The parental experience and emotional response to sibling sexual abuse: When a parent's most valuable gift becomes a source of trauma.

BACKGROUND: Sibling sexual abuse, believed to be the most common form of sexual abuse, is a marginalized area of study. Even so, available literature largely focuses on the survivors and a gap remains in understanding the experience of the parents in these circumstances. OBJECTIVE: The study aims to examine the experience of parents who learn that sexual abuse has been perpetrated on their child(ren) by a sibling(s). PARTICIPANTS AND SETTING: The sample includes 58 participants who identify as a parent of a child who was sexually abused by a sibling, a child who sexually harmed a sibling, or both. The sample was recruited by 5WAVES, a grassroots charity that supports families experiencing sibling sexual trauma. METHODS: Participants completed a voluntary and anonymous online questionnaire which inquired on how they learned of the abuse in their family as well as how they reacted and continue to cope. The current qualitative analysis follows a reflexive thematic method and is a portion of a larger mixed-methods study. RESULTS: Four overarching themes were identified: (1) Parental trauma experience upon learning of sibling sexual trauma, (2) Initial and continual parental emotional responses to the trauma, (3) Breakdown of the ideal family and (4) Parental attempts at coping. CONCLUSIONS: These results recognize the unique trauma experienced by parents where sibling sexual abuse occurred in their family. It acknowledges the crucial need for clinicians, professionals, family and friends to support parents during this time in order that they can best support their children and family.

Sibling sexual abuse: What do we know? What do we need to know? Stage 1 analysis of a 2-stage scoping review.

BACKGROUND: Sibling sexual abuse is a common form of intra-familial sexual abuse, yet it remains under-studied and under-recognised, leaving many children unprotected and unsupported. Practitioners need rigorously conducted evidence syntheses to inform decision making in this complex practice area. OBJECTIVE: A scoping review was conducted with the broad research question: What is known about sibling sexual abuse? in order to map the research and to establish areas of knowledge and gaps requiring attention. METHOD: The review followed the guidelines of Arksey and O'Malley (2005), and through searches of 11 academic databases, 3 grey literature databases, journal handsearch and Google, identified 91 empirical papers for review. RESULTS: While poorly and inconsistently defined, sibling sexual abuse is a common form of child sexual abuse with significant consequences for the whole family. It may involve children of any age and sex, entail the full range of sexual behaviours, and can take place in families from across the socioeconomic spectrum. Disclosure is uncommon during childhood, with multiple barriers including the nature of the caregiving environment in which sibling sexual abuse often takes place. Official records are likely to under-report the frequency and duration of the abuse. CONCLUSIONS: There is considerable scope for further research across all aspects of sibling sexual abuse. This paper represents the most comprehensive (albeit not complete) overview of the current body of knowledge in this field to date, and presents key findings as well as a summary of practice and research recommendations.

Characteristics of preschool-age children who engage in problematic sexual behaviors with siblings.

BACKGROUND: Problematic sexual behavior (PSB) between siblings can be a form of sibling sexual abuse (SSA). A notable gap in research are studies examining PSB among preschool-age children with siblings. OBJECTIVE: This study examined the impact of child maltreatment, exposure to family sexuality, and use of coercive sexual behavior on preschool-aged children PSB with siblings and with nonsiblings. PARTICIPANTS AND SETTING: All 284 children were ages 3-6 years with PSB who had siblings in the home (197 initiated PSB with siblings and 87 initiated PSB with non-siblings). METHODS: The two groups were compared on types of PSB, use of coercion, child maltreatment history, exposure to family sexuality, and caregiver attitudes. Caregiver report measures were the Child Sexual Behavior Inventory- Third Edition (CSBI-III), the Family Sexuality Index, and intake form on maltreatment experienced (i.e., physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence, caregiver drug use, and failure to protect). RESULTS: Maltreatment history was significant, t(258) = -3.36, p < .001; sibling initiators were associated with higher rates of sexual and physical abuse, and neglect than non-sibling. Exposure to family sexuality was significant with non-sibling initiators demonstrating greater exposure than the sibling group, t(282) = 2.66, p = .008. There was no significance between groups for types of PSB including use of coercion. CONCLUSIONS: Results illuminated unique dynamics of PSB with siblings of preschool-aged children. A developmental framework integrating child maltreatment, impulsivity, environmental factors, and capabilities are key considerations for conceptualization, prevention, and response that is distinct from SSA of adolescents.

'We can be a family again, but different than before'. A single-case study on therapeutic interventions that initiated a recovery process in a family after the disclosure of sibling sexual behavior.

Disclosures of sibling sexual behavior (SSB) usually affect all family members but there remains, however, a paucity in studies on therapeutical family interventions and how they can initiate changes in families. This study was designed to explore relational impacts of SSB disclosures, goals for therapy and interventions that helped a family initiate the recovery process after a SSB disclosure. A single case study design was used to analyze a family's long-term therapy process. Data on this N = 1 study comprised 18 interviews with involved therapists, five interviews with involved family members, therapy files, and notes on family sessions. Data was analyzed using a thematic approach. Relational traumas were experienced in broken relationships, relationships under pressure and damaged trust between family members. Therapy goals were to (1) recreate family's safety, (2) help the family process the SSB consequences and (3) restore trust and search for relationship healing. Appropriate interventions to target the goals included individual-centered psycho trauma treatment as well as interventions for the parents, the involved siblings, and the uninvolved siblings, followed by sessions between the involved siblings and with the whole family. Therapy outcomes were found in reduced individual trauma symptoms, a recreated sense of family safety, the start of relational trauma processing, and newfound forms of sibling/family relationships. This study provides a unique and comprehensive insight into a family's healing process after SSB disclosures from the perspectives of both professionals and family members. The effective interventions identified in this study may provide tools for therapists working with these families. This study may also offer greater insights into both the abusive and mutual types of SSB.

Family characteristics, responses, and dynamics associated with sibling sexual abuse: A scoping review.

BACKGROUND: Sibling sexual abuse (SSA) is influenced by and occurs within an interconnected family system, because of this there is a growing move towards recognising SSA as a family issue. Families also play a vital role in the disclosure of SSA and in the aftermath of recovery. Nevertheless, a descriptive review consolidating the known family dynamics, characteristics, and responses associated with SSA is absent from research. OBJECTIVE: A scoping review was conducted to synthesise known family characteristics and dynamics associated with SSA. The review also sought to explore how families respond following the disclosure/discovery of SSA. METHOD: Arksey and O'Malley's (2005) five-part scoping review framework was used. Web of Science, PsycInfo, ProQuest, Google Scholar and specialist journals were searched for empirical research and results were assessed for eligibility, leaving 28 studies in the final review. RESULTS: SSA was related to: (1) family demographics, (2) a history of abuse and neglect within the family, and (3) household stressors and environmental factors. The review also found that families largely respond using strategies of minimisation. CONCLUSIONS: Research and practice need to ensure that SSA is understood within the context of family dynamics and histories, in a way that may not be necessary when understanding other 'types' of child sexual abuse (CSA). Consideration must be given to the fact that children affected by SSA can be situated in families where, as well as SSA, there is a history of abuse and neglect within the family, and various environmental stressors are present.

An empirical analysis of sibling sexual abuse: Examining offender, victim, and event characteristics in National Incident-Based Reporting System (NIBRS) data, 2018-2022.

BACKGROUND: Sibling sexual abuse (SSA) is a pervasive form of intrafamilial sexual violence. A review of existing literature underscores ongoing challenges to comprehensive understanding of this offense due to definitional inconsistencies, small sample sizes, data constraints, methodological shortcomings including reporting practices, and a dearth of empirical scrutiny. Previous studies have relied on retrospective, non-representative, clinical, or homogeneous samples. OBJECTIVE: The present work updates knowledge on SSA addressing several persistent limitations in previous studies and offering contemporary victim, offender, and incident-based profiles to promote avenues for future risk assessment, prevention, and intervention strategies. METHODS: This study, both exploratory and descriptive, draws on the five most recent years (2018-2022) of data from the National Incident-Based Reporting System (NIBRS), the largest available dataset (N = 30,640), containing SSA incidents reported to law enforcement. RESULTS: Significant sex differences were noted across age, race, victim injury, offense type, and relationship. Female victims were more likely to experience abuse from older siblings and were nearly 2.5 times more likely to be victimized as an adult than their male counterparts. Female victims were also more likely to report injury, yet less likely than male victims to experience forcible penetration during an SSA incident. CONCLUSIONS: Findings substantiate the ongoing need for continued refinement of SSA definitional criteria, which, in turn, will lead to greater identification and reporting of incidents. Moreover, findings here underscore the importance of considering age and gender dynamics to guide risk assessment, intervention, and prevention strategies.

Reviewing the Evidence on Sibling Sexual Behaviour: Impact on Research, Policy and Practice.

PURPOSE OF REVIEW: This paper reviews recent research into sibling sexual behaviour (SSB). This is an emerging professional and community issue that binds together a limited evidence base across research, practice and policy in psychology, criminology, politics, social work and policy studies. The review will demonstrate that a multi-disciplinary, life course, family system approach is the most effective way of starting to develop interventions to prevent and respond to this issue. RECENT FINDINGS: SSB has previously been researched as a form of intrafamilial abuse or sibling incest. As a result of this SSB is poorly and inconsistently defined as a concept, meaning that research, practice and policy are sometimes at odds with each other and need to pull together to develop a cohesive framing of the issue. This means that a lot of older research needs to be contextualised in new emerging frames of thinking and ways of working. Current research emphasises the importance of understanding the role of the family system in creating conditions where SSB can occur and its central role in preventing and stopping it from occurring. The research also stresses the importance of professionals understanding the family context of SSB and has the confidence to identify and work proactively with families in a multi-agency and cross-disciplinary way. The prevention of, and response to, SSB requires a multi-level, multi-disciplinary approach. Successful prevention of and response to SSB are as much about the family system as it is about the attitudes, behaviours and experiences of the siblings impacted by the abuse.

"I Never Said Anything. I Didn't Tell Anyone. What Would I Tell?" Adults' Perspectives on Disclosing Childhood Sibling Sexual Behavior and Abuse in the Orthodox Jewish Communities.

Sibling sexual harmful dynamics (SSHD) is a term used, in this study, to refer to childhood sexual behaviors that are inconsistent with age-appropriate curiosity, including sibling sexual abuse (SSA). Although SSA is a prevalent and long-lasting form of intrafamilial sexual abuse, it is the least reported, studied, and treated. This study aims to deepen the understanding of the disclosure process of this phenomenon in the Israeli Orthodox Jewish society, as perceived by those involved. Participants were adults from the Orthodox communities in Israel who experienced sexual interactions/abuse with one or more of their siblings. This qualitative constructivist-grounded theory study was based on semi-structured interviews with 24 adults from the Israeli Orthodox Jewish communities. Seven barriers to disclosure were identified and organized into three main categories: intrapersonal, including denial of the acts, guilt, and shame; interpersonal, including the sibling relationship and perceiving the sexual acts as routine; and cultural, including lack of sexual knowledge, the concept of modesty, and marriage prospects. In addition, we highlight the intersectionality between the different contexts of the SSHD. This study explored the barriers to disclosing SSHD in the siblings' context and the context of the Jewish Orthodox communities. The findings contribute to understanding the unique aspects of the disclosure, as expressed in religious and cultural contexts, the sibling context, and their intersectionality. Cultural and religious sensitivity is crucial for practitioners, especially as issues of sexuality and sexual understanding stem from the related norms and values.

Sibling Sexual Abuse: A Review of Empirical Studies in the Field.

Although sibling sexual abuse (SSA) is one of the most common forms of sexual abuse, it has been particularly neglected in previous research. Hence, characteristics of this form of abuse and its longer term implications are not well understood. The aims of the current review were to precisely characterize the phenomenon of SSA and to condense the implications known to date of SSA on survivors. We included 15 studies with a total sample size of 14,680 individuals. Our results indicate that SSA has some unequivocal features such as an early onset, an extended duration and frequency, and a particularly high intensity (i.e., involvement of coercion, force, superiority, and manipulation). Our findings also revealed that SSA is linked to later depression, anxiety, impaired self-esteem, and sexual functioning. The findings of the current review suggest that (1) SSA is common, (2) SSA has various negative effects on survivors' mental health, and that (3) SSA and its implications have been and to date are marginalized in research and practice. Results are discussed with a special focus on clinical implications.

"I don't fit into any category": Adult perspectives on the dynamics of past sexual acts between siblings in Jewish Orthodox society.

BACKGROUND: 'Harmful sexual sibling behavior' is a term used in this study to refer to childhood sexual behaviors, including abuse (SSA), that are inconsistent with the category of age-appropriate curiosity. Although SSA may be the most prevalent and longest-lasting form of intrafamilial sexual abuse, it is the least reported, studied, and treated. OBJECTIVE: This study aims to deepen our understanding of the sexual characteristics and dynamics of such behavior, as perceived by those involved. PARTICIPANTS AND SETTING: Twenty adults from the Orthodox community in Israel, who experienced sexual interactions with one or more of their siblings, were recruited as participants. METHODS: This qualitative, constructivist, grounded-theory study was based on semi-structured interviews with 20 adults. RESULTS: Four types of sexual dynamics were revealed: an "abusive dynamic," "mutual relations," "sexual routine," and "incidental," with the latter stemming from a new understanding that deepens our knowledge of the subject. The participants discussed the broad, long-term consequences and life-long psychological implications of each dynamic and the coexistence of these dynamics. The results also reveal two cultural dimensions of the participants' perception of the sexual acts: "lack of sexual knowledge" and "the perception that all religious prohibitions are of equal severity." CONCLUSIONS: The findings highlight the importance of adapting interventions to the siblings' perceptions and avoiding treatment that exacerbates their complex situation. We employ the concepts of dynamics and dimension in describing the phenomenon rather than continuum. The study also highlights the importance of understanding relevant religious-cultural factors.

'When it comes to relational trauma, you need people at the table': Therapist experiences of online therapy for families with a prior disclosure of sibling sexual abuse during Covid-19 pandemic lockdowns.

This study aims to contribute to the evaluation of online therapy during Covid-19 pandemic lockdowns, by exploring family therapists' experiences of therapy for twelve Sibling Sexual Abuse (SSA) families in the Netherlands. Seven transcripts of interviews with highly specialised Dutch family therapists were analysed using thematic analysis (TA). Two main findings emerged from this study. First, the Dutch therapists reported no acute worries about their clients' sexual safety during the pandemic lockdowns. Nonetheless, the switch to online therapy for the SSA families created concern regarding victim safety in speaking out freely at home. Second, while the sudden switch to online therapy enabled SSA therapists to stay connected with their SSA families, therapists experienced a decline in therapy quality and in their own well-being. In the therapists' experience, it was almost impossible to conduct their most fundamental interventions online, such as intervening in family relationships.

Comparison of children's advocacy center responses to harmful sexual behavior among siblings: An international perspective.

BACKGROUND: Harmful sexual behavior (HSB) is sexual behavior exhibited by children and adolescents that is developmentally inappropriate and/or harmful or abusive towards themselves or others. Victims of children with HSB are commonly siblings. Multiple professionals may be involved in cases of youth HSB involving siblings, which places Children's Advocacy Centers (CACs) in a key position to directly address intrafamilial HSB. Approximately 25% of all cases seen at CACs in the U.S. are youth-initiated HSB. However, no known research has examined how CAC professionals approach decision-making and response to intrafamilial and sibling HSB, particularly across regions and cultures. OBJECTIVES: To examine the perspectives of professionals from three separate CACs in Israel, eastern U.S., and southwestern U.S. regarding their decision-making and response process for sibling HSB. PARTICIPANTS AND SETTING: Thirty-seven multidisciplinary team members from the three CACs, including representatives from child welfare, law enforcement, family advocacy, mental health, and the court system, among others, participated in the study. METHODS: Participants completed focus groups that asked them to discuss how their system would respond to a vignette case. Dedoose was used for thematic analysis. RESULTS: Using qualitative thematic analysis, results indicate all sites perceived sibling HSB as a family crisis, and they prioritized establishing safety and providing therapeutic interventions. Differences across sites were on how to establish safety and when to use legal actions. CONCLUSIONS: The study draws attention to the influences that formal policy and community contexts have on CAC decision-making, particularly around the availability of evidence-based treatments and caregiver engagement.

Barriers to Accessing Treatment Services: Child Victims of Youths with Problematic Sexual Behavior.

Child sexual abuse (CSA) remains a significant public health problem. Although the deleterious effects on the child victims could be mitigated through evidence-based interventions, victims often fail to be identified and receive clinical assessment and therapy services, particularly when they have been victimized by another youth. Given that at least a third of CSA cases are committed by another youth, understanding the process of identifying and addressing the needs of CSA victims of youth is the focus of the present study. Factors impacting services for child victims of youths with problematic sexual behavior (PSB) were examined through qualitative interviews (N = 226) with mental health agency administrators, direct service providers, and community stakeholders from eight geographically diverse communities across the United States. Responses focused on macro and micro level barriers to the identification and service provision for child victims of PSB of youths. Implications for clinicians and policymakers are discussed, along with strategies to enhance access and provision of services to meet the needs of the child victims.

Disclosure of Sibling Sexual Abuse by Hospitalized Adolescent Girls: Three Case Reports.

Although sibling sexual abuse (SSA) may be the most common type of intrafamilial sexual abuse, it has not been widely studied. The lack of studies makes it very difficult for clinicians to create a comprehensive framework about this complex phenomenon, particularly in comparison with other forms of intrafamilial sexual abuse, such as father-daughter incest. SSA is still underrecognized and underdisclosed but it has the potential to be every bit as harmful as sexual abuse by a parent. The topic rarely finds its way into the more general psychiatry or social work literature. It is imperative to increase healthcare practitioners' awareness of this complex subject to improve their ability to listen to, detect, and manage the disclosures of SSA in adolescent populations. This paper presents vignettes of three 13-to-15-year-old adolescent girls who disclosed SSA during inpatient hospitalization in an adolescent psychiatric and medicine department. These cases illustrate the complexity of SSA, which has been associated with a wide spectrum of both mental and physical symptoms. Adolescent victims of SSA experience serious distress, with various and numerous psychiatric manifestations, including but not limited to depression and suicide attempts, addictive behaviors, post-traumatic stress symptoms, and eating disorders. Physical symptoms should also alert practitioners: adolescent survivors are more likely to be affected by somatic complications such as sexually transmitted diseases, chronic pain, urogenital symptoms, and nutritional disorders. We offer some recommendations to improve the detection and support of distressed adolescents disclosing SSA. Listening to them and offering a protective multidisciplinary response can limit the lasting damage and contribute to the repair process.

"And I Let It All Out": Survivors' Sibling Sexual Abuse Disclosures.

There is consensus in child sexual abuse (CSA) literature with respect to the central role of the disclosure process. However, CSA disclosure is challenging for all children, those who have experienced intrafamilial abuse. In recent years, there has been growing research into sibling sexual abuse (SSA), which is a prevalent and severe, but also the least studied form of intrafamilial CSA. This study was designed to advance theory on SSA disclosure by examining the narratives of adults who have disclosed the abuse and discuss it with reference to the perceived role of disclosure recipients-including perpetrating siblings, parents, and professionals. In-depth interviews with 25 adults were conducted and analyzed thematically. The results highlighted the significance of disclosure for survivors, as well as the central roles played by significant others in the process, including the offending and nonoffending siblings, parents, and professionals. The discussion addresses the important role of the family system in the disclosure narratives. The conclusions point to the need of all actors taking part in the disclosure itself, as well as in the survivors' lives postdisclosure, to become "better" disclosure recipients by acknowledging survivors' needs. This in turn would also empower survivors to disclose their stories and cope with the potential familial and societal ramifications of their disclosure.

"I Love and Hate Him in the Same Breath": Relationships of Adult Survivors of Sexual Abuse With Their Perpetrating Siblings.

The term sibling sexual abuse (SSA) captures a broad continuum of sexual behaviors in childhood and adolescence that exceed the threshold of age-appropriate curiosity. Based on a sample of 15 adult survivors of SSA, this qualitative study examines experiences of relationships with perpetrating siblings during childhood and adulthood. Thematic analysis of semistructured qualitative interviews reveals two continua that characterize SSA survivors' lives: the "reciprocity-coercion" continuum in childhood and the "distance-closeness" continuum in adulthood. Findings reveal that regardless of how the relationships were perceived in childhood, most participants chose to distance themselves from their perpetrating siblings as adults. Thus, even in cases where the relationships were considered mutual during childhood, reconceptualization of the abuse in adulthood led to renewed understanding of its meanings and implications for the survivors' personal lives. Research findings underscore the need to further study the experiences of SSA survivors to better inform policy makers, therapists, and welfare workers, to address the complex and multifaceted nature of SSA, and to provide adequate interventions to survivors and other family members.

Child Advocacy Center intervention with sibling sexual abuse cases: Cross-cultural comparison of professionals' perspectives and experiences.

BACKGROUND: Despite being a complex phenomenon with potentially significant short- and long-term consequences for all involved including siblings, parents and the family as a whole, sibling sexual abuse (SSA) has not received sufficient empirical and clinical attention. Practitioners are often left to cope without appropriate guidance. OBJECTIVE: This study aimed to compare staff perspectives and experiences of working with sibling sexual abuse cases across two Child Advocacy Centers (CACs) within different countries and different cultural and legal contexts. PARTICIPANTS AND SETTING: Participants were staff members from two Child Advocacy Centers: one in Jerusalem, Israel, and the other in Montgomery County, Pennsylvania, United States of America. METHODS: This qualitative cross-cultural comparative study analyzes staff experiences of sibling sexual abuse cases based upon 14 focus groups, in Jerusalem (N = 7) and Montgomery County (N = 7). RESULTS: Findings reveal that both CACs focused on parents, the parents' negative emotional responses to SSA, and the impossible nature of their predicament. The Montgomery County CAC tended to emphasize the needs of the victim while being attuned to the legal proceedings, whereas the Jerusalem CAC emphasized supportive therapeutic responses for the whole family. CONCLUSIONS: The differences across the two Child Advocacy Centers are related to the different legal and cultural contexts of the two CACs and underscore the need to review what may be the most appropriate policy and practice response to SSA that does not itself cause further harm.

"Victim, Perpetrator, or Just My Brother?" Sibling Sexual Abuse in Large Families: A Child Advocacy Center Study.

Sibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit the category of age-appropriate curiosity. Although SSA may be the most prevalent and longest lasting form of intrafamilial sexual abuse-as well as the one with the worst repercussions-it is also the least reported, studied, and treated. Based on 100 mostly religious Jewish families referred to a child advocacy center (CAC) in Jerusalem from 2010 to 2015, this qualitative study examines SSA characteristics, dynamics, and perceptions of deviancy in multisibling subsystems. The findings are based on an analysis of case summaries, demographic charts, and documented conversations between social workers and siblings. Qualitative document analysis reveals two types of SSA dynamics: "identified perpetrator" and "routine relationship," the latter being a particularly understudied dynamic that challenges common stereotypes. We also found sibling perceptions of deviancy to vary along a continuum from deviant to completely normative. These perceptions are affected by the type of dynamics as well as by factors associated with disclosure. Our findings highlight the importance of studying the lived experiences of children involved in SSA as an input with critical policy, treatment, and research implications. Interventions must be adjusted to the family system and sibling subsystem's perceptions and needs to avoid treatment that exacerbates the crisis already experienced by the family. Common assumptions-there must be a "perpetrator"; abuse is necessarily traumatic; and treatment should focus on the trauma-are challenged by the routine type. We conclude that treatment should account for the complexity of SSA by shedding these assumptions and considering the sibling subsystem as an autonomous unit within the large family.

Exemption committees as an alternative to legal procedure in cases of sibling sexual abuse: The approaches of Israeli CAC professionals.

BACKGROUND: Sibling sexual abuse (SSA) is a widespread form of intrafamilial child sexual abuse frequently regarded as play or normal sexual behavior, and therefore highly underreported. Israeli law allows Child Protection Officers (CPOs) to suspend police intervention after the disclosure of SSA, and refer the family to therapy, by applying to an "exemption committee." OBJECTIVE: This study will examine the characteristics of cases referred to the exemption committee or legal procedure and the justifications provided by CPOs to support the decisions. PARTICIPANTS AND SETTING: The study was based on 40 family cases referred to the Child Advocacy Center in Jerusalem: twenty cases were referred to an exemption committee and the rest to legal procedure. METHOD: Qualitative document analysis conducted on the two groups of cases (N = 40). Files were then analyzed using the thematic analysis approach. RESULTS: During the decision-making process, CPOs assess each of the cases in a broad and holistic manner, basing their decisions on various contextual factors, including the characteristics of the survivor, the perpetrator, the parents and other siblings, and the types of sexual acts involved. CONCLUSIONS: This comprehensive approach to understanding and handling the complex family story and nature of SSA underscores the need to address SSA and subsequent interventions - legal or therapeutic - not exclusively in terms of quantifiable criteria, but also in terms of a crisis involving the relationships in the entire family, past and future course of treatment, and the perceptions of family members involved.

Therapeutic interventions with child survivors of sibling sexual abuse: The professionals' perspective.

BACKGROUND: Sibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit age-appropriate curiosity. SSA may be the most prevalent, longest lasting form of intrafamilial sexual abuse - and the least reported, studied and treated. OBJECTIVE: This exploratory qualitative study examined the experience of intervention with SSA survivors from the perspective of mental health professionals, and explored their major therapeutic challenges. PARTICIPANTS AND SETTING: The sample consisted of 20 Jewish Israeli mental health professionals working in private clinics or public social welfare services who had experience with SSA. METHODS: Semi-structured interviews focusing on the characteristics of SSA events, perceptions about the effects of abuse, intervention priorities and therapeutic challenges compared to other types of child abuse. RESULTS: Professionals working with SSA survivors are preoccupied with the need to provide them with physical and emotional protection, as well as to help them process the abuse narrative. They also find themselves dealing with survivors who do not experience themselves as victims despite external evidence of abuse, or with the need to reconcile their perception of the sexual relationship as mutual, as opposed to the formal requirement to differentiate between "offender" and "victim". In either case, the reality of these survivors can be just as painful as in other SSA cases. CONCLUSIONS: The complexity of SSA calls for unique intervention skills, including working with survivor narratives that do not fit the victim/offender dichotomy on one hand and that do not minimize the potentially harsh consequences of SSA on the other.