When one thinks of family composition and the unity between family members, it is automatically assumed that a family’s intimacy is comprised of genuine and wholesome love. However, in some families that is not the case. Some family members experience a completely different and most often, unwelcomed and inappropriate type of closeness called incest. Incest is basically described as closely related members within the same family line who are engaging in sexual behaviors. Caruso (1987) defines incest as:
• Sexual contact or interaction between family members who are not marital partners;
• Oral-genital contact, genital or anal penetration, genital touching of the victim by the perpetrator, any other touching of private body parts, sexual kissing and hugging;
• Sexually staring at the victim by the perpetrator, accidental or disguised touching of the victim's body by the perpetrator, verbal invitations to engage in sexual activity, verbal ridiculing of body parts, pornographic photography, reading of sexually explicit material to children, and exposure to inappropriate sexual activity (as cited in Incest, 2008, para. 4).
This type of abuse is considered more complex and disturbing in nature; however, it is increasing and becoming more apparent in families who experience domestic/physical violence or sexual abuse within the family unit. Most often these families are considered to be broken and dysfunctional which results in a higher risk of abuse which then leads to the developing of severe issues and problem areas within the family. “Individuals in families that physically and sexually abuse tend to have low self-esteem, high impulsivity, low frustration tolerance, and inability to identify or meet needs, a lace of problem-solving skills, affective and expressive problems, communication deficits, feelings of helplessness and futility, frequent and unresolved losses, and isolation (Haskins, 2003, p. 341). Haskins also notes that abusive and incestuous families have an increased level of stress in their personal, social, and economic lives leading to unfulfilling relationships that often include emotional, verbal, and physical abuse (p. 341). Unfortunately for all family members involved, incest does not discriminate and includes both males and females and according to Ramsey (1994, para. 1), “There are several different types of sexual contact that are labeled as incest: father-daughter, stepfather-daughter, father-son, stepfather-son, mother-son, stepmother-son, mother-daughter, and stepmother-daughter.” At times incest can go unrecognized due to the victim not willing to disclose information for reasons of fear, humiliation, consequences, or fear not being believed. It also goes silenced as more often than not the perpetrator is a “person in a position of trust and authority for the victim” (Incest, 2008, para. 9). If this person of trust is excluded from the family the victim’s feelings of guilt and ambivalence increased, in particular, if it is noted in court and testimony from the victim is needed (Mohl, 2010, p. 168). Mohl (2010) stated that many of the victims had experienced a close relationship with the perpetrator and wanted to reunite. Phillips-Green, Caffaro & Conn-Caffaro state that sibling sexual assault has historically been underreported and undisclosed because potentially the young person abused worries about themselves in the family, the sibling or young relative who has abused them and the broader family response. They suggest the young person who has been abused may fear being disbelieved, be concerned about the consequences or punishment for the offender, fear being separated from the family or sibling, and/or they may experience confusion as to their own 'participation' (as cited in McNevin, 2008, p.61). Unfortunately for those individuals who continue to silence the abuse, it can go untreated, hence, can lead to lifelong obstacles resulting in an unproductive and oppressed life. “Effective treatment approaches should be developed to deal with the all-encompassing aspects of these aftereffects” (Ray, 2001). It has also been noted that individuals who experience incest will suffer severe ramifications, hence, resulting in trauma, fear, depression, isolation etc. Courtois stated that some of the aftereffects can include: inability to trust (which effects the therapeutic relationship), fear of intimacy, depression, suicidal ideation and other self-destructive behaviors, and low self-esteem, guilt, anger, isolation and alienation from others, drug and alcohol dependency, and eating disorders (as cited in McClendon, 1991, para. 9). Historically, it has been assumed that the most common form of incest is between father-daughter; however, research shows that a more common type is that of sibling incest. Most family system investigations of child abuse trauma continue to focus on father-daughter incest, despite recognition that sibling incest and assault occur more frequently (Caffaro, & Conn-Caffaro, 1998, p.11). Sibling incest most often occurs due to the bonds that are shared with one another throughout the years and according to Haskins often outlasting ties with their parents by several years (p. 337). ‘Siblings share more of their lives genetically and contextually than anyone else” (Haskins, 2003, p. 338). At times this closeness can result in a sort of inquisitiveness between siblings resulting in an incestuous relationship. “This unique relationship that siblings share is sometimes the reason why incidences of sibling incest are regarded as sexual curiosity” (Thompson, 2009, p. 531). When incest occurs between siblings it can appear in several forms including sexual intercourse; however, can occur in other forms. It can be demonstrated through inappropriate advances, forceful viewing of sexually explicit materials including films, magazines, or sex toys, or through making suggestive comments with the intent of initiating sexual arousal. This type of inappropriate behavior can make just as great an impact as the act of sexual intercourse. Whelan (2003) state that it has been shown that unwanted sexual advances, sexual leers, and forcing a sibling to view pornographic material can have as much of a psychological impact on the victim as actual intercourse (as cited in Morrill-Richards, & Kiselica, p. 150). Incestuous occurrences between siblings are often kept silent by immediate familial members because they do not want to report one of their own family members due to loyalty or may often see the behavior as normal. Caffaro & Conn-Caffaro (1998, p. 104) “suggest reasons why families, as well as clinicians, researchers and the culture at large, have all tended to ignore sibling abuse. These include the fact that parents often turn a blind eye to sibling abuse for a variety of reasons related to their individual histories; that even if parents see that abuse is occurring, they are not likely to turn to outsiders for help, perhaps because of shame; and that child protective services and the legal profession tend not to take sibling abuse seriously, in part because of their view that siblings normally fight and harass one another.” Incestuous relationships between siblings can be seen as normal or natural behavior and according to Rowntree (2007, p. 351) women experienced attitudes and responses that reflected the view that they were ‘‘in it together’’ with their brothers. (Bass, Taylor, Knudson-Martin, & Huenergardt, 2006) completed a study on the Hernandez family who viewed the abuse as normal. The family included Ms. Hernandez and her seven children with only three participating in the study including the fifteen year old male alleged perpetrator, twelve year old male victim, and ten year old male victim. Each family member was provided with individual therapy sessions for three months and it was concluded that “(a) family relationships were perceived as distant; (b) secrecy was used to maintain abuse and/or promote personal gain, and (c) outside systems were viewed as intrusive” (Bass, Taylor, Knudson-Martin, C & Huenergardt, 2006, p. 95). In this case, the abuse was seen as being “inevitable” and “not a big deal” due to the family environment that consistently included violence and aggression (Bass et al., 2006).
“Although estimates of the incidence of reported child sexual maltreatment vary greatly, most authors agree there is a predominance of female to male victims (Farber, Showers, Johnson, Joseph, & Oshins, 1984, p. 294). Since males are seen as more aggressive and have a greater ability than females to defend themselves, they often see themselves as being feeble and find it more difficult to disclose information about the incestuous relationship (Farber, et al. p. 294). Struve, 1990 states that men are expected to protect themselves from violations and, consequently, society in general does not require the victimization of males. Despite the fact that males are more hesitant to come forward it eventually surfaces and it has been noted that many of the aftereffects of incest are similar in males in females including feelings of shame, fear, depression, low self esteem, anger, etc.. However, according to Ray (2001, p. 50) males tend to suffer a higher level of sociological factors. In a study conducted on twenty five males who experienced incest or other forms of sexual abuse, it was determined by responses of The Incest Questionnaire that the long-term effects in the areas of social, psychological/emotional, physical, sexual, familial, sense of self, relation to men, relation to women were all negative (Ray, 2001). Ray (2001) also states that unless these issues are addressed and remedied in therapy, male survivors of incest will continue to have problems in their relationships.
For females, research concludes that females are at a higher risk of being sexually abused than males. According to Kristensen & Lau (2007), symptoms in the abused women manifest themselves both on an internal psychological level, and as relationship disturbances (p. 115).
Females are less inclined to defend themselves against males who are seen as authority figures and are considered more aggressive; therefore, are noted to be at an increased risk of being targeted for incest. Often times, females will keep the abuse silent due to fear and shame which can often become very damaging for the victim. Ramsey (1994) states that females feel that they have to remain silent about what happened and worse, will often feel that she was to blame for what happened to her (para. 10). Females tend to experience long term effects in the areas of self esteem, trust issues, in particular, with men, anger directed more towards male figures, depression, difficulties with intimate relationships, etc. According to Landis and Wyre (1984) the issues for females are similar including fear of intimate relationships with men, and distrust and anger towards men (p.115). These feelings of repressed memories, working through painful emotions, and understanding the deep-seated underlying conflicts should be addressed and once this has occurred, it is believed that the client will then undergo healing and change (Atwood, J., 2007, p. 308).
There are several types of therapies that can effectively help victims who have experienced incest. Individual therapy is one form of treatment that is beneficial due to the variation of feelings and problem areas from one family member to another. Although the focus is on the family, typically the counselor will supplement family sessions with individual sessions (Kiselica & Morrill-Richards, 2007, p. 155). According to Kiselica & Morrill-Richards (2007), Counselors can help the abused sibling to
• Feel that his or her sense of victimization is valid
• Remove self-blame for the abuse
• Modify behaviors that might annoy or instigate the abusive sibling
• Learn assertiveness strategies for responding to taunting and threats
• Seek positive friendships outside of the family as an additional source of support
• Identify and change patterns of self-abuse and self degradation (p. 156). Once these feelings have been addressed, the victim can then engage in another form of treatment known as group therapy. Group therapy is a type of treatment that can work with different types of issues and populations to effectively target aftereffects of incest. When engaging in group therapy members can share their stories with one another addressing effects of interpersonal oppression and can identify similarities in their experiences making it less difficult to disclose information. “Clinical lore suggests that the group setting can help mitigate many of the interpersonal symptoms incest survivors exhibit” (Marotta & Asner, 1999, p. 315). Marotta & Asner (1999) also state that the social setting of a group serves as a “therapeutic laboratory” wherein incest survivors can create new meaning, applying and testing out the insights gained from individual counseling. (p. 315). Groups can also look further into the dynamics within the family and investigate the personal and social personalities and characteristics of the foundation of the family unit and determine issues that might be influencing their present behaviors (Marotta & Asner, 1999, p. 315). In certain cases, daughters will blame their mothers and feel like they did not protect them against the abuse often resulting in poor mother-daughter relationships and communication. When groups interact it helps in providing an atmosphere that is sympathetic and supportive so that members can discover underlying areas that cause them harm and stress in their personal lives due to the abuse and ultimately remediate those areas of concern.
Family therapy is another effective treatment method that can be beneficial for victims of abuse. Sexual abuse within the family unit can cause devastating impacts on the family as a whole. When this occurs, “it leads to divided loyalties, relational damage and ruptures in the fabric of family functioning (Thorton, Stevens, Grant, Indermaur, Chamarette, & Halse, 2008, p. 363). Most often sexual abuse within the family occurs when the family is incomplete and already has a foundation of being characterized as dysfunctional. Thorton, et al. (2008) state that disorganized family structures and absent parents have been repeatedly found in families of adolescents who have engaged in sexually inappropriate behavior (p. 363). Coming into family therapy there are a vast amount of unresolved issues which have not been communicated with one another due to the shame, anger, and fear that each family has kept silent. In family therapy each family member has the ability to disclose feelings that have been concealed often causing them to become oppressed. When engaging in family therapy members are able to share their prevalent feelings of resentment, fear, and humiliation with one another and according to Thorton et al. (2008) often struggle to understand and make sense of the offence and expressed concern about the quality of their relationship with the offender (p. 368). Often times, prior family issues that may have contributed to sexual abuse will be resurfaced making it more difficult to move forward. Parents whose children were directly involved in the sexual abuse (brother-sister); struggle with trust issues. In group therapy, mothers share these experiences and discuss ways how they can communicate openly with their daughters and ultimately accept their daughter’s feelings towards them as being seen as s mother who did not protect them from harm (Landis & Wyre, 1984). They need to talk about the inappropriate behaviour, to understand the reasons for the offence, and to establish the capacity to trust their offending child again (Thorton et al., 2008, p. 369). In group therapy, although difficult, family members can dissect and discuss problematic areas and be provided with guidance on how to prevent this type of abuse from resurfacing. Thorton, et al. (2008) states that majority of parents found it difficult to talk with their adolescents about what had happened. They also found it difficult to find the right words to use (p. 369). After disclosure families are often able to cope and understand more effectively and according to Thorton, et al. parents often expressed a greater awareness and understanding of how their role as a patent had influenced family functioning, both positively and negatively, in the past (2008, p.369). After family therapy, families often experience significant progress in that more positive attitudes, a sense of normalcy within the home, and developing trust are occurring within each family member often leading to a more positive way of looking at family life.
Spiritual therapy is an additional type of treatment that can benefit victims of sexual abuse. According to Beveridge & Cheung (2004), often times when distressing experiences occur it can lead to a loss or questioning of faith or spiritual values not necessarily associated with a church or religious institution (p. 111). Many times, survivors according to Curtois & Russell (1986, 1988), struggle with ambivalent and hostile feelings toward God, religion, and spirituality (as cited in Beveridge & Cheung, 2004, p. 111). According to Beveridge & Cheung (2004) spiritual healing is individualized to meet the needs of the victim and will turn to spirituality in an attempt to replace what was taken from them (p. 111). In this type of treatment, according to Beveridge & Cheung (2004) there are three phases that working towards a spiritual framework comprise of including Safety and Alliance Building where the focus is on the therapeutic relationship where the therapist uses client-centered and cognitive restructuring techniques to begin the discussion of personal safety. The second phase deals with Self-Awareness and Resolution where the focus is to find strengths, to own a positive self-image, to develop healthy communication skills, to address the perpetrator’s wrongdoing, and to integrate self into the environment. The final phase is the Self-Development and Reconnection phase where the client is encouraged to integrate her positive views by focusing on daily healing and reconnection with a supportive environment (111, 112). “It is critical that incest survivors go through their unique integrative experiences. For many this process includes work toward a sound spiritual foundation, in which distortions in their beliefs can permeate every facet of the treatment process” (Beveridge & Cheung, 2004, p. 116).
In conclusion, the probability of incest victims who may experience long lasting and negative effects in their lives is extremely high and the recovery process will most often be gradual. “Whether an incest victim endured an isolated incident of abuse or ongoing assaults over an extended period of time, the process of recovery can be exceptionally painful and difficult” (Incest, 2008, para. 16). The most common problematic areas include: anger, fear, shame, depression, difficult relationships, and trust issues. Whether the aftereffects of the abuse are minimal or severe, it is most beneficial for these victims to seek professional help to remedy the adverse effects of the abuse. If issues go untreated, it will most likely lead to an oppressed life which can often lead to an overall negative and nonproductive life. For incest victims there is hope for discovering peace and positively rebuild their lives through the help of therapy and willingness to accept the help. A gradual process it will be; however, certainly worth the wait.

References
Bass, L., Taylor, B., Knudson-Martin, C., & Huenergardt, D. (2006). Making sense of abuse: 28(1), 87-109. doi:10.1007/s10591-006-9697-0
Beveridge, K., & Cheung, M. (2004). A spiritual framework in incest survivors treatment. Journal of Child Sexual Abuse, 13(2), 105-120. doi:10.1300/J070v13n02_06
Caffaro, J., & Conn-Caffaro, A. (1998). Sibling Abuse Trauma: Assessment and Intervention Strategies for Children, Families, and Adults. The Haworth Press, Inc. Binghamton, NY. Retrieved from http://www.amazon.com/Sibling-Abuse-Trauma-Assessment-Intervention/dp/0789004917#reader_0789004917
Chamarette , C., Grant, J., Halse, A., Indermaur, D., Stevens, G. & Thorton, J. (2008). Intrafamilial Adolescent Sex Offenders: Family Functioning and Treatment. Journal of Family Studies, 14, 362-375.
Glover, N. M., Janikowski, T. P., & Benshoff, J. J. (1995). The incidence of incest histories among clients receiving substance abuse treatment. Journal of Counseling & Development, 73(4), 475-480. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
Grossman, F. K. (2004). Sibling abuse trauma: Assessment and intervention strategies for children, families, and adults. Journal of Trauma Practice, 3(2), 104-107. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
Haskins, C. (2003). Treating sibling incest using a family systems approach. Journal of Mental Health Counseling, 25(4), 337. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
Incest. (2008). The National Center for Victims of Crime. Retrieved from http://www.ncvc.org/ncvc/main.aspx?dbName=DocumentViewer&DocumentID=32360#3
Kingston, D. A., Firestone, P., Wexler, A., & Bradford, J. M. (2008). Factors associated with recidivism among intrafamilial child molesters. Journal of Sexual Aggression, 14(1), 3-18. doi:10.1080/13552600802074924
Kiselica, M. S., & Morrill-Richards, M. (2007). Sibling maltreatment: The forgotten abuse. Journal of Counseling & Development, 85(2), 148-160. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
Kristensen, E., & Lau, M. (2007). Women with a history of childhood sexual abuse. long-term social and psychiatric aspects. Nordic Journal of Psychiatry, 61(2), 115-120. doi:10.1080/08039480701226096
Landis, L. & Wyre, C. (1984). Group Treatment for Mothers of Incest Victims: A Step by Step Approach. Journal of Counseling and Development, Vol. 63, 115-116.
Lau, M., & Kristensen, E. (2007). Outcome of systemic and analytic group psychotherapy for adult women with history of intrafamilial childhood sexual abuse: A randomized controlled study. Acta Psychiatrica Scandinavica, 116(2), 96-104. doi:10.1111/j.1600-0447.2006.00977.x
Lorentzen, E., Nilsen, H., & Traeen, B. (2008). Will it never end? the narratives of incest victims on the termination of sexual abuse. Journal of Sex Research, 45(2), 164-174. doi:10.1080/00224490801987473
Marotta, S. A., & Asner, K. K. (1999). Group psychotherapy for women with a history of incest: The research base. Journal of Counseling & Development, 77(3), 315. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
McClendon, P. (1991). Incest/Sexual Abuse of Children. Retrieved from http://www.clinicalsocialwork.com/incest.html
McNevin, E. (2010). Applied restorative justice as a complement to systemic family therapy: Theory and practice implications for families experiencing intra-familial adolescent sibling incest. Australian & New Zealand Journal of Family Therapy, 31(1), 60-72. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
MOHL, A. (2010). Sexual abuse of the child: A treatment model for the incestuous family. Journal of Psychohistory, 38(2), 168-181. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
Ramsey, P. (1994). Psychological Effects of Incest on Girls Focusing on Sibling Incest. Retrieved from http://www.pamramsey.com/incest.htm
Ray, S. L. (2001). Male survivors' perspectives of Incest/Sexual abuse. Perspectives in Psychiatric Care, 37(2), 49. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=
Rowntree, M. (2007). Responses to sibling sexual abuse: Are they as harmful as the abuse? Australian Social Work, 60(3), 347-361. doi:10.1080/03124070701519645
Thompson, K. (2009). Sibling incest: A model for group practice with adult female victims of Brother–Sister incest. Journal of Family Violence, 24(7), 531-537. doi:10.1007/s10896-009-9251-6
THORNTON, J. A., STEVENS, G., GRANT, J., INDERMAUR, D., CHAMARETTE, C., & HALSE, A. (2008). Intrafamilial adolescent sex offenders: Family functioning and treatment. Journal of Family Studies, 14(2), 362-375. Retrieved from http://pathfinder.utb.edu:2048/login?auth=utblib&url=