A Clinician’s Guide to the Understanding and Therapeutic Treatment of Incest

Healing the Incest Wound, originally published in 1988, was a landmark achievement in the modern era of trauma psychiatry and psychology. Christine Courtois, PhD is one of the pioneers who helped rediscover the long-neglected effects of pandemic childhood sexual abuse and to introduce treatment models that could help incest victims reclaim their lives. The original book became a classic, providing guidance and support to countless clinicians during a time when there was a profound dearth of information on the subject of incest. Now, more than 20 years later, Courtois has succeeding in integrating the explosion of knowledge and expertise developed over the intervening years into a comprehensive and authoritative second edition. In the original edition, she relied largely on her own experience and expertise along with the relatively few published papers concerning sexual abuse and posttraumatic responses. In this current edition, she has supported her observations with the empirical evidence and clinical wisdom of hundreds of publications. Courtois has heightened the complexity of her thinking with the expertise of other professionals in the trauma field – many of whom based their efforts on her earlier work.

As in the original edition, Healing the Incest Wound is divided into three sections. Section I provides a meticulous review of the characteristics, categories, epidemiology and dynamics of incest. Section II describes the many and varied aftereffects of incest. Perhaps most helpful to practitioners is Section III that comprehensively details the treatment process: the philosophy, goals, sequencing, diagnostic considerations and psychotherapeutic processes, as well as specifics concerning treatment modalities and special populations. This second edition is nearly twice length of the original. Quality should not be judged by quantity, but the additions and elaborations in this edition provide information that is timely, relevant and useful.

It is testament to the quality of the original edition of Healing the Incest Wound that Courtois’ observations and understanding of the nature, effects and treatment of sexual abuse have held up extremely well. For example, in the 1988 original edition, based on nascent research and anecdotal experiences in the trauma field, Courtois speculated about the association of sexual abuse with deficits in physiologic, developmental and psychological functioning. In this new edition, there is a wealth of data and findings that support these negative effects of sexual about in virtually all domains of human functioning. The new edition also helps to integrate many diverse approaches to treatment that have been developed in the past decades including feminist, traumatic stress, developmental/attachment, relational, and loss/bereavement perspectives, which can be of enormous assistance to clinicians in using effective and eclectic approaches in their treatment of sexual abuse survivors.

In the current edition of Healing the Incest Wound, Courtois describes the stage-oriented treatment model for complex PTSD. Developed in the 1990s, this model of treatment proposed that effective treatment for severely and chronically abused individuals requites an early stage of safety and stabilization along with building functional and relational skills prior to active work on the traumatic events themselves. Courtois offers a clear and concise description for stage-oriented treatment for complex PTSD, a model which has become the standard of care for severely traumatized patients. Throughout the remainder of the book, she further elaborates on the issues that will allow clinicians to learn about how to provide skillful, effective and helpful care to some of their most challenging patients. Consistent with developments in the trauma field, the current edition offers a new focus on both the intricacies of working with patients who have sustained immense relational damage and the effects on the clinicians who treat them. Courtois pays particular attention to how the dynamics of the original abuse become reenacted in the transference-countertransference relationships in the therapy.

Although this book is a truly academic work and a source book for both historical and current information in the trauma field, its primary value is for practicing clinicians. For example, there are nuanced discussions of the assessment process concerning how to interview and how to detect hidden presentations of sexual abuse. There are also detailed discussions of new newer treatment modalities including various cognitive-behavioral techniques, EMDR, expressive therapies, and more recent proposed treatments such as sensorimotor, somatosensory and energy techniques. As an added benefit, Treating the Incest Wound concludes with comprehensive appendices that provide a rich resource for both professionals and survivors of sexual abuse.

I have been an unapologetic admirer of Courtois over many years as a colleague, a collaborator in teaching workshops, and a reader of her published works. She is one of those gifted professionals who can combine the kind of meticulous academicity, clinical wisdom, warmth and compassion that is so evident in Healing the Incest Wound.