Healing the incest wound: a treatment update with attention to recovered-memory issues

This article provides an updated treatment model for adults who report having experienced incestuous abuse in childhood. It integrates psychodynamic, traumatic stress, developmental and feminist formulations, accords greater emphasis to object relations and self-psychology perspectives, includes more attention to dissociative reactions, and utilizes more cognitive-behavioral interventions. It is also responsive to issues raised in the recovered/false memory controversy. This holistic model is sequenced, paced, and titrated according to the patient's characterological structure, ego strength, and needs as well as the range and severity of presenting problems and life difficulties. Special consideration is given to issues pertaining to memory and the maintenance of a neutral stance by the therapist, especially in the case of recovered rather than continuous memories and/or suspicions rather than actual knowledge of abuse. Contemporary perspectives regarding some of the unique transference, countertransference, and vicarious traumatization issues with this population and their potential impact on treatment are also discussed.