoidance coping scales with regard to a parenting problem identified by participants
were .73 and .49, respectively (Cronbach's alphas). Alpha coefficients for reappraisal and
avoidance scales with regard to an abuse related problem were .78 and .62, respectively.

L_ack of resolution of abuse. The Resolution Questionnaire is a 12-item measure
developed for this study to assess the extent to which women believe they have resolved
their relationships with their perpetrators as well as their non-abusive parents (Appendix
F). Items assess the extent to which the participant has reconciled with each parent (e.g.,
"To what extent have you forgiven your abuser?") as well as the extent to which she
continues to feel bound by her memories and feelings associated with the abuse (e.g., "To
what extent do you feel that much of your energy is tied up in working through your
feelings related to the abuse?").

Items are rated on a 4-point Likert type scale. The internal consistency score for
this population was .7 9 (Cronbach's alpha). High scores on this measure correspond to
lack of resolution regarding abuse issues.

Maternal depression. The Center for Epidemiological Studies Depression Scale
(CES-D) is a 20-item measure that draws fi'om several widely utilized measures of
depression including the Beck Depression Scale (Beck, Ward, Mendelson, Mock, &
Erbaugh, 1961), the Minnesota Multiphasic Personality Inventory (Dohlstrom & Welsh,
1960), the lung Depression Scale (Zung, 1965), the Raskin Self-Reported Depression

Scale (Raskin, Chulterbrandt, Reating, & McKeon, 1970), and the Gardner Symptom

4 3
Checklist (Gardner, 1968)(Appendix G). This scale assesses the major characteristics
associated with depressive symptomatology including feelings of guilt and worthlessness,
depressive mood, sleep disturbance, feelings of helplessness and hopelessness, eating
disturbance, and psychomotor retardation that the woman has experienced over the past
week (e.g., "I felt tearful," "I felt I was just as good as other people").

The CES-D, initially developed to assess depression within a community sample,
has high internal consistency (Radloff, 1977) and test-retest reliability. It's also
significantly associated with other standardized depression scales (Weissman & Locke,
1975; Weissman et al., 197 7). The internal consistency score for the current sample was
.92 (Cronbach's alpha).

Measures of parenting. To eliminate the potentially confounding effects of gender
and birth-order, women were asked questions about how they parented their eldest
daughter. Three areas of parenting were assessed: Parenting Confidence, Maternal
Control, and Maternal Warmth. For those cases in which daughters no longer lived at
home (approximately 10 cases), women were asked to respond retrospectively.

Maternal confidence and control. The Family Experiences Questionnaire (Frank,
Hole, Jacobson, Justkowski, & Huyck, 1986) is a 56-item questionnaire that assesses
various aspects of the spousal and parenting relationships (Appendix H). This
questionnaire uses a 4—point Likert type scale and has demonstrated both reliability and
validity within a number of populations (Frank et al., 1991; Floyd & Zmich, 1992).

Two subscales of this questionnaire were used in this study. The maternal

confidence scale contains 15 items that assess the respondent's ability as a parent (e.g., "I

4 4
know that I am doing a good job as a parent"). The maternal control scale contains 11
items, which assess respondent's need to protect her child fiom external influences as well
as control her child's behavior (e. g., "I am overly protective of my children").

Alphas for these scales range fi'om .80 to .94 (Cole, Woolger, Power & Smith,
1992; Frank, Hole, Jacobson, & Huyck, 1986). Internal consistencies for the parental
confidence and parental control scales in the present sample were .92 and .76,
respectively (Cronbach's alphas).

Maternal warmth. An adapted form of the Parental Relationship Inventory's
relatedness scale (Stutman & Lich, 1984) was used to assess the extent to which
participants experience their relationship with their child as warm and enjoyable
(Appendix I). The maternal warmth scale contains 10 items which are rated on a 4—point,
Likert type scale. These items were originally designed for completion by the child;
however, given the lack of an adequate measure of parental warmth, this scale was chosen
as an appropriate, face valid tool and adapted such that the items now apply to maternal
perceptions of relatedness (e.g., "It is fun to be with my daughter," "I feel very warmly
towards my daughter"). Internal consistency reliability for the present sample was .81
(Cronbach's alpha).

Procedures

Recruitment took place in two sites, central Michigan and northern California.
Participants were made aware of this study through advertisements in local newspapers
and parenting magazines and flyers posted in public areas such as community centers,

laundromats, stores, and libraries. Facilitators of sexual abuse survivor support groups

4 5
and private therapists specializing in work with survivors were also contacted and flyers
were provided to place in their waiting rooms.

Study flyers and advertisements contained a brief description of the "Women's
Research Project", initial criteria for participation and a phone number to call for more
information. Criteria included on the flyer was as follows: 1) being a woman who is a
survivor of childhood sexual abuse and 2) having a daughter (see Appendix J). When a
woman called the project number on the flyer, the principal investigator provided any
additional information requested by the woman and also conducted a brief follow-up
screening to determine final eligibility for the study. Specifically, women were asked
whether they had clear memories of the abuse and their relation to the abuser. Only
women who had clear memories of the abuse and whose abusers were male were allowed
to participate in the study. Women who were survivors but did not meet participation
criteria were offered information about resources in their community for survivors of
sexual abuse.

Approximately 80% of participants heard about the Women's Research Project
through advertisements or flyers. The remainder of participants were made aware of the
study through survivor support resources and by word-of-mouth from other women who
had been interviewed. Approximately 60 women and one man called the number
provided on the flyer or ad. The man who called indicated that he had been sexually
abused by his mother and was referred to local resources for survivors alter the criteria of
this study were explained. For the remaining women, reasons for not qualifying for

participation included: not having a daughter, not having a clear memory of who the

4 6
perpetrator was, indicating that the primary perpetrator was female, and having a daughter
who was sexually abused (although the caller had not been). A few women also called
seeking more information regarding the study for friends or family members.

Interviews were conducted in a one-on-one format with either the principal
investigator or a trained research assistant. All of the interviews conducted in California
(N=15) were completed by the principal investigator.

At the Michigan site, three undergraduate research assistants enrolled in an
independent study with the principal investigator for approximately one year. All
assistants attended weekly 2-hour meetings to discuss theoretical and practical issues
related to the study. Each student participated in at least 4 months (approximately 50
hours) of training directly related to conducting project interviews. Training proceeded
along the following schedule: 1) reading, discussion of articles related to the area of
sexual abuse and its effects on women with the goal of raising consciousness, 2) training
in the area of interview skills, including the acquisition of active/empathic listening skills,
role plays utilizing these skills in general situations and then in situations involving
sexual abuse, 3) completion of mock interviews with other assistants, which were taped
and reviewed by the principal investigator and 4) training in the administration of the
questionnaires.

In addition, interviewers discussed and role—played what to do if a woman were to
become upset during the interview. For example, if a woman became obviously
distressed while discussing her experience of abuse, the interviewer was instructed to

acknowledge this empathically and offer her the opportunity to take a break or even stop

4 7
for the day. In addition, women were informed at the onset of the interview that, if they
became too uncomfortable, they had the right to stop at any point during the process. One
woman asked to complete the interview in two sessions and, following the first meeting,
indicated that she would rather not complete the second session because she anticipated
that the material covered, which dealt primarily with details about the sexual abuse,
would be too difficult to discuss.

Although many women reported that portions of the interview had been
emotionally difficult for them to complete, all women reported that they felt the process
had been respectful and supportive. In addition, many women indicated that they felt
empowered by talking about their experiences and knowing that they were contributing to
a larger fund of knowledge about sexual abuse.

Following the telephone screening procedure, if a woman met criteria for
participation and was interested in completing an interview, she was informed that the
interview would last approximately 2 hours and could be conducted over 1 or 2 meetings.
She was also provided with a brief overview of the types of questions she would be asked
and the rationale for the study. Participants were provided with the choice of whether to
complete the interview in their homes, in a public place, or in the project office.
Approximately 80% of participants opted to complete the interview in their homes.

At the beginning of the interview, participants were asked to review and sign an
informed consent (Appendix K). In order to establish and maintain rapport, as well as to
decrease the risk of missing data, the majority of questionnaires were read to women by

the interviewers. Participants were provided with index cards for each questionnaire that

4 8

indicated response choices based on Likert-type scales (e. g., 1=strongly agree, 2=agree,
3=disagree, 4=strongly disagree). Questionnaires assessing depression and participants'
perceptions of their relationships with their daughters were given directly to the women
and they were asked to complete them independently. With the exception of the
demographic questions and the questions specifically regarding the sexual abuse, which
were administered first and last, respectively, questionnaire order was counterbalanced to
avoid bias created by ordering effects.

Following the interview, participants were encouraged to contact the project office
if they had concerns or questions following the interview. Approximately 10-15% of the
women who participated did contact the principal investigator following the interview,

mostly to seek information regarding referrals for survivor resources.

CHAPTER III
RESULTS
Descriptive Analyses

Tables 3-5 summarize various aspects of the abuse reported by subjects. Slightly
over half of the women reported more than one perpetrator. All women were able to
identify a primary perpetrator, the person whom they indicated to be the perpetrator of the
majority of the abuse. The most common forms of sexual abuse from the primary
perpetrator included sexual kissing, being forced to fondle the perpetrator's unclothed
genitals and clothed/unclothed breast fondling by the perpetrator. Women reported that
their primary perpetrator was most frequently their biological father (54%). Step-fathers,
grandfathers, uncles and brothers (at least 5 years older than the participant) were also
reported to be primary perpetrators.

The average Abuse severity score was 21.21 (S_D=23.06; range=1.45 to 141.09),
suggesting a wide range in abuse experiences as assessed by a combination of sexual
abuse frequency, number of perpetrators, and retrospective report of distress. Lack of
Resolution scores ranged from 1.17 to 3.58 with a mean score of 2.38 (S_D=.61). This
suggests that generally women in this study perceived themselves to be generally satisfied
with the nature and level of social support available to them; however, the range in scores
also indicates that some women perceived themselves to have little support, while others
were extremely satisfied by their current level of support. Overall Stress scores ranged
from .11 to 1.35 with a mean score of .66 SD= .28). The mean Depression score for the

sample was 2.18 SD=.41) with a range of 1.50 to 3.05. These findings suggest that

49

50

Table 3

Number of Perpetrators Reported by Women

# of Peppetrators N
1 23
2 13
3 6
4 5

f’/o_ofsam—.rzl_e
46%
26%
12%
10%

6%

51

Table 4

Number of Women Reporting Abuse Types (Primary Perpetrator)

Abuse Type N %
1. Sexual Kissing 36 72%
2. Breast contact (clothed) 31 62%
3. Breast contact (unclothed) 3O 60%
4. Genitals fondled by perpetrator

(clothed) 31 62%
5. Perpetrator forced you to

fondle his genitals (clothed) 20 40%
6. Perpetrator forced you to

fondle his genitals (unclothed) 41 82%
7. Genitals fondled by perpetrator

(unclothed) 23 46%
8. Perpetrator performed oral sex 28 36%
9. Perpetrator forced you to

perform oral sex 17 34%
10. Vaginal Intercourse 22 44%

11. Anal Intercourse 4 8%

Table 5

Relationship of Woman to Primary Perpetrator

Perpetrator

Biological Father
Step-father

Maternal Grandfather
Paternal Grandfather
Maternal Uncle
Paternal Uncle

Brother (at least 5
years older)

Other

I2

27

29mm

54%
10%
6%
2%
5%

4%

10%

8%

5 3

while this population reported a range in their self-reported severity levels of depressive
symptomatology, the range of responses regarding severity of daily stress was somewhat
more restricted. Regarding coping strategies, mean scores for Parental/Abuse Avoidant
and Parental/Abuse Reappraisal Coping ranged from .89 to 1.26, with scale scores
ranging from O to 3.00. Finally, regarding parenting outcome variables, the mean score
for Maternal Warmth was 3.39 (S_D=.58) and scale scores ranged from 1.80 to 4.0. This
suggests that, generally, women in this study reported that they perceived their
relationships with their daughters to be nurturing, respectful and supportive. The mean
score for Maternal Control was 2.17 (32:46) and the range in scale scores was 1.45 to
3.36, which suggests slightly more variability in responses regarding issues of
protectiveness and control in comparison to those associated with warmth. Similarly, the
mean score for Maternal Confidence was 2.76 SD=.62) and scale scores ranged from
1.47 to 3.87, suggesting variability in the level of self-reported confidence in parenting
abilities endorsed by women in this study.
Intercorrelations of Study Variables

Table 6 contains intercorrelations between all variables in this study. Notably,
level of Abuse is significantly correlated with a Lack of Resolution regarding the abuse
(r=.37, p _<_ .05) and level of Maternal Control (r=.28, p _<_ .05). In addition, although level
of Abuse is not significantly correlated with Stress, Depression, Maternal Warmth or
Maternal Confidence, Lack of Resolution is significantly related to all of these variables.
Specifically, Lack of Resolution is positively correlated with Stress (r=.45, p 5 .01),

Depression (r=.4l, p _<_ .01) and negatively correlated with levels of Maternal Warmth

54

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55

(_r=-.31, p S .05) and Maternal Confidence (_r=-.30, p 5 .05).

In addition, Stress was positively correlated with level of Depression (gr-.49, p _<_
.001) and negatively correlated with Social Support (r=-.37, p _<_ .01) and Maternal
Confidence (rs-.29, p 5 .05). Depression was negatively correlated with level of Social
Support (_r=-.56, p 5 .001) and Maternal Confidence (F-.27, p 5 .05).

With regard to coping style, Parental Reappraisal Coping was positively
correlated with Maternal Confidence (r=.47, p 5 .001) and Maternal Warmth (gr-.29, p 5
.05). Parental Reappraisal Coping was also positively correlated with Abuse Reappraisal
Coping (r=.47, p S .001). Parental Avoidant Coping was slightly correlated with Abuse
Avoidant Coping (r=.27, p 5 .07).

Effects of Abuse-Relatedapd Demographic Variables

A series of analyses were conducted to determine the presence of any significant
effects of abuse and demographic variables that were not included in the hypotheses but
were considered potentially relevant.

Parenting outcome variables were regressed onto subject's income, current age,
age at which the abuse began, and age of daughter. None of these variables contributed
significantly to the variance in parenting outcome scores (32: .16, F=2.1 1, p=.10).
Results of analysis of variance indicated that subject education level and race are not
significantly associated with parenting outcomes (F (3,40)= .23, 1.43, and .34 for
Maternal Warmth, Control and Confidence, respectively for education level; P
(5,44)=l.00, .36, and 1.54 for Maternal Warmth, Control and Confidence, respectively for

race). Similarly, the relationship of the perpetrator to the woman was not significantly

56

associated with any parenting outcomes (F (6,39)= 1.49, .35, and .38 for Maternal
Warmth, Control and Confidence, respectively). Neither disclosure of abuse during
childhood (F (1,47)=1.62, .00, and 1.53 for Maternal Warmth, Control, and Confidence,
respectively) nor reaction to disclosure (F (3,11)=.40, .29, and .72 for Maternal Warmth,
Control and Confidence, respectively) were related to parenting outcomes.
Testing the Research Hypotheses

Given the number of analyses required to test for the buffering and mediational
effects of social support and coping, respectively, and the overall N, only findings that are
significant at p 5 .05 were interpreted.
Hypothesis 1: Testing the Stress-Buffenn'ALHypothesis with aCSA Population

The first empirical question posed by this study was whether the stress-buffering
hypothesis would hold up with this population. Regression analysis was conducted.
Predicting Depression, the Main Effects for Stress and Social Support were entered in the
first block using the Enter command. The interaction between Stress and Social Support
were entered in the second block. Women's reported level of Stress and current Social
Support significantly contributed to their self-reported levels of Depression (R2=.40,
F=15.81, p 5 .001). High levels of stress positively predicted Depression. Social Support
was negatively associated with Depression. In addition, the interaction between Stress
and Social Support was significant at the p 5 .05 level; therefore, although notable, this
finding will not be interpreted. See Table 7(a) for a summary of these results.
Hypothesis 2: Sexual Abuse aggressor

It was next hypothesized that Abuse would function as a chronic stressor in

57

women's lives, the effects of which would be buffered by Social Support in a manner
similar to the initial hypothesis. In a regression analysis, the Main Effects of Abuse and
Social Support were entered together in the first block predicting Depression. The
interaction between Social Support and Abuse was entered in the second block. Table 7
(b) summarizes these results. Social Support negatively predicted Depression. The Main
Effect for Abuse was not significant. The interaction between Social Support and Abuse
was not significant and did not significantly add to the variance in Depression scores (R2
change=.02, F=8.53).

Hypothesis 3: The Effects of Abuse on ParentingOutcomes

A series of linear regression analyses were conducted to determine the relative
effects of Abuse and Social Support on parenting outcome variables. Analyses focused
on three specific parenting variables including self-reported levels of parenting
confidence (Maternal Confidence), levels of interpersonal warmth (Maternal Warmth)
and controlling parenting behaviors (Matemal Control) within the mother-daughter
relationship. Table 8 provides an overview of these results.

Similar to previous analyses, Abuse and Social Support were entered in the first
block to predict Parenting Confidence. Depression, which is correlated with Maternal
Confidence (Pearson r=-.27, p=.06), was entered first to control for its effects.
Depression, Abuse and Social Support accounted for 19% of the variance in Maternal
Confidence (F=3.54, p 5 .05). The Main effect of Social Support emerged as the
strongest positive predictor of Maternal Confidence (Beta=.41, T=2.51, p 5 .05). The

interaction between Abuse and Social Support, which was entered in the second step, was

58

Table 7

Social Support as a Buffer of Stress and Abuse Predicting Depression

(a) R2 133g. .1: age
Stress .40 15.81c .32
Social Support -.44
Stress X

Social Support .44 .04 12.27c .22
(b)

Abuse .34 12.01c .19
Social Support -.56
Abuse X

Social Support .36 .02 8.53c .16

Note. a= p 5 .05, b= p S .01, c= p < .001

lv-l

2.68"

3.61c

1.87

1.58

-4.70“

1.17

Table 8

59

Social Support as a Buffer of Abuse Predicting Parenting Outcomes

Abuse
Social Support

Abuse X
Social Support

Abuse
Social Support

Abuse X
Social Support

Abuse
Social Support

Abuse X
Social Support

Note. a= p S .05

.19

.06

.11

.08

.08

RZCh.

.03

.05

.00

Maternal Confidence
E Beta
3.54al .02

.41

3.15a .21

Maternal Warmth
1.46 -. 18

.1 8

1 .82 .26

Maternal Control

2.05 .28

-.02

1 .37 .05

|'-l

1.06

2.51a

1.34

-1.24

1.22

1.57

2.02a

- .02

.30

6 0
not a significant predictor of confidence.

The second parenting outcome variable which was examined was the degree of
interpersonal warmth within the mother-daughter relationship as reported by mothers.
Since Depression was not correlated with Maternal Warmth, it was not added into the
equation. Abuse and Social Support were entered in the first block of the regression
analysis, predicting level of Maternal Warmth. Neither variable significantly contributed
to the variance in Maternal Warmth (R2=.06, F=1.46, p=.24), nor was the interaction
between Abuse and Social Support, which was entered in the second block, (R2
change=.05, F=1.82, p=.l6) significant.

The final parenting variable which was examined was the level of self-reported
Maternal Control which is exhibited within the mother-daughter relationship. When
entered together in the first block, Social Support and Abuse did not significantly
contribute to the variance in Maternal Control (R2=.08, F=2.05, p=.14). However, the T-
score for Abuse was significant in predicting Maternal Control (Beta=.28, T=2.02, p 5
.05). The interaction between Abuse and Social Support, entered in the second block of
the regression analysis, was not a significant predictor of Maternal Control (R2
change=.00, F=1.37, p=.26).

The Mediational Roles of Copingand Lac_k of Resolution

The role of coping in mediating the effects of sexual abuse was examined next.
According to Baron and Kenny (1986), three regression equations are used to test for
mediation: 1) regressing the mediator on the independent variable, 2) regressing the

dependent variable on the independent variable, and 3) regressing the dependent variable

61

on both the independent variable and the mediator. To prove that a variable is
functioning as a mediator, the following three conditions must be met: 1) The
independent variable must affect the mediator, 2) the independent variable must affect the
dependent variable, and 3) the mediator must affect the dependent variable in the last
equation. In addition, the effect of the independent variable in the last equation must be
larger than the effect in the second equation.

Following Baron & Kenny's (1986) guidelines for testing mediational hypotheses,
a series of regression analyses were conducted. First, proposed mediators (coping
variables and Lack of Resolution) were regressed onto the independent variable (Abuse).
Outcome variables were then regressed onto the independent variable (Abuse). In the
final analyses, the outcome variables were regressed onto both the IV and mediators. If
results are significant in the first two analyses and the effects of the independent variable
decrease in from the second to the final analysis, a mediational effect was considered to
be proven.

Hymthesis 4: Mediators Related to Maternal Depression

 

In the first set of analyses predicting the women's self-reported levels of
Depression, two types of coping were included: Abuse Avoidant Coping and Abuse
Reappraisal Coping. Another regression analysis tested Lack of Resolution mediated the
association between Abuse and Depression. Figure 5 summarizes the results of the
regression analyses.

Results of these analyses indicated that none of the proposed variables (Abuse

Avoidance Coping, Abuse Reappraisal Coping, Lack of Resolution) mediated the

62

 

 

 

 

 

 

Abuse Avoidant Coping
3) R2=.04
Abuse > Depression
2) R2=.03
Abuse Reappraisal Coping
3) R2=.07
Abuse > Depression
2) R2=.03
Lack of Resolution
N32=. 1 7a
Abuse b Depression
2) R2=.03
Figure 5

Coping and Lack of Resolution as Mediators of the Effects of Abuse on Level of
Depression

_N_Q;e_. Pathway 1= Mediator regressed onto IV
2= DV regressed onto IV
3= DV regressed onto IV and mediator
a= pg .05; b=p5 .01

63

association between sexual abuse and depression. Abuse did not predict Abuse Avoidant
Coping and neither Abuse nor Abuse Avoidance Coping predicted Depression. Similarly,
Abuse did not predict Abuse Reappraisal Coping and neither Abuse nor Abuse
Reappraisal Coping predicted Depression. In the final set of analyses, Abuse did account
for a significant amount of variance in Lack of Resolution scores (132; 14, F=7.27, p 5
.01). In addition, Lack of Resolution positively predicted depression (Beta=.40, T=2.74,
p 5 .01).
Hypothesis 5: Mediators Related to Parenting Outcomes

The second set of analyses focused on the mediational effects of coping variables
and Lack of Resolution on the association between Abuse and parenting outcomes.
Coping related to both parenting and abuse-related issues were included to determine
whether one type of coping was more relevant to parenting outcomes than the others.

Figure 6 summarizes the results for Parenting Confidence. Neither Abuse
Avoidant Coping nor Abuse Reappraisal Coping related to abuse stressors mediated the
association between Abuse and Parenting Confidence. Similarly, Parental Avoidant
Coping and Parental Reappraisal Coping did not mediate the relationship between Abuse
and Parenting Confidence. However Parental Reappraisal Coping directly predicted
Parenting Confidence (RZ=.23, F=6.84, p 5 .01, Beta=.48, T=3.69, p _<_ .001). Abuse
predicted Lack of Resolution (32:.14, p 5 .01, Beta=.37, T=2.70, p 5 .01). In addition,
Lack of Resolution was associated with Maternal Confidence (132; 12, F =3.00, p=.06,

Beta=-.37, T=-2.43, p _<_ .05), but at the p 2 .05 level. Since there was no direct

64

 

 

 

 

 

 

Abuse Avoidant Coping
\ 3) R2=.02
Abuse 4 Maternal
2) R2=.00 Confidence
A use Reappraisal Copin
1) 112:. \, 3) R2=.03
Abuse P Maternal
Confidence
2) R2=.OO
arental Avoidant Coping
2 2
1) R =.o \lfizm
Abuse Maternal
2) R2=.00 Confidence
arental Reappraisal Cop'
1) R2=.0 N2?
Abuse , Maternal
2) R2=.OO Confidence
Lack of Resolutio
1) 18:14" + "Milan
Abuse ’ Maternal
2) R2=.OO Confidence
Figure 6

Coping and Lack of Resolution as Mediators of the Effects of Abuse on Maternal
Confidence

Nata Pathway 1= Mediator regressed onto IV
2= DV regressed onto IV
3= DV regressed onto IV and mediator
a= p 5 .05; b= p 5 .01; c= p 5.001

65

relationship between Abuse and Parenting Confidence, no mediational effect emerged.
Similarly, no mediational effects for any of the coping variables or Lack of
Resolution were found predicting either Maternal Warmth or Maternal Control from
Abuse. See Figures 7 and 8 for a summary of the regression analyses for Warmth and
Control, respectively. However, Parental Reappraisal Coping directly predicted Maternal
Warmth (32:13, F=3 .47, 12 5 .05, Beta .32, T=2.32, p _<_ .05). In addition, Abuse directly
predicted Maternal Control @2=.08, F=4.23, p 5 .05, Beta=.28, T=2.06, p 5 .05) and
Lack of Resolution @214, F=7.27, p 5 .01, Beta=.37, T=2.70, p 5 .01). Finally,
Parental Reappraisal Coping negatively predicted Maternal Control (Bz=.l6, F=4.58, p 5

.05, Beta=-.Z9, T=-.215, p 5 .05).

66

Abuse Avoidant Co ing
1) R2=.01 \ 3) R2103
Abuse Maternal

 

 

 

 

 

2) R2=.03 Warmth
Abuse Reappraisal Co ing
Abuse > Maternal
2) R2=.03 Warmth
Parental Avoidant Coping
1) R2=.0 \ 3) R2=.04
Abuse Maternal
2) R2=.03 Warmth
Parental Reappraisal Coping
1) R2=.O \ 3) R2=.13'
Abuse > Maternal
2) R2=.03 Warmth
Lack of Resolution
1) R2=. " + 3) R2=.10
Abuse - > Maternal
2) R2=.O3 Warmth
FIGURE 7

Coping and Lack of Resolution as Mediators of the Effects of Abuse on Maternal
Warmth

Nola Pathway l= Mediator regressed onto IV
2= DV regressed onto IV
3= DV regressed onto IV and mediator
a= p 5 .05; b= p 5.01

67

Abuse Avoidant Co ing
1) R2=.01 \ 3) R2=.11

 

 

 

Abuse + , Maternal
2) R2=.08“ Control
00
2 Abuse Reappraisal Cofing\> 2
1)R=.OO/' 3) R =.13
Abuse + a. Maternal
2) R2=.08’ Control
Parental Avoidant Coping
V \ 3) R2=.09
Abuse + p Maternal
2) R2=.083 Control

Parental Reappraisal Co ing

1) R2=.02 - 3) R2=.16“
Abuse + Mammal

 

 

2) R2=.08a Control
Lack of Resoluti n
W \ 3) R2=.08
Abuse + p Maternal
2) R2=.08° Control

Figure 8
Coping and Lack of Resolution as Mediators of the Effects of Abuse on Maternal Control

M Pathway l= Mediator regressed onto IV
2= DV regressed onto IV
3= DV regressed onto IV and mediator
a= p5 .05; b=p5 .01

CHAPTER IV
DISCUSSION

The primary goal of this study was to explore the impact of social support and
coping on the associations between sexual abuse and various outcome variables. In
addition, this study sought to depart from a purely deficit-focused approach by including
psychological well-being as well as parenting outcomes in analyses. Until recently, the
effects of childhood sexual abuse have been studied largely outside the framework of
theoretical models that include potential moderating and mediating variables. This study
used two bodies of related work as a theoretical basis: (1) the stress-buffering effects of
social support and (2) Spiccarelli's (1994) recently proposed model, which conceptualizes
abuse as a stressor that is mediated by coping style and cognitive appraisal, which, in
turn, predicts psychological symptomatology. Support and individual factors are also
predicted to affect coping in Spiccarelli's model. In addition, Spiccarelli's model assumes
that the effects are being assessed near the time of abuse.

The current study departed from both the typical stress-buffering studies and
Spiccarelli's work in two major ways. First, in comparison to Spiccarelli's work, the data
in this study were retrospective. A second and more compelling difference is that the
outcome variables in this study included psychological well-being as well as parenting.
The majority of prior research has tended to focus on variables associated with clinical
pathology (e.g., sexual dysfunction, post traumatic stress symptomatology) rather than

focusing on non-clinical life events.

68

69

Results of this study indicated that social support did not act as a stress buffer.
However, social support was negatively associated with depression. This is consistent
with prior research demonstrating the arneliorative effects of social support on
psychological well-being (Andrews, Tennant, Hewson, & Vaillant, 1978; Bell, LeRoy, &
Stephenson, 1982; Lin, Simeone, Ensel, & Kuo, 19791 Miller & Ingharn, 1976; Paykel et
al., 1980; Surtees, 1980; Valentine, Holahand, & Moos, 1994).

In addition, although significant at only the p 3 .05 level, and therefore not
interpreted according to the criteria of the current study, it is notable that social support
interacted with stress level. Interestingly, post-hoe analysis revealed that social support
interacted most strongly at lo_wa_r levels of stress to predict less depression. This finding
is in the opposite direction of what most have come to expect when testing the stress-
buffering hypothesis. That is, the moderating effects of social support are commonly
found at high levels of stress rather than low levels. However, at least one researcher
(Cutrona, 1984) has found that social support signifcantly attenuates the effects of stress
at lower levels but has no impact as level of stress rises. In Cutrona’s study, the outcome
variables were also related to parenting, which may suggest that social support may be
relevant and irnpactful up to a point when looking at parenting outcomes; however,
beyond a certain level of stress, social support loses its potency when it comes to
affecting aspects of parenting.

This finding departs from Cohen & Wills' (1985) position that when measures of
functional support are used (as in the present study), buffering effects are more likely to

emerge. The lack of stress-buffering effects in the current study may reflect the

7 O
differences in the populations studied. Vaux (1985) highlighted the importance of
considering the variance across subgroups when testing for direct versus stress-buffering
effects of social support. The population of this study was comprised of survivors of
sexual abuse, reflecting a very specific experience. The arguably unique character of this
experience may be associated with differences in the way social support fits into this
association from other groups in which the buffering hypothesis is supported. Future
research that compares the role of social support in the lives of sexual abuse survivors
with similar, non-abused population would help to clarify this issue.

It was next hypothesized that when sexual abuse was substituted for a global
measure of stress, social support would not buffer the effects of abuse; rather, sexual
abuse and social support would have direct effects on the outcome variables, depression
and parenting. This hypothesis was consistent with Cohen & McKay's (1984) call for
more specific measures of stress to help illuminate the effects of social support.
Specifically, it was hypothesized that social support would be associated with lower
levels of depression, greater maternal confidence and warmth, and less maternal control.
Similarly, it was predicted that severity of sexual abuse would be positively related to
depression and maternal control, and negatively related to maternal confidence and
warmth.

Results indicated that social support did not buffer or moderate the effects of
sexual abuse on level of depression or parenting outcomes. However, as noted in the first
set of analyses, social support was directly associated with lower levels of depression. In

the current study, the measure of functional social support that was used is characterized

71

by the woman's perceptions that she belongs to a group with similar concerns, beliefs, and
interests and that she is part of a network from whom she is able to access emotional and
practical support. Given that depression is clinically hallmarked by feelings of
hopelessness and worthlessness, the presence of this type of support is likely functioning
to diminish feelings associated with isolation and disconnection. Addressing the issue of
disconnection may be of particular importance for survivors of sexual abuse. As Herman
(1992, p.51) notes, "Traumatic events have primary effects not only on the psychological
structures of the self but also on the systems of attachment and meaning that link
individual and community." The heightened level of "otherness" and isolation that is
experienced by the survivor of sexual abuse may make social support, which engenders a
sense of belonging, particularly relevant.

Social support was also significantly related to higher levels of self-reported
maternal confidence. Supporting prior research (Barrett, 1978; Pascoe, Loda, J effiies, &
Earp, 1981; Tetzloff & Barrera, 1987), social support likely protects against the feelings
of isolation and resultant self-doubt as well as providing relevant, practical support.
Notably, the measure of support used in this study did not specifically address the
presence of parenting support per se, but rather the woman's perception that she had
access to a network with similar concerns and interests and that she felt valued and
supported by this network. It can be hypothesized that, for a survivor and mother, this
support would include parent-specific aspects.

Interestingly, social support was not directly related to either maternal warmth or

maternal control. There is some evidence that social support is associated with decreased

7 2
likelihood of child maltreatment (Egeland, Brietenbacher, & Rosenberg, 1980); therefore,
one might have expected that mothers in this study who perceived themselves as having
less social support may also report more problematic relationships with their daughters
(e.g., excessive control, lack of warmth). However, prior research in this area has often
focused on adolescent mothers with young children. In the current study, the ages of
mothers and daughters varied. It is possible that the role of social support varies
according to the developmental stage (and associated needs) of mothers and daughters. In
addition, the type of support provided likely contributes to the identified associations with
particular outcomes.

Regarding the lack of findings associating support with maternal control, it is also
important to consider that control, per se, may not always be associated with "abusive"
behavior or negative parent-child dynamics. In the current study, maternal control was
operationalized in terms of the mother's attempts to protect her child (particularly from
negative events) through attempts to impact her daughter's behavior and environment.
While excessive levels of control may be associated with negative child outcomes,
particularly at specific developmental stages, maternal control may also reflect a level of
protectiveness that is both understandable and potentially helpful for the child.

Directly related to this point is the finding that severity of childhood sexual abuse
was associated with higher levels of self-reported maternal control. This finding may
reflect an association between level of violation accompanying more severe abuse and
women's subsequent need to more carefully evaluate and guard against potentially unsafe

interpersonal or social situations, particularly to the extent these situations affect her

7 3

child. As Herman (1992) points out, the survivor's basic assumptions regarding the safety
of the world are dismantled following the trauma. In this case, women who experienced
more severe abuse may understandably be less able to believe in a safe or just world.

This finding also provides another, less deficit-focused, way in which to
understand the sexual abuse survivor's role as protector of her own children. Within the
context of the intergenerational transmission of abuse hypothesis, it has been well
documented that a history of abuse is a risk factor for abusing one's own children
(Altemeier et al., 1984; Kaufman & Zigler, 1987; Kempe, 1973). This body of research
has focused primarily on the transmission of physical abuse. Similarly, a history of
maternal sexual abuse has been suggested to be a potential risk factor that may increase
her child's vulnerability to sexual abuse (Koch & Jarvis, 1987). However, it is important
to note the qualitative differences between these two proposed pathways. While the
transmission of emotional an physical abuse is often direct, the pathway that sexual abuse
travels is notably more complex. For example, it has been suggested that a woman may
be unable to adequately attend to her child's safety due to her own preoccupation and/or
unconscious denial of her own abuse. Subsequently, she may have difficulty
acknowledging that her own child is being abused, often by a significant male in the
woman’s life.

While it is beyond the scope of this study to determine whether this increased
vulnerability exists, the results do suggest that some women who are survivors of abuse
may actually be more attentive and protective of their own children, rather than victims of

their own experiences who are presumably blind to the needs and vulnerabilities of their

7 4
own children. Notably, this "overprotectiveness" is often cast within a pathological light
and assumed to result in negative adjustment for the child (Koch & Jarvis, 1987). As
noted previously, it is likely that high levels of maternal control may prove to be a
hindrance inasmuch as it impedes age appropriate movements towards more autonomous
behavior, which by necessity requires the parent to allow her child to take certain risks as
she moves toward adulthood. However, an attempt to protect one's child from negative
experiences, particularly for the parent with first-hand knowledge regarding the
detrimental effects of such experiences, is not necessarily indicative of a pathological
process. Furthermore, it is also common for the original perpetrator (e. g., the mother’s
father) to have ongoing contact with the mother and, therefore, pose a very real risk to
her child. Therefore, her attempts in limiting her daughter’s exposure to potentially risky
situations can be seen as a proactive attempt to protect her daughter from serious harm
rather than simply an unconscious process. Future research that provides longitudinal
data regarding child outcomes and child-reports of maternal control would provide a
more refined understanding of the potentially deleterious and positive long-term effects of
this variable.

The lack of findings regarding the effect of sexual abuse on depression, maternal
confidence, and maternal warmth are somewhat more surprising. However, it is likely
that the structure of this study contributed to this phenomenon. That is, the outcomes
were predicted from severity of abuse, not its presence or absence. As noted by Green
(1993), relative severity of abuse is often neglected in sexual abuse research. While some

research has found an association between severity of abuse (often defined by type of

75

sexual act) and severity of outcomes (Bagley & Ramsay, 1985; Tufts, 1984), the majority
of studies that have found associations between sexual abuse and psychological well-
being compare symptomatology between abused groups and non-abused controls (e. g.,
Briere & Runtz, 1985; Gorcey, Santiago, & McCall-Perez, 1986; Sedney & Brooks,
1984). This methodological approach is even more pronounced when associations
between sexual abuse and parenting outcomes are studied (Burkett, 1991; Cole &
Woolger, 1989; Cole et al., 1992). The findings of this study suggest that the presence or
absence of abuse, rather than level per se, is the more powerful predictor of certain
outcomes.

In addition to examining the role of social support, this study explored the
mediating effects of various coping strategies on the association between sexual abuse
and depression and parenting outcomes. No mediational effects were found for any of the
5 proposed variables (parental avoidant coping, abuse avoidant coping, parental
reappraisal coping, abuse reappraisal coping, and lack of resolution). However, several
direct relationships between variables emerged.

First, severity of sexual abuse directly predicted the extent to which women
remain unresolved regarding their abuse. Interestingly, although childhood sexual abuse
did not directly predict level of depression, severity of abuse was related to the extent to
which the woman felt consumed by issues related to the abuse in her day-to-day life. In
addition, the greater the woman's lack of resolution around the abuse, the higher the level
of self-reported depression. These findings may partially account for the inconsistent

findings regarding the impact of abuse-related variables on outcomes (e. g., Leitenberg et

7 6
al., 1992). That is, it is the extent to which the abuse remains an active part of the
woman's life, a "daily hassle" of enormous proportions, that is related to psychological
well-being, rather than solely the specifics surrounding the abuse itself. The importance
of an individual's perception of the abuse has been shown to impact the outcomes
experienced. For example, Hirnelein & McElrath (1996) found that "refusal to dwell on
child sexual abuse" was associated with better adjustment. One subject fiom that study,
who was categorized as well-adjusted, reported the following regarding her experience of
sexual abuse: "(Don't) let it control you. I think that's what I did for the first 10 years
after it happened. It was just everything. Once I was able to put it aside..it made a huge
difference" (p. 755). The present study supports and further refines the phenomenon
underlying this comment providing an operationalized measure of resolution and
exploring its impact on a variety of outcomes.

Similarly, lack of resolution was associated with less maternal confidence. Again,
the pathway between abuse and parenting outcomes may be best understood by first
understanding the woman's current level of preoccupation with abuse-related issues. It is
likely that the woman who feels overwhelmed and preoccupied with abuse-related
thoughts and feelings would also feel unsure about her ability to succeed in the parental
role. Notably, given the lack of a direct association between severity of abuse and
maternal confidence or ability to express maternal warmth, these fears may or may not be
related to fact. As pointed out by Herman (1981) and Courtois (1988), survivors of
sexual abuse tend to express significant concern about their ability to parent, some to the

extent that they ended up setting unrealistic expectations for themselves.

7 7

Although beyond the scope of this study, it is also important to explore the
different pathways that resolution of abuse issues may take for individual women. For
example, it is likely that achieving resolution is not a linear process, but rather influenced
by developmental and situational factors in the woman's life. If a woman is actively
dealing with abuse—related issues, it is highly likely that she is "preoccupied" with these
issues. However, this may actually reflect a stage of therapeutic healing that must occur
before further progress can be made. However, for other women, lack of resolution may
reflect the woman's entanglement in abuse issues that is static rather than progressive.
Future research could provide additional information regarding whether qualitatively
different types of resolution exist (and whether these types are differentially associated
with outcomes).

Parental reappraisal coping was associated with more maternal confidence and
less maternal control. Reappraisal coping, or a positive cognitive restructuring of an
event, has been associated with greater resilience from stressfirl experiences (Charlton &
Thompson, 1996; Mrazek etal., 1987). Therefore, being able to refi'ame a stressfirl
parent-child interaction proved to be a source of self-worth for mothers. This ability to
refrarne the situation into a positive may also have predicted less controlling behaviors
due to the fact mothers who are able to focus on the positive aspects of the situation may
experience less anxiety or fear regarding their child's behavior, which in turn may be
related to less of a general need to impose control in order to manage that anxiety.

Avoidant coping was unrelated to either psychological or parenting outcomes.

This is in contrast to research that has shown that denial and avoidance-based coping has

78

been found to mediate the association between sexual abuse and poor psychological
outcomes (J anoff-Bulman, 1985; Koss & Burkhart, 1989; Leitenberg et al., 1992; Proulx,
Koverola, F edorowicz, & Kral, 1995).

The lack of findings regarding the mediational and even direct effects of coping
and resolution variables may have been associated with some of the limitations of this
study. Most notably, the small sample size of this study greatly impacted statistical
power. This fact, in addition to utilizing Baron & Kenny’s relatively stringent criteria for
testing for mediation, likely contributed to the lack of significant findings. For example,
although CSA predicted Lack of Resolution and Lack of Resolution predicted
Depression, Lack of Resolution was not determined to mediated the association between
CSA and Depression because CSA did not predict Depression. However, according to
Cohen’s (1992) guidelines for conducting statistical power analysis, even anticipating a
medium effect size (ES=.15) at a .05 level of significance with 2 independent variables
would require at least 67 subjects to achieve a power of .80. The effect size of the
association predicting Depression fi'om CSA was notably small (R2=.03; ES=.O2), which
would have required over 400 subjects to attain a statistical power value of .80.
Therefore, it is highly likely that, with a larger sample size, a more robust association
between CSA and Depression, and, subsequently, stronger evidence for the mediational
role of Lack of Resoltuion, would have emerged.

In addition to the issue of lack of adequate statistical power, the inclusion of a
non-abused control group would also have potentially allowed for the detection of more

significant differences than could be obtained by only assessing differences in severity.

79

Additionally, the Ways of Coping measure may not have been the best choice for
assessing coping with abuse-related issues. The manner in which this measure is
structured required the woman to describe a specific problem (i.e. related to the abuse)
and then answer questions regarding how she coped with the situation. In contrast to
describing stressful parenting situations, many women had difficulty identifying specific
abuse-related situations in their current lives. Most women discussed issues such as
flashbacks or more general difficulties they felt were resultant of their abuse. Forcing the
woman to describe a particular event may have unnecessarily limited her responses to the
subsequent coping questions. That is, a more general question such as "How have you
generally coped with the abuse in your adulthood" may have tapped a wider and more
representative range of responses. More recent studies that have shown more robust
effects of coping with sexual abuse survivors have utilized this approach (Leitenberg et
al., 1992) and have also used a revised version of the WOC that asked respondents to
indicate how often different strategies were used within a specific time period (e.g., the
past few weeks) without asking the individual to describe a specific stressful situation
(Proulx et al., 1995).

Several methodological and statistical choices were made in the process of
conducting this study that presented specific costs and benefits. For example, although it
was believed that limiting the sample to women with daughters would decrease potential
confounds in the outcomes, the age of daughters ranged from infancy to adulthood.
Therefore, the types of parenting outcome measures that could be utilized were somewhat

limited. For example, it would have been useful to assess the quality of emotional

8 O

boundaries within mother-daughter relationships given that boundary violations are a
central component of sexual abuse trauma. However, the level of maternal involvement
in her child's life (e. g., making choices regarding clothing, friends) varies greatly
depending upon the child's developmental stage. Therefore, this aspect of the
relationship could not have been validly assessed. Another important decision involved
the computation of a sexual abuse severity score. In this study, the overall CSA severity
score included information regarding the type and frequency of sexual abuse experienced,
the number of perpetrators, and the level of perceived distress at the time of the abuse.
Clearly, by including a number of abuse-related factors in one score, there is an increased
risk that certain discrete findings may have been overshadowed. However, it was felt that
it was necessary to include more information than merely, for example, how severe the
woman perceived her abuse to be. Similarly, certain abuse-related variable were not
included due to the specific nature of this sample. For example, there is some anecdotal
evidence that when children reach the age at which their mothers’ were sexually abused,
certain mothers can experience extreme distress related to their memories of the abuse.
While this is a compelling empirical question, in reality, this sample only contained 2
mothers whose daughters were currently at the age at which the women were abused.
Therefore, including this variable would have been meaningless.

Finally, this study used retrospective and cross-sectional, self-report data. As
with any retrospective study, the recollection of specific events, particularly involving
trauma, is fraught with potential errors in reporting. However, given that the most

striking results involve the importance of a woman's current preoccupation with the

8 1
abuse, the accuracy of specifics related to the actual abuse may be less relevant than one
would expect. The cross-sectional nature of this study provides a glimpse of the mother-
child relationship that would be considerably more informed by a longitudinal approach
that assesses parenting outcomes, support and coping over time to determine the extent to
which each varies across time and developmental stage. Mirns (1982) suggested that
survivors' coping styles may transform as the time from the actual abuse increases.
Finally, the fact that all the data in this study was self-report posed a problem,
particularly when it came to testing for mediation. Trying to establish a series of causal
relationships can yield potentially questionable results when self-report data alone is
relied upon for measurement. Given coping’s established role as a mediator in the extant
literature, it’s role in the present study was similarly tested. However, it may have
provided fewer potential confounds to the study if less sensitive analyses (e. g., direct
effects and/or moderators) were considered.

In conclusion, this study demonstrated the importance of considering the effects
of abuse and related variables on both psychological well-being and parenting outcomes.
In particular, the extent to which women are preoccupied with issues around their prior
abuse may affect both their level of depression as well as their level of confidence
regarding their ability to parent. However, results of this study also indicated that abuse
did not directly affect a woman's ability to experience and express warmth in her
relationship with her daughter. Severity of abuse did predict the women’s level of control
in their relationships with their daughters. This highlights the importance of reaching

beyond a deficit-focused theory when assessing the effects of sexual abuse.

8 2

Consistent with prior research, social support was found to help attenuate the
effects of general stress and was related to less depression and greater parenting
confidence. However, general social support did not affect the impact of abuse nor did it
buffer the effects of abuse on outcome variables. Clinical implications of this research
include assessing the woman's current level of resolution regarding her abuse, which may
be as important as the abuse itself for predicting level of depression and certain parenting
outcomes, and providing the appropriate support and interventions. For example, support
groups that provides specific assistance around parenting and abuse issues may be of
particular help. Because abuse itself was related to the mother's self-reported level of
maternal control, this aspect of the relationship should be addressed. Control might be
refrained for the mother as a way she is seeking to protect her daughter from a similar
fate.

Future research would do well to gain the daughter's perspectives on her
relationship with her mother to determine how these findings are associated with child
outcomes. In addition, a longitudinal approach that included abused and non-abused
groups and followed mothers pre- and post-partum and then across childhood would
capture a much more refined picture of how women simultaneously cope with parenting
and a history of abuse. This type of approach would also contribute to the current pool of
knowledge and help to develop an actual model for sexual abuse, social support and
coping as they relate to parenting outcomes over time. By limiting the age of the child in
such a way, this would also allow for a wider variety of parenting outcomes to be

assessed. For example, parental encouragement of autonomy, which could be interpreted

8 3
differently depending upon the age of the child and has been identified as a relevant
variable for sexual abuse survivors (Cole & Woolger, 1989), could be included in such an

assessment.

LIST OF REFERENCES

LIST OF REFERENCES

Aldwin, C., Folkman, 8., Schaefer, C., Coyne, J.C., & Lazarus, RS. (1980). Ways
of Coping: A process measure. Paper presented at the annual meeting of the American
Psychological Association. Montreal.

Altrneier, W.A., O'Connor, S., Veitze, P., Sandler, H., & Sherrod, K. (1984).
Prediction of child abuse: A prospective study of feasibility. Child Abuse and NeglecL8.
393-400.

Anderson, SC, Bach, C.M., & Griffith, S. (1981). Psychosocial sequelae in
intrafamilial victims of sexual assault and abuse. Paper presented at the Third
International Conference on Child Abuse and Neglect, Amsterdam, The Netherlands.

Andrews, 6., Tennant, C., Hewson, D.M., & Valliant, GE. (1978). Life event
stress, social support, coping style, and risk of psychological impairment. Journal of
Nervous and Mental Disease. 166(5), 307-316.

Bagley, C., & Ramsay, R. (1985). Disrupted childhood and vulnerability to sexual
assault: Long-term sequels with implications for counseling. Paper presented at the
Conference on Counselling the Sexual Abuse Survivor, Winnipeg, Canada.

Bagley, C. & Ramsay, R. (1986). Sexual abuse in childhood: Psychosocial
outcomes and implications for social work practice. Journal of Social Worl_g_and Humg
Sexpality, 4. 33-47.

Barrera, M.E., Rosenbaum, P.L., & Cunningham, CE. (1986). Early home
intervention with low-birth-weight infants and their parents. Child Development. 51. 407-
414.

Barrett, C. (1978). Effectiveness of widows' groups in facilitating change. Journal
of Consultingand Clinical Psychology, 46, 20-31.

Bass, E. & Davis, L. (1988). The courage to heal; A gaide for women survivors of
child sexual abuse. New York: Harper & Row.

84

85

Beigel, D., Naparstek, A., & Khan, M. (1980). Social_support and mental healfi
An examination of interrelationships. Paper presented at the meeting of the American
Psychological Association, Montreal.

Beitchman, J .H., Zucker, K.F., Hood, J .E., DaCosta, G.A., Arkrnan, D., &
Cassavia, E. (1992). A review of the long-term effects of child sexual abuse. Child Abuse
and Neglect. 16. 101-118.

Bell, R.A., LeRoy, J.B., & Stephenson, J .J . (1982). Evaluating the mediating
effects of social supports upon life events and depressive symptomatology. Journal of

Communig Psychology, 10, 325-340.

Belsky, J. (1980). Child maltreatment: An ecological integration. American
Psychologist, 35, 320-335.

Booth, C.L., Barnard, K.E., Mitchell, S.K., & Spieker, SJ. (1987). Successful
intervention with multi-problem mothers: Effects on the mother-infant relationship.
In_f_ant Mental Health Journal, 8, 288-306.

Briere, J. (1984). The effects of childhood sexual abuse on later psychological
functioning: Defining a "post-sexual-abuse syndrome". Paper presented at the Third
National Conference on Sexual Victimization, Washington, DC.

Briere, J. & Runtz, M. (1985). Symptomatology associated with prior sexual
abuse in a non-clinical sample. Paper presented at the annual meeting of the American
Psychological Association. Los Angeles.

Bronfenbrenner, U. (1977). Toward an experimental ecology of human
development. American Psychologist, 32, 513-531.

Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA:
Harvard University Press.

Browne, A. & F inkelhor, D. (1986). Impact of child sexual abuse: A review of the
research. Psychological Bullet1_n,' 99, 66-77.

Brunngraber, LS. (1986). Father-daughter incest: Immediate and long-term
effects of sexual abuse. Advaaces in Nursing Science, 15-35.

Burkett, LP. (1991). Parenting behaviors of women who were sexually abused as
children in their families of origin. Family Process. 30. 421-434.

Charlton, P.F.C. & Thompson, J .A. (1996). Ways of coping with psychological
distress after trauma. British Journal of Cling Psychology, 35, 517-530.

86

Chesler, P. (1972). Women and madness. New York: Doubleday.

Ciccheti, D. & Carlson, V. (1989). Child maltreatment: Theory and research on
the causes and consequences of chilcgbuse and neglect. New York: Cambridge
University Press.

Cohen, J. (1992). A power primer. Psychological Bulletin. 1 1 2. 1 55-1 59.

Cohen, S. & McKay, G. (1984). Social support, stress and the buffering
hypothesis: An empirical review and theoretical analysis. In A. Buam, J. Singer, & S.
Taylor (Eds) Handbook of psychology and health (Vol. 4, pp. 253-267). Hillsdale, NJ:
Erlbatun.

Cohen, RS., & Weisman, SH. (1984). The parenting alliance. In R.S. Cohen, B.J.
Cohler, & S.H. Weisman (Eds) Parenthood: A gychodynamic perapective (pp. 33-49).
New York: Guilford Press.

Cohen, S. & Wills, T.A. (1985). Stress, social support and the buffering
hypothesis. Psychological Bulletin. 98. 310-357.

Cole, P., & Woolger, C. (1989). Incest survivors: The relation of their perceptions
of their parents and their own parenting behavior. Child Abuse and Neglect, 13, 1-8.

Cole, P., Woolger, C., Power, T.G., & Smith, K.D. (1992). Parenting difficulties
among adult survivors of father-daughter incest. Child Abuse and Neglect, 16, 239-249.

Courtois, C. (1979). The incest experience and its aftermath. Victirnology: An
lntemational Journal 4 337-347.

 

Courtois, C. (1988). Healing the incest wound. New York: W.W. Norton & Co.

Cutrona, C. (1984). Social support in the transition to parenthood. Journal of
Abnormal Psychology, 93, 378-390.

Cutrona, C. (1986). Objective determinants of perceived social support. Journal of

Personalng and Social Psychology, 50(2), 349-355.

Damon, L., Todd, J ., & MacFarlane, K. (1987). Treatment issues with sexually
abused young children. Child Welfare. 66(2), 125-137.

Davenport, C., Browne, K., & Pahner, R. (1994). Opinions on the traumatizing
effects of child sexual abuse: Evidence for consensus. Child Abuse and Neglect, 18(9),
725-738.

87

Dawson, P., vanDoominck, W.J., & Robinson, J .L. (1989). Effects of home-
based, informal social support on child health. Journal of Developmental_ and Behavioral
Pediatrics. 10, 63-67.

Dean, A. (1986). Social support in epidemiological perspective. In N. Lin, A.
Dean, & W. Ensel (Eds), Social support. life events. and depression (pp. 3-15). Orlando,
FL: Academic Press.

DeLongis, A., Coyne, J .C., Dakof, G., Folkman, S., & Lazarus, RS. (1982).
Relationship of daily hassles, uplifts, and major life events to health status. Health

Psychology, 1, 119-136.

D'Ercole, A. (1988). Single mothers: Stress, coping and social support. Journal of
Comrntmig Psychology, 16, 41-54.

de Araujo, G.P., Van Arsdel, P., Holmes, T.H., & Dudley, D.L. (1973). Life
change, coping ability and chronic intrinsic asthma. Journal of Psychosomatic Research,
_11, 359-363.

DeYoung, M. (1982). The sexual victimization of children. London: McFarland.

Dohrenwend, B.S. & Dohrenwend, BR (1974). Stressfirl life eventjs: Their nature
and effects. New York: Wiley

Dohrenwend, B.P. & Shrout, RE. (1985). "Hassles" in the conceptualization and
measurement of life stress variables. American Psychologi_st. 40(7), 780-785.

Dunkel-Schetter, C., Folkman, S., & Lazarus, RS. (1987). Correlates of social
support receipt. Journal of Persgllity and Social Psychology, 53, 71-80.

Egeland, B., Brietenbacher, M. & Rosenberg, D. (1980). A prospective study of
the significance of life stress in the etiology of child abuse. J ouml of Coughing and
Clinical Psychology, 48, 195-205.

Egeland, B. & J acobvitz, D. (1984). Intergenerational continuity of parental
abuse: Causes and consequences. Paper presented at the Conference on Biosocial
Perspectives in Abuse and Neglect, York, Maine.

Ensel, W.M. & Lin, N. (1991). The life stress paradigm and psychological
distress. Journal of Health and SocialfiBehaviom 321-341.

Field, T., Healy, G., Goldstein, S., Perry, 8., Bendell, D., Schanberg, S.,
Zimmerman, E.A., & Kuhn, C. (1988). Infants of depressed mothers show depressed
behaviour even with non-depressed adults. Child Development. 52, 1569-1579.

88

Finkelhor, D. (1979). Sexually victimized children. New York: Free Press.

F inkelhor, D. (1984). Child sexual abuse: New theory and research. New York:
The Free Press.

F inkelhor, D. (1990). Early and long-term effects of child sexual abuse: An
update. Professional Psychology: Research and Practice. 21(5), 325-330.

Finkelhor, D., Hotaling, G., Lewis, I.A., & Smith, C. (1990). Sexual abuse in a
national survey of adult men and women: Prevalence, characteristics, and risk factors.
Child Abuse and Neglect. 14. 19-28.

Folkman, S., Chesney, M., McKusick, L., Ironson, G., Johnson, D.S., & Coates,
T.J. (1991). Translating coping theory into an intervention. In J. Eckenrode (Ed.), EC.
social context of coping (pp. 239-260). New York: Plenum Press.

Folkman, S. & Lazarus, RS. (1980). An analysis of coping in a middle-aged
community sample. Journal of Health and Social Behavior. 21. 219-239.

Folkman, S., Lazarus, R.S., Gruen, R.J., & DeLongis, A. (1986). Appraisal,
coping, health status, and psychological symptoms. Journal of Personalityand Social
Psychology. 50(3), 571-579.

Frank, 8., Hole, C.B., Jacobson, S., Justkowski, R., & Huyck, M. (1986).
Psychological predictors of parents' sense of confidence and control and self- versus
child-focused gratifications. Developmental Psychology, 22,- 348-355.

Freud, A. (1981). A psychoanalyst's view of sexual abuse by parents. In P.B.
Mrazek and CH. Kempe (Eds.), Sexually abused children and their families (pp. 33-34).
Oxford: Pergamon Press.

 

Friedrich, W.N., Urquiza, A.J., & Beilke, R.L. (1986). Behavior problems in
sexually abused young children. Journal of Pediatric Psychology, 11(1), 47-57.

Gagliano, CK. (1987). Group treatment for sexually abuse girls. Social
Casewogrk: The Joml of Contemporary Social Worla68(2), 102-108.

Garbarino, J. (1977). The human ecology of child maltreatment: A conceptual
model for research. Jomnalmf Marriage and Family Therapy, 39, 721-736.

Golding, J .M., Siegel, J.M., Sorenson, S.B., & Bumam, M.A. (1989). Social

support sources following sexual assault. Journal of Communig Psychology, 17(1), 92-
107.

89

Gorcey, M., Santiago, J .M., & McCall-Perez, F. (1986). Psychological
consequences for women sexually abused in childhood. Social Psychiatry. 2_1, 129-133.

Green, AH. (1993). Child sexual abuse: Immediate and long-term effects and
intervention. Journal of the American Academcy of Child and Adoleacent Psychiatyy,
12(5), 890-902.

Green, CM. (1982). F ilicidal impulses as an anniversary reaction to childhood
incest. American J om of Psychotherapy, 36, 264-271.

Greenspan, M. (1983). A new approach to women and thegpy. New York:
McGraw-Hill.

Greenwald, E., Leitenberg, H., Cado, S., & Tarran, M.J. ( 1990). Childhood sexual
abuse: Long-term effects on psychological and sexual functioning in a nonclinical
sample of adult women. Child Abuse and Neglect. 14, 503-513.

Hazzard, A., King, H.E., & Webb, C. (1986). Group therapy with sexually abused
adolescent girls. American Journal of Psychotherapy. 40(2), 213-223.

Herman, J. (1981). F ather-daughter incest. Cambridge, MA: Harvard University
Press.

Herrenkohl, E., Herrenkohl, R., & Toedtler, L. (1983). Perspectives on the
intergenerational transmission of abuse. In D. Finkelhor, R. Gelles, G. Hotaling, & M.
Straus (Eds.) The dar_kside of families: Current Family Violence RCflICh. Beverly Hills,
CA: Sage.

Herzog, E.P., Gara, M.A., & Rosenberg, S. (1992). The abused child as parent:
Perception of self and other. Infant Mental Health Journal, 13(1), 83-98.

Himelein, M. & McElrath, J .V. (1996). Resilient child sexual abuse survivors:
Cognitive coping and illusion. Child Abuse and Neglect. 20(8), 747-758.

Holmes, T.H. & Masuda, M. (1974). Life changes and illness susceptibility. In
BS. and B.P. Dohrenwend (Eds.), Streasful life eventL Their nature and effects. New
York: Wiley.

Holmes, T.H. & Rahe, RH. (1967). The Social Readjustrnent Rating Scale.
Journal of Psychosomatic Research, 11, 213-218.

House, J .S. (1981). Workatress and social support. Reading, MA: Addison-
Wesley Publishing Company.

90

Hunter, R.S. & Kilstrom, N. (1979). Breaking the cycle in abusive families.
American Journal of Psychiatry. 136. 1320-1322.

J ehu, D., Gazen, M., & Kassen, C. (1985). Common therapeutic targets among
women who were sexually abused in childhood. Feminist Pmectives on Social Work
and Human Sexuality. 3(2-3), 25-45.

Kanner, A.D., Coyne, J .C., Schaefer, C., & Lazarus, RS, (1981). Comparison of
two modes of stress measurement: Daily hassles and uplifts versus major life events.
Journal of Behavioral Medicine. 4. 1-39.

Kaufman, J. & Zigler, E. (1987). Do abused children become abusive parents?
American Journal of Orthopsychiatry. 57. 186-192.

Kempe, H. (1973). The battered child syndrome. Journal of the American Medical
Associatioa, 1 8 1 , 1 7-24.

Kempe, H. & Kempe, R. (1978). Child abuse. Cambridge, MA: Harvard
University Press.

Kendall-Tackett, K.A., Meyer Williams, L., & Finkelhor, D. (1993). Impact of
sexual abuse on children: A review and synthesis of recent empirical studies.
Psychological Bulletin. 113(1), 164-180.

Koch, K. & Jarvis, C. (1987). Symbiotic mother-daughter relationships in incest
families. Journal of Contemporary Social Work(February), 94-101.

Lazarus, RS. (1966). Psychological stress and the coping process. New York:
McGraw-Hill.

Lazarus, R.S. & Delongis, A. (1983). Psychological stress and coping in aging.
American Psychologist, 38, 245-254.

Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal, and coping. New York:
Springer Press.

Leavy, R.L. (1983). Social support and psychological disorder: A review. Journal
of Communig Psychology, 11, 3-21.

Levay, A.N., & Kagle, A. (1977). Ego deficiencies in areas of pleasure, intimacy,
and cooperation: Guidelines in the diagnosis and treatment of sexual dysfunction. Joumal
of Sex Research 3 10-18.

 

Lin, N., Dean, A., & Ensel, W.M. (1981). Social support scales: A
methodological note. Schizophrenia Bulletin. 7. 73-87.

91

Lin, N., Simeone, R.S., Ensel, W.M., & Kuo, W. (1979). Social support, stressful
life events, and illness: A model and an empirical test. J ouonf Health and Social
Behavior 20 108-119.

 

Lindberg, F.H., & Distad, L]. (1985). Post-traumatic stress disorders in women
who experienced childhood incest. Child Abuse and Neglect. 9. 329-334.

Lukianowicz, N. (1972). Incest. Briti_S_h Journfl of Psychiatry. 120. 301-313.

Luster, T. & Small, SA. (1997). Sexual abuse history and problems in
adolescence: Exploring the effects of moderating variables. Journal of Marriage and the
Family, 59, 131-142.

MacEwen, K. (1994). Refining the intergenerational transmission hypothesis.
Journal of Interpersonal Violence. 9(3), 350-365.

Main, M & Goldwyn, R (1984) Predicting rejection of her infant fi'om mother's
representations of her own experience: Implications for the abused-abusing
intergenerational cycle. Child abuse and neglect, 8, 203-217.

Mandoki, C.A. & Burkhart, BR. (1989). Sexual victimization: Is there a vicious
cycle? Violence and Victima,_4(3), 179-190.

Meiselrnan, K. (197 8). Incest: A psychologic_al study of causes and effects with
t__r_e_atment recommendations. San Francisco: J ossey-Bass.

Miller, P.M. & lngham, J .G. (1979). Reflections on the life events to illness link
with some preliminary findings. In I.G. Sarason & C.D. Spielberger (Eds.), Stress and
anxieg (pp. 313-336). New York: Hemisphere.

Mirns, RH. (1982). Sexual stress: Coping and adaptation. Nursing Clinics of
North America. 17. 395-405.

Mullen, P.E., Romans-Clarkson, S.E., Walton, V.A., & Herbison, GP. (1988).
Impact of sexual and physical abuse on women's mental health. Lancet 1 841-845.

 

Nuckolls, K.B., Cassel, J ., & Kaplan, RH. (1972). Psychosocial assets, life crisis,
and the prognosis of pregnancy. American Journal of Epidemiology, 95, 431-441.

Oates, R., Forrest, D. & Peacock, A. (1985). Self-esteem of abused children.
Child Abuse and Neglect. 9. 159-163.

92

Olds, D.L., Henderson, C.R., Tatelbaum, R., & Chamberlin, R.(1986). Preventing
child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics. 78. 65-
7 8.

Palmer, R.L., Chaloner, D.A., & Oppenheimer, R. (1992). Childhood sexual
experiences with adults reported psychiatric patients. British Journal of Psychiatry. 160.
261-265.

 

Pascoe, J .M., Loda, M., Jeffiies, U., & Earp, J. (1981). The associations between
mothers' social support and provision of stimulation to their children. Development
aria Behafivioral Pediatrics. 2, 15-19.

Paykel, E.S., Emms, E.M., Fletcher, J ., & Rassaby, ES. (1980). Life events and
social support in puerperal depression. British Journal of Psychiatry. 136. 339-346.

Pearlin, L.I., Lieberman, M.A., Menaghan, E.G., & Mullan, J .T. (1981). The
stress process. J oumalaof Health and Social Behavior 22 337-356.

 

Pearlin, L.I. & Schooler, C. (1978). The structure of coping. Journal of Health and
Social Behavior. 19. 2-21.

 

Peters, J .J . (1976). Children who are victims of sexual assault and the psychology
of offenders. American J oumarl of Psychotherapy, 30, 398-421.

Peters, SD. (1984). The relationship between childhood sexual victimization and
adult depression among Afro-American and white women. Unpublished doctoral
dissertation, University of Califomia, Los Angeles, CA.

Popiel, D.A. & Susskind, EC. (1985). The impact of rape: Social support as a
moderator of stress. American Journal of Communig Psychology,13(6), 645-676.

Porter, F .S., Blick, L.C., & Sgroi, SM. (1982). In S.M. Sgroi (Ed.), Handbook of
clinical intervention in child sexual abuse (pp. 109- 145). Lexington, MA: Lexington
Books.

Poston, C. & Lison, K. (1989). Reclaiming our lives: Hope forfi adult survivors of
incest. New York: Bantam Books.

Proulx, J ., Koverola, C., Fedorowicz, A., & Kral, M. (1995). Coping strategies as
predictors of distress in survivors of single and multiple sexual victinrizations and
nonvictimized controls. Journal of Applied Social Psychology, 25(16), 1464-1483.

Quinton, D., Rutter, M., & Liddle, C. (1984). Institutional rearing, parental
difficulties and marital support. Psychological Medicine. 144 107-124.

93

Resick, RA. (1993). The psychological impact of rape. Journal of Integpersonal
Violence 8(2), 223-255.

 

Rohner, R. & Rohner, E. (1980). Antecedents and consequences of parental
rejection: A theory of emotional abuse. Child Abuse and Neglect. 4. 189-198.

Russell, D. & Cutrona, CE. (1985). The Social Provisions Scale: A Qualitative
measure of faaets of social support. Manuscript in preparation.

Schaffer, HR. (1984). The child's entry with a social world (pp. 1834). London:
Academic Press.

Sedney, M.A., & Brooks, B. (1984). Factors associated with a history of
childhood sexual experience in a nonclinical female population. Journal of the American
Academy of Child Psychian, 23, 215-218.

 

Selye, H. (1956). The stress of life. New York: McGraw-Hill.

Sharnra, A. (1986). A women's center support group for sexual assault victims.
Journal of Counseling and Development. 64(8), 525-527.

Silver, R.L., Boon, C., & Stones, M.H. (1983). Searching for meaning in
misfortune: Making sense of incest. Journal of Social Sciences. 39(2), 81-102.

Sgroi, S.M., Blick, L.C., & Porter, ES. (1982). A conceptual framework for child
sexual abuse. In S.M. S groi (Ed.), _Iiandboogk of clinical:intervention in child sexual abuse
(pp-37). Lexington, MA: Lexington Press.

Shaunesey, K., Cohen, J .L., Plummer, B., & Berrnan, A. (1993). Suicidality in
hospitalized adolescents: Relationship to prior abuse. American Journal of
Orthopsychiatry. 63. 1 13-1 19.

Slater, J. & Depue, RA. (1981). The contributions of environmental events and
social support to serious suicide attempts in primary depressive disorder. Journal of

Abnormal Psychology, 90, 275-285.

Slater, M.A. & Power, TO. (1987). Multidimensional assessment of parenting in
single-parent families. Advances in Family Intervention. AssesamenL and Theory. 4.
1 97-228.

Steele, B.F. & Alexander, H. (1981). Long term effects of sexual abuse in
childhood. In P.B. Mrazek and CH. Kempe (Eds.), Sexually abuse children and their
families (223-234). Oxford: Pergamon Press.

94

Steele, B. & Pollock, C. (1968). A psychiatric study of parents who abuse infants
and small children. In R. Helfer and C. Kempe (Eds.), The bafiered child syndrome.
Chicago: University of Chicago Press.

Stone, A.A. & Neale, J .M. (1984). A new measure of daily coping: Development
and preliminary results. Journal of Personality aad Social Psychology, 46, 892-906.

 

Straus, M. (1979). Family patterns and child abuse in a nationally representative
sample. lntemational Journal of Child Abuse and Neglect. 3. 23-31.

Surtees, PG. (1980). Social support, residual adversity, and depressive outcome.
Social Psychiaary, 15, 71-80.

Tetzloff, C.E. & Barrerra, M. (1987). Divorcing mothers and social support:
Testing the specificity of buffering effects. American Journal of Communig Psychology,
15(4), 419-434.

Thoits, P. (1982). Conceptual, methodological and theoretical problems in
studying social support as a buffer against life stress. Journal of Health and Social
Behavior 23 145-159.

 

Tinbergen, N. (1951). The study of in_stinct. London: Oxford University Press.

Tolsdorf, CC. (1976). Social networks, support, and coping: An exploratory
study. Family Process. 15. 407-417.

Tufts' New England Medical Center, Division of Child Psychiatry. (1984).
Sexually exploited children: Service and research proiect. Final report for the Office of
Juvenile Justice and Delinquency Prevention, Washington, DC: US. Department of
Justice.

Vaux, A. (1985). Variations in social support associated with gender, ethnicity,
and age. Journal of Social Issues. 41(1), 89-110.

Valentine, L. & Feinauer, LL. (1993). Resilience factors associated with female
survivors of childhood sexual abuse. The American Journal of Family Therapy, 21, 216-
224.

van der Kolk, B.A., Perry, J .C., & Herman, J .L. (1991). Childhood origins of self-
destructive behavior. Amerfin Journal of Psychim. 148. 1665-1671.

Waller, G. & Ruddock, A. (1993). Experiences of disclosure of childhood sexual
abuse and psychopathology. Child Abuse Review. 2(3), 186-197.

95

Weinraub, M. & Wolf, BM. (1983). Effects of stress and social supports on
mother-child interactions in single- and two-parent families. Child Development. 54.
1297- 1 31 1.

Weiss, R. (1974). The provisions of social relationships. In Z. Rubin (Ed.), Doing
unto others (pp. 17-26). Englewood Cliff, NJ: Prentice Hall.

Weissman, S. & Cohen, RS. (1985). The parenting alliance and adolescence.
Adolescent Psychiaay, 12, 24-45.

Wolfe, A.W. (1981). Stress, social support, and schizophrenia: Discussion.
Schizophreniflulletin. 7. 173-177.

Wortrnan, CB. (1976). Causal attributions and personal control. In New
directions in attributional research, J. Harvey, W. Ickes, & R.F. Kidd (Eds.), pp. 23-52.
Hillsdale, NJ: Erlbaum.

Zuravin, S., McMillan, C., DePanfilis, D., & Risley-Curtiss, C. (1996). The
intergenerational cycle of child matreatrnent. Journal of Intarpersonal Violence. 11(3),
3 1 5-3 34.

APPENDICES

APPENDIX A

APPENDIX A

DEMOGRAPHIC QUESTIONNAIRE
(Completed by Interviewer)

1. What is your date of birth?

 

2. What is Your race? (please circle appropriate letter)
a) Caucasian
b) African-American/Black
c) Asian American/Pacific Islander
d) North American Indian/Native American
e) Latino/Hispanic
f) Chicano/Mexican American
9) Other:

 

3. What is your highest level of education? (please circle
the appropriate letter)
a) less than high school e) graduate or
b) high school professional degree
c) 2 year post—high school
d) 4 year post-high school

4. What is your current occupation?

 

5. What is your current estimated family income?
6. Who did you live with while you were growing up?

a) biological mother and biological father
b) biological mother and step-father '
c) biological father and step-mother

d) biological mother alone

e) biological father alone

f) other (explain):

 

7. What was your mother's highest level of education?
a) less than high school e) graduate or
b) high school professional degree
c) 2 year post-high school
d) 4 year post-high school

8. What is/was her occupation?

96

97

9. What was your father's highest level of education?
a) less than high school e) graduate or
b) high school professional degree
c) 2 year post-high school
d) 4 year post-high school

10. What is/was his occupation?
11. Can you estimate your family's yearly income and/or SES

level (e.g., working class, middle class, poverty level)
while you were growing up?

 

12. What is your current relationship status? (check one)
Single and dating
Single and not dating _____
Living with opposite-sex partner
Living with same-sex partner

Involved with opposite-sex partner,
living apart

Involved with same—sex partner,
living apart - ‘

 

 

 

13. Are you currently married? Yes - No
If yes, how many years?
Were you married previously? Yes No

If yes, how long ago were you divorced?

 

How long were you married?

 

14. Do you currently have a parenting partner? Yes

No
If yes, what is this person's relationship to you?

 

15. How many children do you have?

 

16. What are their ages and sex?

17. Are all of your children currently living in the home?

Yes
No , please describe situation (use other

side if needed):

 

 

APPENDIX B

APPENDIX B

CSA QUESTIONNAIRE

INTERVIEWER: READ THE BELOW DESCRIPTION TO THE WOMAN BEFORE
YOU START ASKING THE QUESTIONS. EXPLAIN THAT YOU UNDERSTAND
THESE QUESTIONS ARE VERY PERSONAL AND REMIND THE WOMAN THAT
ALL OF HER ANSWERS WILL BE HELD IN STRICTEST CONFIDENCE.
PROVIDE THE WOMAN WITH CARDS AND ASK HER TO INDICATE WHICH
RATING BEST FITS HER EXPERIENCE.

Description: The following questions refer to the type of
abuse you may have experienced. First look at CSA Card and
please indicate the extent to which you experienced each of
the following types of abuse. I also want to understand how
personally distressing each experience was for you
specifically, so after you have decided on a rating, look at
the rating card and let me know how distressing that type of
abuse was for you. Please take your time and if you have
any questions, please ask.

1. Who abused you (e.g., determine whether it was
biological father, step-father, uncle, etc.) **NOTE: IF THE
WOMAN HAD MORE THAN ONE ABUSER MAKE SURE YOU INDICATE EACH
ONE AND WHAT THEIR RELATIONSHIP IS/WAS TO HER

2. At what age did your abuse begin? **NOTE: IF THE WOMAN
HAD MORE THAN ONE ABUSER, FIND OUT WHEN THE ABUSE BEGAN AND
ENDED FOR:§ACH PERPETRATOR (e.g., father-age 7; brother—age
12; uncle-age 8)

3. At what age did your abuse end? **SEE NOTE IN PREVIOUS
QUESTION

4. Did (fill in identity of abuser here, e.g., "your
father") abuse any other members of your family?

1=NO
2=YES

If yes, who else was abused?

98

99
5. Were you abused (either physically, sexually, or
emotionally) by anyone else as a child?

1=NO
2=YES
If yes, who else abused you and what happened?

6. Did you ever tell anyone about the abuse?

1=NO
2=YES

If yes, what happened (who did you tell, what was their
reaction, what happened after you told, did the abuse
stop?)

**READ THE FOLLOWING DIRECTIONS TO THE WOMAN***

DIRECTIONS: Now I am going to ask you about different types
of sexual abuse you may or may not have experienced. First
I will ask you whether and how often you experienced each of
these types of abuse. You can use this card (hand woman
card with "number of times" scale) to let me know how often,
if at all, this happened. Then, using this card (hand woman
"how distressing" scale) to let me know, as best as you can
remember, how distressing these instances were at the time.

1. Sexual kissing, intentional touching of buttocks, thigh,
leg, or clothed breasts or genitals

1a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

1b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
NOt very Somewhat Quite Very
‘Distressing Distressing Distressing Distressing

100
2. Breast contact (over clothes)

2a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

2b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

3. Breast contact (unclothed)

3a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less '

3b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 ' 4
Not very Somewhat Quite Very
Distressing Distressing Distressing . Distressing

4. Genital contact by abuser (over your clothes)

4a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1—2x Several times Several times Several times N/A
a year a year a month a week

or less

4b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

101

5. Abuser forced you to touch his clothed, genital area
(over clothes)

5a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

5b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

6. Abuser forced you to touch his unclothed, genital area

6a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

6b. In your own opinion, how distressing were these
experiences of abuse? -

1 2 3 4
Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

7. Abuser touched or penetrated your unclothed, genital area

7a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

7b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
Not.very Somewhat Quite Very
Distressing Distressing Distressing Distressing

102

8. Oral sex (performed by abuser)

8a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

8b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

9. Oral sex (abuser forced you to perform on him)

9a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

9b. In your own opinion, how distressing were these
experiences of abuse?

9

1 2 3 4

Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

10. Vaginal intercourse

10a. Approximately how frequently did the abuse occur?

1 2 3 4 8
1-2x Several times Several times Several times N/A
a year a year a month a week

or less

10b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

103

11. Anal intercourse

11a. Approximately how frequently did the abuse occur?

1 2 3 4 8
l-Zx Several times Several times Several times N/A
a year a year a month a week

or less

11b. In your own opinion, how distressing were these
experiences of abuse?

1 2 3 4
Not very Somewhat Quite Very
Distressing Distressing Distressing Distressing

APPENDIX C

lURPEDflDIXII:

Hassles Scale

Qtrectlons: Hassles ere IrrItants that can range from mInor annoyances
to FsIrIy meJor pressures. problems. or dIffIcuItIes. They can occur few
or many tlmes.

Ltsted on the following pages are a number of ways In whlch e person
can feel hessIed. Read through the IIst. and every tIme you (Ind a
hassle that he; heppgned tom "Lang 3st mont . widerllne that Item.
For example. the fIrst Item on the IIst Is 'hIspIecIng or Ioslng thIngs.’
If thIs has been an annoyance or problemfor you In the past month, then
underIIne that statement. For now. Ignore the Items to the rIght of the
statement. Just read through the Ilst and underllne ALL the Items that
have hessIed you. If an Item has not hessIed you In the pest month.
don't underIIne It.

 

Somewhat Moderately Extremely

Severe Severe ' Severe
I. NIspIecIng or IosIng thIngs............... I 2 3
2. Troublesome nelghbors..................... I 2 3
3. SocIaI obIIgetIons. ......... ..............I 2 3
4. Inconslderate smokers..................... I 2 3
5. Troubllng thoughts about your future...... I 2 3
6. Thoughts about death...................... It ‘2 3
7. Health of e femlly member................. I Z. 3
8. Not enough money for cIothIng............. I ' i 2 3
9. Not enough money for housIng.............. I 2 3
IO. Concerns about owIng money................ I 2 3
II. Concerns about getting credlt............. I 2 3
12. Concerns about money for emergencles...... I 2 3
I3. Someone owes you money.................... I 2 3
It. FInancIeI responsIbIIIty For someone...... I 2 3

who doesn't IIve wIth you.

104

105

Somewhat hoderately Extremely

Severe Severe Severe

IS. Cuttlng down on electrIcIty. water. etc. I 2 3
l6. Smoklng too much ............... ........... I 2 3
I7. Use of alc0hol. ........... . ....... . ....... I 2 3
I8. Personal use of drugs.......... ........... I 2 3
I9. Too many responsIbIIItIes................. I Z 3
20. OecIsIons about havlng chIIdren......... I 2 3
2l. Non-Famlly members IIvIng In your house... I 2 3
22. Care For pet... ..... ...................... l 2 3
23. Plannlng meals I 2 3

24. Concerned about the meanlng of IIFe....... I Z 3
25. Trouble relaxlng.......................... l 2 3
26. Trouble maklng decIsIons.................. l 2 3
27. Problems gettlng along wlth Fellow workers I 2 3
28. Customers or cllents gIve you a hard tlme. l '2 3
29. Home malntenance (Inslde)........... ...... I . z. 3
30. Concerns about Job securIty.... .......... I 2 3
3I. Concerns about retlrement ......... . ...... I 2 3
32. LaId-oFF or out of work...... ............ I Z 3
33. Don't lIke current work dutles.... ....... l 2 3
34. Don't llke Fellow workers ..... ... ........ l 2 3
35. Not enough money For basIc necessltles... I 2 3
36. Not enough money for Food... .............. l 2 3
37. Tbo many Interruptlons .................... I 2 3
38. Unexpected company........................ I 2 3
39. Too much tlme on hands......... ........... I 2 3
40. Havlng to walt............................ l 2 3
AI. Concerns about accldents...... ...... ...... I 2 3
42. Belng lonely.............................. l 2 3

43. Not enough money for health care .......... l 2 3

106
Somewhat hoderately Extremely

Severe Severe Severe

44. Fear of confrontation .......... . ......... l 2 3
4S. FInancIaI securlty ........................ I Z 3
46. SIIIy practlcal mIstakes. ............... .. I 2 3
47. InabIlIty to express yourself...a......... I 2 3
48. Physlcal IIlness.......................... l 2 3
49. Slde effects of medlcatlon................ I 2 3
50. Concerns about medlcal treatment.......... I 2 3
SI. Physlcal appearance.... ...... ............ I 2 3
52. Fear of rejectlon.................... ..... I 2 3
S3. DIffIcuItIes wlth gettlng pregnant........ I 2 3
54. Sexual problems that result from

physlcal problems......................... I 2 3
55. Sexual problems other than those

resultlng from physlcal problems.......... I 2 3
56. Concerns about health In general..... ..... I 2 3
57. Not seelng enough people.................. I 2' 3
58. Frlends or relatlves too far away......... I 2 3
59. Preparlng meals .................. ......... I ‘ .2 3
60. Hastlng tlme ........ ... ............... .... I 2 3
6I. Auto malntenance ...................... .... I 2 3
62. FIIIIng out forms ........ . .......... ...... I 2 3
63. Nelghborhood deterIoratIon................ I 2 3
64. FInancIng chlldren's educatlon...... ...... I 2 3
65. Problems wlth employees ............. ...... l ' 2 3
66. Problem! on Job due to belng a woman

or man..... ....... . .............. ......... I 2 3
67. Decllnlng physlcal abllltles ........... ... l 2 3
68. 8eIng explolted ........................... I 2 3
69. Concerns about bodlly functlons........... l 2 3'
70. Rlslng prlces of common goods ...... ....... I 2 _3

107

Somewhat Hoderately Extremely

Severe Severe Severe

7I. Not getting enough rest ...... . ..... ....... I 2 3
72. Not getting enough sleep ......... . ........ I 2 3
73. Problems with aging parents... ....... ..... I 2 3
74. Problems with your children............... I 2 3
75. Problems wlth persons younger than

yourself................. ..... ............ I 2 3
76. Problems wlth your lover.......... ..... ... I 2 3
77. Difficulties seeing or hearing............ I 2 3
78. Overloaded wlth famlly responsibilities... I 2 3
79. Too many things to do..................... I Z 3
80. Unchallenglng work........................ I 2 3
8l. Concerns about meeting high standards..... I 2 3
82. Financial dealings with friends

or acquaintances .............. . ........... I 2 . 3
83. Job dissatisfactions......................-I 2 3
84. Worries about declslons to change Jobs.... I 2 . 3
85. Trouble with reading. writing or ‘ '

spelling abIIItIes ..... ..... .............. I 2 3
86. Too many meetings. ..... .......... ....... .. I 2 3
87. Problems wlth divorce or separation....... I 2 3
88. Trouble with arithmetic skills.. ..... ..... I 2 3
89. Gossip.............. ............... ....... I 2 3
90. Legal problems...... .......... ............ I 2 3
9i. Concerns about weight..................... I 2 3
92. Not enough time to do the things

you need to do..... ...... .......... ..... .. I 2 3
93. Television................................ I 2 3
94. Not enough personal energy................ I 2 3
9S. Concerns about Inner conflicts............ I 2 3
96. Feel conflicted over what to do.. ...... ... I 2 3

97. Regrets over past decisions............... I 2 3

108

Somewhat Noderately Extremely

Severe Severe Severe

98. Menstrual (period) Problems ........ . ...... I . 2 3

99. The weather ...................... .. ....... I 2 3
I00. Nightmares..... ............ ............... I 2 3
IOI. Concerns about getting ahead.............. I 2 3
I02. Hassles from boss or supervIsor........... I 2 3
I03. Difficulties with friends................. I 2 3
I04. Not enough time for family................ I 2 3
I05. Transportation problema................... l 2 3
I06. Not enough money for transportation....... I 2 3
l07. Not enough money for entertainment A

and recreation............................ I 2 3
I08. Shopping..... ....... . ......... ............ I ' 2 3
I09. Prejudice and discrimination from others.. I 2 3
IIO. Property. investments or taxes............ I , ' '2 3
III. Not enough time fOr entertainment
and recreation .............. ......... ..... I 2 3

II2. Yard work or outside home maintenance..... I 2 3
lI3. Concerns about news events................ I 2 3
Ila. Noise..... .................... ............ I 2 3
IIS. Crime .............................. ....... I 2 3
II6. Traffic... ..................... ........... I 2 3
Il7. Pollution.... ..................... . ....... I 2 3

HAVE HE HISSEO ANY OF YOUR HASStES? IF SO‘ HRITE THEN IN BELOH:

Il8. I 2 3

ONE HORE THING: HAS THERE BEEN A CHANGE IN YOUR LIFE THAT AFFECTED HON
YOU ANSNERED THIS SCALE? IF SO. TELL US

HHAT IT HAS:

 

NON GO BACK TO PAGE ONE. AND FOR ALL THE ITEHS THAT YOU'VE UNDERLINED. THINK
ABOUT HON SEVERE the hassle has been In the past month. and give your answer by
circling a l. 2. or 3. Only circle the items you have already underlined.
Leave the others blank.

APPENDIX D

APPENDIX D

SOCIAL PROVISIONS SCALE

INTERVIEWER: PROVIDE PARTICIPANT WITH CARD #2 AND READ THE
FOLLOWING ITEMS TO HER, ASKING HER TO RATE EACH ONE. WRITE
THE APPROPRIATE NUMBER IN THE SPACE AS SHE PROVIDES IT.

Description: This next questionnaire asks about the types of
supports you have in your life. After I read an item,
please look at the rating card and decide how true each is
of you. There are no right or wrong answers and if you have
any questions, please ask.

1=Strong1y Disagree
2=Disagree
3=Agree
4=Strongly Agree
Rating
1. There are people I can depend on to help me if I
really need it.

2. I feel that I do not have any close personal
relationships with other people.

3. There is no one I can turn to for guidance in
times of stress. -

4. There are people who depend on me for help.

5. There are people who enjoy the same social
activities I do.

6. Other people do not view me as competent.

7. I feel personally responsible for the well-being
of another person.

8. I feel part of a group of people who share my
attitudes and beliefs.

9. I do not think other people respect my skills and
abilities.

10. If something went wrong, no one would come to my
assistance.

109

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.
22.
23.

24.

110

I have close relationships that provide me with a
sense of emotional security and well-being.

There is someone I could talk to about important
decisions in my life.

I have relationships where my competence and
skill are recognized.

There is no one who shares my interests and
concerns.

There is no one who really relies on me for their
well-being.

There is a trustworthy person I could turn to for
advice if I were having problems.

I feel a strong emotional bond with at least one
other person.

There is no one I can depend on for aid if I
really need it.

There is no one I feel comfortable talking about
problems with.

There are people who admire my talents and abili—
ties.

I lack a feeling of intimacy with another person.
There is no one who likes to do the things I do.
There are people I can count on in an emergency.

No one needs me to care for them anymore.

APPENDIX E

APPENDIX E

WAYS OF COPING-PARENTING

Description: The next two questionnaires ask about different
ways you may deal with difficult situations. The first one
involves parenting. First, I am going to ask you to
describe a stressful event related to your parenting and
they I will ask you a series of questions about how you
coped with this. Do you have any questions?

INTERVIEWER:

1.ASK THE WOMAN TO DESCRIBE A STRESSFUL SITUATION INVOLVING
HER EXPERIENCE OF PARENTING. WRITE THE SITUATION BELOW:

2. AFTER SHE FINISHES DESCRIBING THE SITUATION, PROVIDE HER
WITH CARD #2 AND ASK HER TO RATE HOW MUCH SHE USED EACH OF
THE TECHNIQUES DESCRIBED ON THE WAYS OF COPING
QUESTIONNAIRE-FORM 1. READ EACH ITEM TO THE WOMAN AND THEN
CIRCLE THE APPROPRIATE NUMBER ON THE QUESTIONNAIRE

3. ASK THE WOMAN IF THERE ARE ANY OTHER WAYS SHE COPES THAT
YOU HAVE NOT MENTIONED. IF SO, WRITE THEM BELOW:

111

112

WAYS OF COPING-FORM 1

INTERVIEWER:

FOR EACH OF THE FOLLOWING ITEMS, ASK THE PARTICIPANT TO RATE
HOW MUCH SHE USED EACH OF THE TECHNIQUES DESCRIBED TO DEAL
WITH THE STRESSFUL SITUATION RELATED TO PARENTING. PROVIDE
HER WITH CARD #2, READ EACH ITEM TO THE WOMAN AND THEN WRITE
THE APPROPRIATE NUMBER IN THE SPACE LOCATED NEXT TO EACH

ITEM.

8=Doesn't apply
1=Used somewhat
2=Used quite a lot
3=Used a great deal

Rating

Avoidant Scale

7.
12.

25.

31.

41.

46.

Hoped a miracle would happen.

Slept more than usual.

Tried to make myself feel better by eating,
drinking,smoking, using drugs or medication, and
so forth. -

Avoided being with people in general.

Refused to believe it had happened.

Wished that the situation would go away or
somehow be over with.

Positive Reappraisal Scale

11.

15.
18.
23.

28.

29.

Looked for the silver lining, so to speak; tried
to look on the bright side of things.

I was inspired to do something creative.
Changed or grew as a person in a good way.

I came out of the experience better than when I
went in.

Found new faith.

RediScovered what is important in life.

113

WAYS OF COPING-ABUSE

Description: The second difficult situation that I am going
to ask you to describe involves any problems or stressful
situations that you believe to be related to your past abuse
(for example, a painful memory that interferes with
something you are trying to do). Like before, I am going to
ask you to describe a stressful event related to your abuse
and then I will ask you a series of questions about how you
coped with this. Do you have any quesitons?

INTERVIEWER:

1.ASK THE WOMAN TO DESCRIBE A STRESSFUL SITUATION INVOLVING
HER PAST ABUSE. WRITE THE SITUATION BELOW:

2. AFTER SHE FINISHES DESCRIBING THE SITUATION, PROVIDE HER
WITH CARD #2 AND ASK HER TO RATE HOW MUCH SHE USED EACH OF
THE TECHNIQUES DESCRIBED ON THE WAYS OF COPING
QUESTIONNAIRE-FORM 2. READ EACH ITEM TO THE WOMAN AND THEN
CIRCLE THE APPROPRIATE NUMBER ON THE QUESTIONNAIRE

3. ASK THE WOMAN IF THERE ARE ANY OTHER WAYS SHE COPES THAT
YOU HAVE NOT MENTIONED. IF SO, WRITE THEM BELOW:

114

WAYS OF COPING-FORM 2

INTERVIEWER:
FOR EACH OF THE FOLLOWING ITEMS, ASK THE PARTICIPANT TO RATE

HOW MUCH SHE USED EACH OF THE TECHNIQUES DESCRIBED TO DEAL
WITH THE STRESSFUL SITUATION RELATED TO HER ABUSE. PROVIDE
HER WITH CARD #2, READ EACH ITEM TO THE WOMAN AND THEN WRITE
THE APPROPRIATE NUMBER IN THE SPACE LOCATED NEXT TO EACH

ITEM.

8=Doesn't apply
1=Used somewhat
2=Used quite a lot
3=Used a great deal

Rating

Avoidant Scale

7.
12.
25.

31.
41.

46.

Hoped a miracle would happen.

Slept more than usual.

Tried to make myself feel better by_eating,
drinking,smoking, using drugs or medication, and

so forth.
Avoided being with people in general;

Refused to believe it had happened.

Wished that the situation would go away or
sbmehow be over with.

Positive Reappraisal Scale

11.

 

15.

18.

.______ 23.

_______ 28.

_______ 29.

Looked for the silver lining, so to speak; tried
to look on the bright side of things.

I was inspired to do something creative.
Changed or grew as a person in a good way.

I came out of the experience better than when I
went in.

Found new faith.

Rediscovered what is important in life.

 

APPENDIX F

APPENDIX F

RESOLUTION QUESTIONNAIRE

INTERVIEWER: READ THE FOLLOWING DESCRIPTION TO THE WOMAN.
PROVIDE HER WITH CARDS #3A AND #38 AND EXPLAIN THAT THE RATING
SCALE-IS WORDED A BIT DIFFERENTLY AND YOU WILL LET HER KNOW
WHICH SCALE TO USE FOR WHICH QUESTIONS.

Description: Now we are going to ask you to think about how
your past abuse currently affects you. Please rate the
following questions in regards to how mmch each applies to
you. We'll start by using this scale (PROVIDE WITH CARD 3A).
Take your time and decide the rating that fits best and let me
know what that is.

KEY 1=not at all
2=some of the time
3=moderate amount of time
4=most of the time

PROVIDE WOMAN WITH CARD #3A
Rating

1. How often do you find yourself thinking about your
abuser?

2. How often do you find yourself trying pg; to think
about your abuser? (e.g., how often do you find
yourself trying to distract yourself from memories
or thoughts related to your abuser?)

3. How often do you find yourself thinking about your
non-abusive parent(s)?

4. How often do you find yourself trying pg; to think
about your non-abusive parent(s)? (e.g., how often
do you find yourself trying to distract yourself
from.memories or thoughts related to your parent(s)
who failed to protect you from the abuse?)

115

 

116

Please answer the following questions in the same manner. The
scale is worded slightly differently.

PROVIDE WOMAN WITH CARD #33

KEY 1=not at all
2:somewhat
3=quite a bit
4=comp1etely

5.

10.

11.

12.

To what extent do you feel you are "at peace"
with your feelings towards your non-abusive
parent(s)?

To what extent to you feel that much of your
energy is tied up in working through your
feelings related to the abuse?

To what extent do you feel your days are spent
replaying the abuse over and over in your mind?

To what extent do you feel free of the distress
and emotional constraints that the abuse has
caused you?

To what extent do you feel that your thinking
about the abuse gets in the way of your day to
day life?

To what extent have you forgiven your abuser?

To what extent have you forgiven your non-abusive
parent(s) for not protecting you from the abuse?

To what extent do you feel you are "at peace" with
your feelings toward your abuser?

APPENDIX C

APPENDIX G

CES-D

Directions: Please read each of the items below and indicate
how often you have felt this way during the last week. Use

the key below to determine your rating and then place the
appropriate number in the space next to each statement.

KEY: 1=Rarely or none of the time
2=Some or a little of the time (1-2 days a week)
3=Occasionally or a moderate amount of the time (3-4
days a week)
4=Most or all of the time (5-7 days a week)

Rating

1. I was bothered by things that ususally don't
bother me.

2. I felt that everything I did was an effort.

3. I felt I was just as good as other people.

uh

I had trouble keeping my mind on what I was
doing.

I felt sad.
I felt tearful.
I felt lonely.

I had crying spells.

\OQQOIU‘I

I talked less than usual.
10. My sleep was restless.
11. I enjoyed life.

12. I felt that I could not shake off the blues
even with the help of my family/friends.

13. I thought my life had been a failure.
14. I was happy.

15. I could not get "going".

117

 

118

KEY: 1=Rarely or none of the time
2=Some or a little of the time (1-2 days a week)
3=Occasionally or a moderate amount of the time (3-4
days a week)
4=Most or all of the time (5-7 days a week)

16. I felt hopeful about the future.
17. People were unfriendly.

18. I did not feel like eating; my appetite was
poor.

19. I felt depressed.

20. I felt that people disliked me.

APPENDIX H

APPENDIX H

PARENTING QUESTIONNAIRE

INTERVIEWER: PROVIDE PARTICIPANT WITH CARD #2 AND READ THE
FOLLOWING ITEMS TO HER, ASKING HER TO RATE EACH ONE. WRITE
THE APPROPRIATE NUMBER IN THE SPACE AS SHE PROVIDES IT.

Description: This next questionnaire asks about some of your
experiences as a parent. Just like you did on the
questionnaire I just read, after I read an item, please look
at the rating card and decide how true each is of you. There
are no right or wrong answers and if you have any questions,
please ask.

1=Strongly disagree
2=Disagree

3=Agree

4=Strongly Agree

Maternal Confidence Scale (*=recoded items)

2. I know I am doing a good job as a parent.

 

3. Being a parent turned out not to be as difficult as I
thought it would be.

 

*5. Being a parent makes me feel drained and depleted.

 

9. I have the knowledge I need to be a good parent.

*13.I should have read more books on parenting because I
often feel like I don't know what I am doing.

 

16. If I could do it over again I would raise my children
the same way I am raising them now.

 

*18. I often worry that I am letting my children down.

*20. Whenever I start feeling comfortable as a parent
something goes wrong and the doubts start all over
again.

 

*22. I worry that I am not doing the right thing as a
parent.

119

120.

*25. No matter how hard I try, I never seem to be a good
enough parent.

 

*27. I often worry that I don't know enough to be a good
parent.

 

*32. I often feel guilty about neglecting my children.

36. Juggling all the responsibilities of being a parent
is one of my talents.

 

38. Parenting means a lot of responsibilities and problems,
but I always feel that I can cope with the difficulties
that come along.

 

43. When there is a crisis with the children, I know that
I will do what needs to be done.

 

Maternal Control Scale (*=recoded items)

*46. I try to give my children direction but mostly I
let them grow by themselves.

47. I am overly protective of my children; it is better
to be safe than sorry.

48. I am a very strict parent.

 

49. I see to it that my children are only exposed to things
that I want them exposed to.

 

*50. I have learned to accept that I cannot shelter my
children from everything I do not like.

*51. I try not box my children in with too many rules.

52. I have to be on guard with my children all the time to
keep them from getting into trouble.

 

53. I work hard at shaping my children's lives rather than
just letting them grow up as they would.

 

54. When my children show their will, I make sure they know
who is boss.

 

55. When I tell my children to do something, they will do
it, no "ifs", "ands", or "buts".

 

*56. I have learned to accept that sometimes my children will
not do what I want no matter how hard I try.

 

APPENDIX I

APPENDIX I

RELATIONSHIP WITH CHILD

Directions: Please read each of the following questions and
decide to which extent each is true in regard to your
relationship with your daughter. Using the key provided,
rate each item and place the appropriate number in the space
located next to the statement.

KEY

1=Strongly Disagree

2=Disagree

3=Agree

4=Strongly Agree

Maternal Warmth Scale (*=recoded items)

1. It is fun to be with my daughter.

2. When my child is trying to reach a goal, she can depend
on me for support.

3*. In her relationship with me, my daughter often feels
like an "orphan".

4*. When she is feeling bad, it is difficult for'me to show
the interest in her feelings that is needed.

5*. My daughter and I feel like strangers to one another.

6. I feel happy when I am with my daughter.

7. When my child is feeling badly, she can count on me to
remind her of her worth.

8*. I feel tense around my daughter.

9*. My daughter and I don't seem to have very much in common
with each other.

10. I feel very warmly towards my daughter.

121

APPENDIX J

APPENDIX J

The HBO Humen's Research Project
CONSENT POR PARTICIPATION IN RESEARCH

I consent to participate in the study involving the family experiences of
woman who are survivors of childhood sexual abuse. This study is being
conducted by Linda Burke of Michigan State university. The purpose of this
study is to understand the effects of sexual abuse on women's later
experiences within their own families.

I understand that I will be interviewed to obtain my thoughts, opinions and
feelings regarding my history of abuse, my relationships with my children.
family and friends, and my general wsll-being.

I understand that my participation in this study is completely voluntary
and that my refusal to participate will involve no penalty. If I decide to
participate, I may refuse to answer certain questions or may quit at any
time without penalty. A summary of the results from this study'will be
available to me upon request when the study is completed.

Participation involves approximately 3 hours, during which time the
interviewer will ask me a series of questions involving my past abuse, my
current coping styles, personal support systems, parenting experiences and
general well-being. The study has been explained to me and I understand
the purpose and procedures.

I understand that any information I provide will be kept completely
confidential. All of my responses will be identified by code number only.
Only the principle investigators will have access to this information,
which will be kept in a locked file in the primary investigator's office.
Furthermore, any audiotaped material will be identified by code number
only. Audio tapes will be kept in a secured area until they are
transcribed, after which point they will be erased.

In order to ensure accuracy, we are asking all participants whether they
would mind having the interview portion tape-recorded. These tapes will
only be heard by the principle investigators and will be erased once your
responses have been transcribed. You do not havelto agree to be tape
recorded in order to participate in this study and, if you do agree to
recording, you may ask to stop the tape at any time during the interview
without penalty.

I agree to being audiotaped

I prefer not to be audiotaped

 

Any questions or concerns I have about the study can be addressed to Linda
Burke, M.A., Department of Psychology, Michigan State University.
(517) 882-2605.

 

 

Signature of Participant Date

 

Signature of Witness/Interviewer

122

APPENDIX K

APPENDIX K

RECRUITMENT FLYER

 

 

SURVIVORS OF SEXUAL ABUSE

The Women ’5 Research Project is looking for
women who:

0 Are survivors of sexual abuse

0 Have a daughter

To participate in a university-based research
project involving women ’s experiences of abuse
and current family relationships

Call 415-322-2049 for more information

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123

 

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