The Association Between Child Maltreatment and Self-Esteem

Bonnie Bhatti, David Derezotes, Seung-Ock Kim, and Harry Specht

The problem of child maltreatment is currently receiving a great deal of public attention, accompanied by a vast array of programs to prevent child abuse and to punish and treat child abusers. Many of these efforts are directed at changing in one way or another the self-esteem of abusers and high-risk parents. A popular TV spot developed by the National Committee on Child Abuse, for example, is directed at lowering the self-esteem of people who abuse their children; the intent is to prevent abuse by making parents feel that abusive behavior is insensitive and reprehensible. In contrast, psychotherapeutic intervention often attempts to increase the self-esteem of abusive parents.

People use the term child abuse to mean many things, ranging from mild physical restraint to emotional rejection to sexual assault. Similarly, the term self-esteem can mean the sense we have of ourselves (regardless of how others see us) or the sense of how we believe others regard us (despite our own inner sense of worthiness). The association between child abuse and self-esteem is exceedingly complex. In this chapter, we will describe the knowledge available in social science literature about the relationship between these two phenomena. We will also attempt to clarify some of the terminology used in debates on these issues, as we focus on the following questions:

1. What is the current scope of the problem of child abuse?

2. How is child abuse defined and measured?

3. How is self-esteem defined and measured?

4. What factors appear to be associated with child abuse, and, specifically, to what extent is one's degree of self-esteem associated with child abuse?

5. In what ways does society attempt to treat (that is, to change the behavior of) child abusers?

6. What evidence is available to assess the effectiveness and efficiency of these treatments?

The Scope of the Problem

Recent statistics on child maltreatment^[*] indicate a continuing rise in the number of reported cases. One national study revealed almost 2 million reported cases of child abuse in 1985 (American Humane Association 1987). This figure represents 30.6 abused children per 1,000 children in the United States. Of the cases reported in the study, 43 percent were substantiated. The authors of this national study caution against inferring that the remaining 57 percent of the reported cases were false allegations; rather, there simply was insufficient evidence at the time of the report to substantiate the allegation.

The American Humane Association (AHA) also conducted a study of abuse cases in Florida, Illinois, New York, and Texas. Of a total of 225,360 abused children in the four states, 21.7 percent were physically abused, 11.7 percent were sexually abused, 55.7 percent were physically and/or emotionally neglected, 8.5 percent were emotionally abused, and 10.2 percent experienced other forms of abuse such as abandonment (AHA 1987). As in other studies, these various forms of abuse overlap one another, resulting in multiple counting of cases. (For example, a particular child may suffer from all forms of abuse and therefore be counted more than once.)

The AHA reports that the numbers in its nationwide study represent an increase of 11.6 percent from 1984 to 1985, and an increase of 100 percent since 1976. These findings are consistent with many other studies showing an increase in the reported incidence of child maltreatment. There is much debate among child abuse experts over what ac-

[*] * The term child maltreatment will be used interchangeably with the term child abuse in this discussion; the former term is currently used by experts to describe the many forms of abuse that children can suffer, including physical abuse, sexual abuse, neglect, and psychological maltreatment.

counts for this increase. In a review of the literature, four perspectives emerge that offer plausible explanations.

The first view argues that there has been a weakening of the taboo against the exploitation of children, particularly the taboo against sexual abuse (Russell 1986; Sgroi 1982; Butler 1978; Rush 1980). This view was introduced by feminist writers and is now a predominant theme in theories of sexual abuse. Feminist theorists hold that public acceptance of child pornography has resulted in the sexualization of children. Groups such as the René Gunyon Society are emerging, with slogans such as "Sex by age eight, or else it's too late." Russell (1986) and others believe that this attitude originated, in part, in the sexual revolution of the 1960s, which promoted a nondiscriminating, "anything goes" attitude toward sexual activities. This perspective suggests that increases in child maltreatment are largely the result of changes in cultural values and beliefs.

A second perspective holds that increased economic pressures result in increased social problems, one of which is child abuse. This perspective not only is supported by feminists but also is popular with other abuse experts such as Gil (1978), Garbarino and Gilliam (1980), Kempe and Kempe (1984), and Justice and Justice (1979). Some experts believe that external pressures such as dissatisfaction in the workplace or lack of financial resources serve as catalysts for many forms of violence in the family (Dietz and Craft 1980; Kempe and Kempe 1984). This argument suggests that child maltreatment is essentially an economic and political problem.

Proponents of a third view link the increase in child abuse to the struggle of women to gain equal rights. Men, they argue, have traditionally been raised to expect deference and admiration from women and to feel a sense of power over them. When men fear losing this power and admiration and feel intimidated by women, they may reach out to or abuse children to satisfy their needs for power and control. A related phenomenon involves the profound changes in the makeup of modern families, particularly the increasing number of stepfamilies, adoptive families, single-parent families, and families in which both parents are working. Some argue that in such families adults often do not experience the bonding that usually occurs between infant and parent, making children in these families more vulnerable to abuse. This perspective suggests that child maltreatment is fundamentally a problem of social structure.

A fourth perspective holds that there has actually been no significant

increase in child abuse. Rather, there has simply been an increase in reporting, because public education has enhanced public awareness both of the problem itself and of child abuse reporting laws, such as those that make reporting the simple suspicion of child abuse mandatory in many states. Some experts believe that child abuse, both in and out of the home, has always existed, but that only recently has the problem been recognized and taken seriously. This perspective suggests that increased child abuse is in fact a statistical phenomenon.

A major problem with incidence studies is that they are based on reported cases. Many researchers believe that such studies do not accurately reflect the extent of the problem. Incidence rates are usually based on the number of reported cases, but there is continuing evidence that much abuse goes unreported. This is particularly characteristic of incest, because of the taboo against discussing it. One study showed that only 6 percent of extrafamilial sexual abuse and 2 percent of intra-familial abuse experienced by the respondents had been reported (Russell 1984). A study of convicted child molesters indicates that the number of molestations they had actually committed was five times greater than the number of incidents for which they were apprehended (Groth, Longo, and McFaddin 1982). A study conducted by the National Center for Child Abuse and Neglect estimates that in 1981 only 33 percent of the known cases of child maltreatment in the United States had actually been reported (Westat Development 1981).

Because incidence studies focus only on those cases receiving professional attention, they are not very useful in determining the scope of the problem in the general population. Prevalence studies are more useful for acquiring this type of information. (Incidence refers to the number of people who "come down" with a condition—for example, the number admitted to mental hospitals each year. Prevalence refers to the number of people who suffer from a condition—for example, those who are mentally ill at a given time.) Samples in incidence studies are often biased, because professionals may label the respondents as "abused" prior to the sample selection process. Prevalence studies seem to give a more accurate picture because they are based on a proportion of the population rather than on a clinical sample. Although more studies have begun using random samples, few of them examine all forms of abuse, and most study a limited geographical area.

Definitional inconsistencies also complicate the process of data collection. Methodical comparison of incidence studies is difficult, because definitions of child abuse in the various studies are often not compa-

rable and may be so imprecise as to be useless. This is often the case in studies of sexual abuse; definitions of incest, for example, vary from fantasies involving the sexualization of a child (Rosenfeld, Nadelson, and Krieger 1979) to very restrictive definitions in which the act involves only heterosexual intercourse between postpubescent children and family members (Bixler 1981). The diagnosis of child maltreatment also presents problems. For example, the Diagnostic and Statistical Manuals of Mental Disorders I, II, and III do not include separate categories for certain forms of child abuse, such as incest. Thus, data collection is hindered because many cases of incest or other abuse may be disguised under labels such as "parent-child problem," or "adjustment reaction of childhood." This categorization skews the incidence rates.

Despite the many pitfalls, national incidence studies are useful in generating public discussion. The fact remains, however, that child abuse research lacks a solid empirical base of information about the extent of the problem, which limits our ability to make sound, effective policy decisions. We may not be able to eliminate the methodological problems of determining the incidence of child maltreatment, but nationwide prevalence studies could certainly add to our knowledge.

Perspectives on Child Maltreatment

Defining child maltreatment is problematic. First, definitions vary across cultures, races, and times (Gelles and Lancaster 1987). These definitions are essentially value-based, and values differ among various peoples, times, and circumstances. Second, definitions may have different purposes. Parton (1979) identifies three approaches to child maltreatment: penal, medical, and social . The penal, or legal, approach is concerned both with protecting the child victim and with the punishment of offenders. The protective component is emphasized by the child protective service (CPS) system, which includes social workers and law-enforcement staff who receive, investigate, and intervene in child abuse cases. The punishment of offenders involves the court system (which can also protect children through removal and placement), in particular the superior courts, which can prosecute offenders.

In the medical approach, child maltreatment is perceived as a result of external conditions, and the emphasis is on cure and prevention. The social approach may incorporate one of two perspectives: the radical view defines child maltreatment as the result of social processes and emphasizes social reorganization; the traditional view is more concerned

with therapeutic rehabilitation of the offender, who is seen as psychologically damaged and socially inadequate. Zigler (1983) provides, in addition, a sociological definition in which he considers the idea that certain practices are socially acceptable and that child abuse should be defined according to the standard of social acceptability.

In many professional settings, definitions of child abuse become operational through guidelines written as specific policies for particular objectives. Thus both explicit definitions and guidelines for professional practice must be considered when examining the relationship between self-esteem and child maltreatment. The question of the specific versus the general concerns both lawmakers and child abuse specialists. An extremely broad definition of abuse could result in a huge number of maltreatment cases flooding an already overburdened CPS system and could generate skepticism among the public. A very narrow definition, however, could result in overlooking serious cases and failing to protect some children who are at risk. A workable definition must fall between these extremes, difficult as it is to pinpoint.

Although a fairly specific definition may be established for a particular professional group, some discretion for the individual professional to determine the nature of child abuse always remains. Professional discretion is necessary because no single definition can include every possible factor that should be considered. Therefore, the training, personal background, characteristics, and—perhaps most important—the values of the individual professional all have significant impact on the selection of cases that are eventually defined as child maltreatment.

Finally, as Calam and Franchi (1987) point out, any particular definition may focus the attention of professionals away from certain kinds of damage that children suffer at the hands of their caretakers. Calam and Franchi argue that definitions should not obstruct the primary goal, which is to protect the child. Such questions as children's rights, child development, and alternative methods of caretaking should be considered when assessing and defining child maltreatment cases.

Using the typologies suggested by Parton (1979), we will next examine the various definitions of child maltreatment in more detail.

Social Definitions

According to Navarre (1987), definitions of child maltreatment have three dimensions: action, outcome, and intent. Action refers to caretaker behavior that has a high probability of an adverse effect on the

child. Outcome refers to the results of child maltreatment experienced by the victims. Unfortunately, research cannot consistently and reliably predict adverse outcomes, because outcomes are related to many other variables, such as developmental age of the child, environmental and familial circumstances, duration and intensity of the maltreatment, and the child's characteristics. Intent refers to the motivation behind the offender's action. Analysis of intent should include not only the intent of the caretaker but also the intent perceived by the child. As Navarre admits, intent is the most difficult of the three dimensions to measure, and therefore its use in an operational definition by the legal or social service system cannot be justified.

Burgess and Garbarino, in their evolutionary analysis of child maltreatment, suggest a definition that includes both caretaker behaviors and damage to the child: "Child abuse refers to any nonaccidental injury sustained by a child under eighteen years of age resulting from acts of commission or omission by a parent, guardian, or other caretakers. . . . Such acts range from violent, impulsive, extreme physical assault to nonimpulsive, seemingly deliberate torture of a child to intensive psychological deprivation" (1986, 88).

Giovannoni and Becerra (1979) describe child maltreatment from what they call a social deviance perspective. This sociological term essentially implies that the meaning of child abuse is determined by taking account of the social system in which it occurs. Giovannoni and Becerra consider the social deviance perspective more useful than the diagnostic perspective of medical professionals, because the former considers significant social and cultural factors that shape how societal groups care for their children.

Gil uses a macro-level perspective to describe child abuse, because of his strong concern for children's economic, social, civil, and political rights. Gil refers to child maltreatment as "any act of commission or omission by individuals, institutions, or society as a whole, and any conditions resulting from such acts or inaction, which deprive children of equal rights and liberties, and/or interfere with their optimal development" (1976, 130). The Child Welfare League of America, in contrast, defines child abuse and neglect from a familial, micro-level perspective: "The child on whose behalf protective services should be given is one whose parents or others responsible for the care of the child do not provide . . . the love, care, guidance, and protection a child requires for healthy growth and development; and whose condition or situation

gives observable evidence of the injurious effects of failure to meet at least the child's minimum needs" (1973, 12).

Giovannoni and Becerra argue that these kinds of social work definitions rest "in part on an implicit assumption that requirements for 'healthy growth and development' are known and that beliefs about children's needs are shared" (1979, 88). They note that even if most professionals were to agree on a definition of sexual abuse, other areas of child maltreatment, such as those involving other issues of morality, would remain controversial—for example, some might raise questions of sexual morality concerning family nudity and bathing practices.

Giovannoni and Becerra conclude that professionals have significant disagreements about the kinds of caretaker behaviors that are abusive and the degree of harm that such behaviors cause. These authors believe that such disagreements stem more from differing professional values and ideologies than from conscious or unconscious intrapsychic processes. However, they also find considerable consensus among both professionals and the public about the seriousness of sexual abuse and extreme forms of physical abuse and physical neglect. Giovannoni and Becerra describe nine forms of child maltreatment: sexual abuse, physical injury, lack of supervision, failure to provide material support, fostering delinquency, emotional maltreatment, educational neglect, harmful parental sexual mores, and parental substance abuse.

Medical Definitions

Medical approaches formulated by physicians tend to focus on the psychopathology of abusive parents and the evidence of physical injury, observed directly or with X-rays (O'Toole, Turbett, and Nalepka 1986). Some attention is given to the importance of stress and the intergenerational "cycle of violence." O'Toole and his colleagues note that nursing texts often have a broader perspective on defining child maltreatment than do texts written by physicians, because the former give greater emphasis to child and parental behaviors as indicators of abuse and to the relative importance of family dynamics and the child's behavior. Although some authors, such as justice and Justice (1976), assume that physical abuse is generally the easiest form of maltreatment to define, O'Toole, Turbett, and Nalepka suggest that medical professionals often use vague concepts such as "normal" and "abnormal" injuries to shape the definition of physical abuse and may ignore information from the

family, community, and school, as well as racial, cultural, and socioeconomic factors.

Giovannoni and Becerra (1979) describe the medical approach to child maltreatment as a "diagnostic perspective," characterized by an emphasis on the processes of pathology, symptoms, and cure; medical professionals may use symptoms to categorize cases of child abuse, for the purpose of forming diagnoses and planning interventions. The work of Kempe and Helfer (1977) is cited as an example of a medical definition of child maltreatment; their focus, though broad, is primarily on parental characteristics.

Legal Definitions

In most states, there are three sets of laws that use definitions of child abuse (Giovannoni and Becerra 1979); California is typical in this regard. One set of laws covers how and when mandated reporters of child maltreatment must report (California Penal Code, section 11161). A second set of laws defines criminal child maltreatment (California Penal Code, section 273). A third set is included in the California Welfare and Institutions Code, chapter 1068, and describes the grounds for making a child a dependent of the court. In all three sets, vague language such as "mental suffering" and "suitable home" is used in describing various forms of child maltreatment. Giovannoni and Becerra suggest that these definitions are useful to social workers and other professionals only if they are complemented by clearly written, more specific guidelines. As Nagi (1977) reports, social workers find that a large proportion of the cases reported to child protective services fall within an "area of doubt"—that is, although the children may be suffering, there is often insufficient evidence of abuse to satisfy the requirements of child maltreatment guidelines and definitions.

The state of California, in its guidelines for professionals, defines child maltreatment to include physical abuse, physical neglect, sexual abuse, and emotional maltreatment (Office of the Attorney General 1985, 5–13). These definitions do not specify degree of injury, but they do consider caretaker behaviors and their effects on victims: "The act of inflicting injury or allowing injury to result, rather than the degree of injury, is the determinant for intervention." Physical abuse is "any act which results in a nonaccidental physical injury." Physical neglect is the "negligent treatment or maltreatment of a child by a parent or caretaker

under circumstances indicating harm or threatened harm to the child's health or welfare." Sexual abuse is defined as "acts of sexual assault on and sexual exploitation of minors." Sexual assault includes rape, rape in concert, incest, sodomy, lewd or lascivious acts upon a child under the age of fourteen, oral copulation, penetration by a foreign object, and child molestation. Sexual exploitation includes child pornography and child prostitution. Emotional maltreatment is defined as "excessive verbal assaults (belittling, screaming, threats, blaming, and sarcasm), unpredictable responses (inconsistency), continual negative moods, constant family discord, and double-message communication." In the guidelines, the state also provides specific behavioral indicators of abusive caretakers and of child victims.

In other states, the degree of specificity in definitions of child maltreatment varies greatly. In her fifty-state survey of child welfare, conducted for the National Conference of State Legislatures, Smith (1986) found that every state except Texas (where legislation is pending) provides statutory definitions of abuse and neglect.

In summary, a very wide range of meanings can be attached to the term child maltreatment . These definitions, of course, affect how we perceive the problem. If we use a medical definition, for example, we deal with a smaller universe than if we use a definition that includes all of the perspectives reported above. The "size of the universe" under consideration is obviously a factor in any analysis of the relation between self-esteem and child maltreatment.

The Concept of Self

The self can be defined as "the totality of a complex and dynamic system of learned beliefs that an individual holds to be true about his or her personal existence and that gives consistency to his or her personality" (Purkey and Schmidt 1987, 32). At first glance, the concept of self may appear ill suited for a central place in the study of social problems, for, as Rosenberg writes, "in its essence, nothing is more quintessentially psychological; an unequivocally subjective phenomenon, its home is located in the inner world of thought and experience" (Rosenberg 1981, 593).

But the relevance of self-concept to the study of social problems is not difficult to grasp. The self develops out of the individual's social experiences and interactions in the different social contexts of the life

course—the family, the school, the workplace, and the community. Although the individual's perception of self is experienced internally, that perception is a product of social interaction.

The concept of self is by no means a simple one. One must attempt to sort out those features of the self that are stable and enduring and those that are "situated" (i.e., those parts of the self that are adjusted to social interaction). As James noted, on the one hand, "there is a certain average tone of self-feeling which each one of us carries about with him, and which is independent of the objective reasons we may have for satisfaction or discontent." But, on the other hand, a person also "has as many different social selves as there are distinct groups of persons about whose opinion he cares. He generally shows a different side of himself to each of these different groups" (James 1890, 294; emphasis in original). Thus, we may be restrained with our parents and teachers, and silly and adolescent with our friends. We do not reveal ourselves to clients and employers in the same way as we do to our colleagues and intimates.

There is an enormous amount of literature and a good deal of empirical research on the ways in which self is affected by social context. Much research has focused on the relation between social esteem and self-esteem. For example, it is commonly believed that minority children develop low self-esteem because they compare themselves unfavorably with the white majority in terms of social class and family structure (traditional nuclear families versus single-parent families). Research offers little support for this conclusion, however. Wylie's review of the research finds that minority group members do not have significantly lower self-esteem (1979, 57–116). Rosenberg's research suggests that all children and adolescents tend to compare themselves with those in their immediate interpersonal environments; when minority children compare themselves with their minority peers, there is a normal distribution of self-esteem. It is only when social circumstances place minority children in situations in which whites are the majority that their self-esteem may suffer (Rosenberg 1981, 605). This research should remind us that situations must be viewed from the perspectives of those who experience them and not just from the perspective of an observer. Findings of this sort are extremely useful in assessing such questions as the effects of school busing, the causes of poor academic achievement, and other problems related to race and ethnicity.

The concept of self has been a central theme of social psychology for the past thirty years. As Stryker (1977) points out, there are two major

traditions in social psychology—the psychological and the sociological . The psychological tradition (Rogers 1965; Epstein 1973; Bandura 1977) focuses on the consequences of the self-concept for individual functioning, that is, how feelings about one's self affect one's behavior and social interactions. In this tradition, Epstein defines the self-concept from an attribution perspective, as a self-theory that a person constructs as an experiencing, functioning individual in interaction with the world. He also points out that the self-theory is a mechanism that serves to "optimize the pleasure/pain balance of the individual over the course of a lifetime" (1973, 407). Thus, one of the important functions of self-theory is to help maintain self-esteem and to organize experience in a manner that enables one to cope with it effectively.

The sociological tradition in social psychology (Rosenberg 1979; Burke 1980) emphasizes how social-structural and contextual factors influence individuals' perceptions of self. The sociological perspective seems to see the structuring of self as developing throughout life, whereas the psychological tradition tends to see the self becoming structured in the earlier years of life. Rosenberg's work is primarily sociological, concentrating on the development of self-evaluative behavior in terms of how social milieu affects behavior (Rosenberg 1965, 1979).

The perspective from which the concept of self is seen obviously influences the ways in which we attempt to deal with social problems. Using the psychological perspective, we will tend to intervene at an individual level; that is, we will favor interventions that alter a person's perception of self in order to change his or her behavior and social interactions. Using the sociological perspective, we will be more likely to intervene at the social level; that is, we will favor interventions that alter social arrangements in order to change the individual's perception of self and his or her behavior and social interactions.

Dimensions of Self-Esteem

Most research on the self-concept focuses on self-esteem, and the self-concept is frequently equated with self-esteem. But self-esteem appears to occupy only a small part of our thoughts about ourselves. McGuire and Padawer-Singer (1976) report the interesting finding that when people are allowed a high degree of freedom in describing themselves, fewer than 10 percent of their responses deal with self-evaluation. Among sixth-graders who were asked, "Tell us about yourself," almost a quarter of all responses were devoted to habitual activities such as rec-

reation and daily routines. The second most frequently mentioned category involved significant others—mostly parents, siblings, and friends. The other categories mentioned were one's attitudes (17 percent), school (15 percent), and demographic characteristics (12 percent). Selfevaluation accounted for only 7 percent of all responses.

A distinction can be made between self-conception (identity), and self-evaluation (self-esteem). Self-conception usually refers to the concept that individuals hold of themselves as physical, social, and spiritual or moral beings. In Rosenberg's terms, the self-conception is broadly defined as the "totality of an individual's thoughts and feelings having reference to himself as an object" (1979, 7). Self-esteem, however, has been referred to as an individual's overall self-evaluation, the self as "an object of knowledge." James (1890) viewed self-esteem as the ratio of our actualities to our supposed potentialities, that is, the ratio of success to pretensions.

According to Gecas, "identity focuses on the meanings comprising the self as an object, gives structure and content to the self-concept, and anchors the self to social systems. Self-evaluation or self-esteem refers to the evaluative and affective aspects of the self-concept" (1982, 4). These aspects of the self-concept are closely interrelated: self-evaluation is typically based on substantive aspects of the self-concept, and identities typically have evaluative components.

Increasingly, aspects of self-esteem have been differentiated: inner and outer self-esteem (Franks and Marolla 1976), self-evaluation and self-worth (Brissett 1972), and sense of power and sense of worth (Gecas 1971), for example. Franks and Marolla use a two-dimensional approach, distinguishing inner self-esteem and outer self-esteem. The sense of inner self-esteem derives from feelings of one's own efficacy and competence—that is, the effects that one's actions have on the environment account for inner self-esteem. In contrast, outer self-esteem is bestowed by others; it deals with approval or acceptance by significant persons. Outer self-esteem refers to our desire to be connected affectively with others. One's sense of power and potency (inner self-esteem) can be quite independent of a sense of being accepted and liked by others (outer self-esteem). Social comparisons become very important in this context. It should be noted, however, that both the inner and outer dimensions of self-esteem can be seen as belonging in a sociological frame of reference (Franks and Marolla 1976). For example, minorities may worry about being accepted by white co-workers, but they

may not be concerned about acceptance from whites with whom they have no relationship.

As Franks and Marolla (1976) show, two dimensions of self-esteem often seem to parallel each other: those situations in which one evaluates oneself highly are often those situations in which one experiences a sense of mastery. The distinction between self-evaluation and self-worth, though conceptually important, tends to blur at the experiential level.

Knapp (1973) raises questions about the stability of self-esteem at different developmental stages in childhood, noting that it may seem to vary dramatically even within short periods of time. Little is known about whether self-esteem can, in fact, be changed and, if it can, the forms of intervention that are effective. The influences of culture, race, and sex-role identification on self-esteem are also relatively unknown.

Martinek and Zaichkowsky (1977), along with Knapp, suggest that the self-esteem of young children may be very unstable until about the age of seven. (Piers [1969] has confirmed this in her extensive investigations with elementary school and secondary school children.) Martinek and Zaichkowsky refer to Jersild's (1969) findings that certain emotional tendencies, feelings for others, and character traits are globally related to the self.

Battle (1981) reports that children's self-esteem has a weak, but statistically significant, positive relationship with intelligence. (Other researchers, such as Coopersmith [1967], have reported similar findings.) Teachers' ratings of students' self-esteem and students' self-reports correlate highly, but, as Piers (1969) and Coopersmith (1967) also found, teachers' ratings and students' school self-esteem (related to academic achievement) are not significantly related. Battle concludes that "one's self-esteem is not dependent on any particular factor (e.g., academic achievement), but on a combination of factors" (1981, 16). Battle also found, as did Coopersmith (1967), that among both adults and youths self-esteem is negatively correlated with depression. Finally, the self-esteem of academically successful students was significantly higher than that of less successful children with learning disabilities.

Sources of Self-Esteem

The difference between a sense of competence based on self-evaluation and a sense of value based on self-worth is important, because each arises

in a different process of self-concept formation. Briefly, the process of reflected appraisal contributes to the formation of self-worth, whereas competency-based self-evaluation is associated with self-attribution and social comparison.

There are four sources for the formation of self-esteem. The first is reflected appraisal, which is grounded in Cooley's concept of the "looking-glass self" (1902) and in Mead's idea of "role-taking" (1934). Cooley's concept of reflected appraisal is the notion that our sense of self is derived largely from our perceptions of how others regard us. In Cooley's view, self-esteem may be more strongly associated with the perceived appraisals of others than with actual appraisals. For example, Rosenberg (1979) found that the association between self-perception and reflected appraisals or social comparisons was stronger if the significant other was highly valued by the subject. Mead (1934) noted that self-image arises in social interaction as an outcome of the individual's concern about how others react to him or her. The "generalized other" serves as a source of internal regulation to guide and stabilize the individual's behavior in response to certain actions.

A second influential source of self-esteem is the social comparison process (Festinger 1954, 117–140), by which individuals assess their own abilities and virtues by comparing themselves to others. Social comparisons are most likely to occur in situations where information and standards are ambiguous or uncertain.

Self-attribution is a third source of self-esteem. It refers to how individuals explain their behavior (e.g., "I did poorly on the test because the teacher doesn't like me"). The notion of self-attribution suggests that self-esteem is tied not so much to an individual's behavior as to his or her interpretation of the behavior. As Gecas (1982) points out, attribution theory is, in general, more appropriate to consideration of self as a causal factor in social interaction than to explanations of the development of self.

Finally, social identity is also closely tied to self-esteem. Social identity refers to socially recognized belonging, such as one's social class and status, race, religion, or organizational affiliations. Low prestige in terms of social stratification does not necessarily produce correspondingly low self-esteem, however. According to Rosenberg's notion of "psychological centrality," the impact of any given stimulus depends on its centrality in the individual's cognitive structure. Thus, individuals must first become aware of their lower status in respect to significant others in the environment, as in the example of minority children in

majority-dominated educational settings cited earlier (Rosenberg 1981; Rosenberg and Pearlin 1978).

Instruments for Measuring Self-Esteem

Instruments that measure self-esteem generally fall into one of four categories, each with certain limitations: behavioral trace reports, direct observations, projective techniques, and self-reports (Knapp 1973). Behavioral trace reports attempt to base judgments on concrete behaviors, such as grades and teachers' comments, thereby eliminating observer bias; problems with memory (e.g., the teachers') and validity (e.g., grades) do exist, however. Direct observations are used with very young children who are not yet able to communicate effectively on a verbal level; but it is possible that the values, feelings, and attitudes of the observer may bias the results. Projective techniques can reveal unconscious processes in children and adults, but scoring procedures are difficult and may be neither objective nor valid. Self-reports are practical and easily scored, but respondents may manipulate their self-reports to obtain desirable results (e.g., to elicit sympathy from the observer). Of course, techniques can be combined in various ways to achieve reliability, but this makes assessment more expensive.

Hughes (1984) reviewed the nineteen most-used instruments for evaluating self-esteem among children aged three to twelve, concluding that although therapists working with children and adults frequently cite changes in self-concept and self-esteem as goals, there is no widely adopted, coherent theory of self-esteem and the self-concept. She believes the Piers-Harris Children's Self-Concept Scale to be the best for clinical application with children aged nine to twelve, because of its high reliability and validity, but she found no measure equally adequate for use with younger children. The McDaniel-Piers Scale was recommended for children aged six to nine because of its reliability and popularity. Hughes also recommends the Behavioral Academic Self-Esteem Scale as the best "teacher report" measure. She notes a distinction made in the literature between self-concept, as "the descriptive perception of the self," and self-esteem, as "the evaluative assessment of those descriptions" (1984, 659).

The Martinek-Zaichkowsky Self-Concept Scale for Children (Martinek and Zaichkowsky 1977) is designed to measure the "global self-concept of children from first grade through eighth grade." Children are given a self-report instrument that utilizes pictures instead of words.

The authors claim that the instrument is "culture-free." Although they have not yet established validity and reliability measures for this scale, as Wylie (1979) indicates in a review of the literature, there is a critical need for a well-validated scale that measures the self-esteem of younger children and that does not require the ability to read or understand English.

The Self-Observation Scale (Katzen and Stenner 1975) also utilizes a self-report instrument in assessing the self-esteem of children at the primary, junior high, and senior high school levels. The authors have completed a fairly extensive validation study of their instrument, and they maintain that it emphasizes the healthy and positive aspects of self rather than the more negative and pathological ones.

Katzen and Stenner use a "practical decision-making orientation" instead of the more traditional orientation of theory and research. According to the authors, the emotional development of children has not received enough attention; the emphasis in research has traditionally been on cognitive development. Their instruments are designed to help educators and psychologists attend more effectively to emotional development in this age group. Their instruments use written questions that are organized into seven scales: self-acceptance, self-security, social confidence, self-assertion, peer affiliation, teacher affiliation, and school affiliation. The forms developed for the primary school level use pictures for student responses, whereas the other forms use a verbal format.

The Culture-Free Self-Esteem Inventory (Battle 1981) provides instruments for use with children from grades one through twelve, as well as with adults. These instruments are designed both to help identify children, youths, and adults who are in need of psychiatric help and to provide general information for the professional helper or researcher. The author claims to have developed inventories that are useful with clients of all cultures and races.

The Coopersmith Self-Esteem Inventory (1975) is designed for subjects aged nine years and older. This instrument is based on a widely known study of self-esteem and has demonstrated a degree of reliability and validity that has made it very popular with researchers. Respondents are asked to check various columns of responses to questions.

The Tennessee Self-Concept Scale (TSCS), developed by Fitts (1965), is one of the most widely utilized self-esteem scales. It is also one of the few well-developed measures of self-esteem for use with adults. Using self-reporting, it measures self-concept across many subareas, providing both an overall self-esteem score and a complex self-concept profile.

The ninety statements (evenly balanced for positivity-negativity) fall into one of five general categories: physical self, moral-ethical self, personal self, family self, and social self. Each category is divided into statements of self-identity, self-acceptance, and behavior. There are also ten items from the Minnesota Multiphasic Personality Inventory (MMPI) lie scale. Each question has five response categories, from completely true to completely false. The TSCS yields an overall self-esteem score, a total positive score, along with self-esteem subscale scores related to different dimensions of perceiving the self.

The Rosenberg Self-Esteem Scale (1965), originally developed for use with high school students, measures the self-acceptance aspect of self-esteem. The scale consists of ten Guttman-type items with four responses, from strongly agree to strongly disagree, which are, however, scored only as agreement or disagreement. The scale is designed with brevity and ease of administration in mind.

Factors Associated with Child Abuse

As concern about child abuse has grown in recent years, a variety of explanations have been proposed to account for the etiology of this problem. Some have argued that child abuse is triggered by stress and psychological disturbance in parents (Oates, Forrest, and Peacock 1985; Morris, Gould, and Matthews 1964; Melnick and Hurley 1969; Steele and Pollock 1974), whereas others have argued that abuse-eliciting characteristics of children (Oates and Forrest 1985; Martin and Beezley 1976; Green 1978; Kinard 1980a), dysfunctional patterns of family interaction (Burgess 1978; Green, Gaines, and Sandgrund 1974), stressinducing social forces (Gelles and Lancaster 1987), or abuse-promoting cultural values (Gil 1987) are primarily responsible for abuse and neglect.

Research on the relationship between culture and child abuse is still in beginning stages. (See, for example, Spearly and Lauderdale 1983.) Wide differences in the definitions and methods used in studying child abuse make it difficult to assess the impact of racial and cultural factors on an international basis (Gelles and Cornell 1983). Evidence exists, however, that both racial and cultural influences (Korbin 1981) and economic factors (Spearly and Lauderdale 1983) can shape parenting practices. Complicating these findings is the fact that differences within any racial, cultural, or economic group are at least as broad as the differences generally found between such groups.

Belsky (1980) provides a system of analysis that draws heavily on

Bronfenbrenner's (1979) ecology of human development. This framework consists of four levels of analysis: ontogenic development, the microsystem, the exosystem, and the macrosystem. Ontogenic development involves personal characteristics that individual abusive parents bring with them to the family setting and to the parenting role. The microsystem refers to the family setting itself, that is, the immediate context in which child maltreatment takes place. The exosystem represents the social structures (e.g., the world of work, the neighborhood, and informal social networks) that encompass the microsystems of the individual and influence what goes on there. The macrosystem refers to cultural values and belief systems that may foster child maltreatment.

On the ontogenic level, Belsky stresses that abusers have repeatedly been found to have histories of maltreatment in their own childhoods. Belsky argues that, within the microsystem of the family, child abuse should not be considered as merely a function of the characteristics of either parent or child, but must be seen as an interactive process, with characteristics of both child and parent (e.g., how the child responds to how the parent behaves) becoming factors in the level of risk of child abuse. Within the exosystem, research evidence links maltreatment with unemployment, which is associated with lack of financial resources, a sense of powerlessness and isolation, and increased parent-child contact. The most significant elements in the macrosystem are society's attitudes toward violence and corporal punishment, particularly a general acceptance of physical punishment as a means of controlling children's behavior; the belief that children are their parents' chattel, property to be handled as the parents choose; and a narcissistic "me first" approach to life in contemporary American society.

Finkelhor (1986) tried to find commonalities in all forms of family violence, including both caretaker actions and outcomes for victims. He argues that child maltreatment is similar to other forms of violence inasmuch as it represents an abuse of power by a child's caretaker. But although caretakers do have obvious power over children, most abusers also perceive themselves as powerless. According to Finkelhor, the victims of child maltreatment are typically "brainwashed" into accepting low self-esteem and a distorted view of reality that legitimizes the abuse.

Self-Esteem of Abusive Parents

Several studies report that abusive parents have lower levels of self-esteem than members of control groups (Shorkey 1980; Oates and For-

rest 1985). But many of the studies on this subject do not provide clear definitions of self-esteem or child abuse. Moreover, it is not possible to determine the extent to which poor self-esteem actually results from a parent's abusing a child or being identified as an abusive parent.

Mothers who abuse their children are said to have low levels of self-esteem and often have histories of emotional deprivation in their own childhoods. Steele's study (1980) shows that it is common for abusive or neglectful caretakers to have histories of significant neglect, with or without physical abuse. From his experience, he stressed the importance of the parent's identification with a harsh, rejecting mother and with a bad childhood self-image.

Most of the earlier studies (Morris, Gould, and Matthews 1964; Steele and Pollock 1974) tend to be based on clinical judgments rather than on empirical evidence, but there have been several empirical studies of the self-esteem of child abusers. Melnick and Hurley (1969) compared ten abusive mothers with ten control mothers. They found that abusive mothers differed significantly from control-group mothers, as revealed by lower scores on the California Test of Personality (CTP) Self-Esteem Scale. Abusive mothers also differed reliably from control mothers in scoring higher on the Thematic Apperception Test (TAT) dependency frustration and Pathogenic Index, and lower on the TAT need to give nurturance and on the Manifest Rejection portion of the test.

Schneider, Hoffmeister, and Helfer devised a predictive screening instrument as part of a program to identify parents who were likely to be abusers. They found that the IM ("I'm no damn good") item cluster was particularly important, and they concluded that "in order to love one-self, one has to first be loved, approved of, and nurtured by parent figures. Lacking this parenting, the high-risk parent cannot develop high self-esteem" (1976, 405).

Green, Gaines, and Sandgrund, comparing a group of thirty abusive parents with an equal number of neglecting parents and a third group of normal parents, found that abusers are likely to develop poor self-concepts as a result of their own experiences in childhood. The authors characterize the abuse-prone mother as follows: "The mother passively re-enacts with the abused child the rejection and humiliation she originally experienced with her own mother. The resulting anxiety, guilt, and loss of self-esteem threaten the mother's fragile, narcissistic equilibrium" (1974, 885). Anderson and Lauderdale (1982) report identical results. They found not only that abusive parents have low self-esteem as measured on the Tennessee Self-Concept Scale, but, more important,

that their sense of self is in conflict and they are confused. Overall, these parents have poorly integrated personalities, as evidenced by a high level of personal maladjustment.

Shorkey (1980) analyzed data from a study of fourteen abusing mothers and an equal number of control mothers, using three personality scales: the sense of personal worth scale of the California Test of Personality, the Srole Anomia Scale, and the Rosenberg Self-Esteem Scale. The abusing mothers did not rate themselves as having lower self-esteem, based on the Rosenberg Scale. In contrast, their ratings on the sense of personal worth scale indicated that they perceived others' evaluations of them as lower than the nonabusing mothers perceived such evaluations to be.

Oates and Forrest (1985) compared thirty-six abusive mothers with thirty-six matched-group mothers. Abusive parents in this study had lower self-esteem and less regard for their partners, as judged by their desire that their children should not grow up to be like themselves or their partners. Also, they were less likely than the comparison mothers to discuss problems with other people.

Self-Esteem of Abused Children

The fact that abused and neglected children experience low self-esteem is well documented; maltreated children have measurably lower levels of self-esteem than children who are not abused (Sturkie and Flanzer 1987; Oates, Forrest, and Peacock 1985). Children with low self-esteem are also more likely than their peers with higher self-esteem to have behavior problems. There is considerable evidence that lowered self-esteem is one result of child sexual abuse, particularly as a longterm effect. Finkelhor (1986), in his review of the literature, found four forms of impact on child victims of sexual abuse: traumatic sexualization, stigmatization, a sense of betrayal, and feelings of powerlessness. Stigmatization includes lowered self-esteem, as well as guilt, shame, and a sense that one is different from others. A number of studies have shown negative effects on the self-esteem of sexually abused children—some effects that were short-term (DeFrancis 1969) and others that were long-term (Briere 1984; Bagley and Ramsay 1985–1986; Courtois 1979; Herman 1981).

Based on behavioral observations, Green (1978) reports that abused children exhibit a depressed affect with low self-esteem as the result of chronic physical and emotional abuse. Sturkie and Flanzer (1987)

found that members of abusive families (twenty-four individuals) were more depressed than the forty members of a cohort of comparison families, although in this case both maltreated adolescents and comparison adolescents were more depressed and had lower self-esteem than their parents. Dembo et al. (1987), studying the relationship between self-esteem and different kinds of maltreatment, found that physical abuse seemed to cause greater feelings of self-derogation than did sexual abuse. That is, child victims of physical abuse often perceive themselves as bad, worthless, and deserving of the "punishment" they receive. This is less the case with sexual victimization, because these victims are frequently valued as "love objects" by their abusers, who may themselves often suffer from early economic deprivation or a history of emotional impoverishment.

Gecas (1971) points out the importance of certain parental behavior patterns—primarily parental support and control—for the development of a child's self-evaluation. He finds that parental support is strongly and consistently related to various measures of adolescent self-evaluation. On the two scales of self-evaluation, support is more strongly related to Self-Esteem (SE)-Worth than to Self-Esteem (SE)-Power. SE-power refers to "the person's feeling of competence and effectiveness," and SE-worth refers to "personal influence and feelings of personal virtue and moral worth" (Gecas 1971, 468). Maternal support has a strong effect on SE-worth, whereas paternal support is more strongly related to SE-power. In general, the relation between parental support and self-esteem is stronger for girls than for boys, and the influence of parental support is stronger for the same-sex child than for the opposite-sex child. Further research may increase understanding of the relationship between abusive parents' behavior patterns and their children's self-esteem. Current interest in the etiology and effects of psychological maltreatment of children may lead to studies that link lack of parental support and control to children's self-esteem.

Oates, Forrest, and Peacock (1985) investigated the self-esteem of abused children through structured interviews with children and use of the Piers-Harris Children's Self-Concept Scale. Thirty-seven abused children were matched with thirty-seven nonabused children. The results show that abused children see themselves as having significantly fewer friends than do the comparison children. Abused children were also significantly lower in self-concept, as well as having less ambitious occupational goals.

In contrast, several other studies have not shown any differences in

self-concept between abused children and control-group children. Elmer (1977) compared seventeen abused children with seventeen matched children who experienced accidents. The majority of the children in both groups were lower-class. Analysis of responses on the Piers-Harris Children's Self-Concept Scale showed no group differences on any of the subscales or on the overall scores. The researchers concluded that membership in lower classes may have as powerful an effect on child development as abuse.

Kinard (1980a, 1982) found conflicting results. On the Piers-Harris Children's Self-Concept Scale, there were no differences between the mean scores of the abused group and those of the nonabused group, even though the abused children were more likely to have scores indicating negative self-concepts. On the Tasks of Emotional Development (TED) Self-Concept Task, the two groups differed significantly on mastering the task of establishing a positive self-concept, as indicated by less mature responses. These results suggest that children's sense of identity is not well formed.

The research findings discussed above are summarized in Table 2.1.

Interventions

Our discussion now moves to the broad range of intervention strategies used to deal with child abuse. Most intervention programs emphasize psychotherapeutic treatment, although the strategy of prevention through education is becoming increasingly important.

Three levels of intervention have been identified by Hart and Brassard (1987): macrosystem, exosystem, and microsystem . Intervention on the macrosystem level involves changing societal values and social policies through political action. Examples of such strategies include raising the standard of living of single-parent families, ensuring that various children's services are priorities in federal and state budgets, creating a national health insurance plan (including mental health insurance), establishing affordable housing and full employment, and providing child care and respite care services for single and working parents or salaries for parents who stay at home with their children. Intervention on the exosystem level is oriented toward community and societal institutions. These interventions might include banning corporal punishment in schools, modifying the scope of legal interventions, and improving the training of child care personnel. Finally, intervention on the microsystem level focuses on the individual and the family, perhaps reducing the levels of stress and isolation of families, intervening with high-risk parents before their children are born, or providing various forms of psychotherapy and education to family members.

On the macrosystem and exosystem levels, some interventions are intended to affect child abuse directly. For example, media spots on television may be designed specifically to describe what psychological maltreatment is and how to prevent it. Other types of intervention may be designed for another primary purpose but may nevertheless have a beneficial, indirect impact on the problem of child abuse. A new policy that establishes free child care for all children may be intended to improve the economic status and the opportunities available to women in society; yet the policy may also result in dramatic reductions in child maltreatment as many women are relieved of the stress of having constant responsibility for their children.

Although exosystem intervention strategies are usually not expressly intended to enhance self-esteem, they may well have a significant effect on the self-esteem of family members. Psychotherapy is emphasized as a treatment strategy in most intervention programs for child abuse. For

example, in a survey of child abuse prevention services in Oakland, California, conducted by the Family Welfare Research Group (1986), about 50 percent of the services had counseling programs. Only 14 percent had parent education classes, 17 percent had in-home intervention services, 11 percent had therapeutic day care, 14 percent offered respite care, and 26 percent had case-management services. Many therapists believe that the most effective counseling programs should include many of these other kinds of services. Nonetheless, psychotherapy seems to be a preferred approach in dealing with family and parenting problems, as well as many other issues, throughout our culture (Garfield and Bergin 1978).

Psychotherapy and Self-Esteem

Freedman, Kaplan, and Sadock define psychotherapy as a "form of treatment for mental illness and behavioral disturbances in which a trained person establishes a professional contact with the patient through definite therapeutic communication." They define the goals of the treatment as an activity in which the therapist "attempts to alleviate the emotional disturbance, reverse or change maladaptive patterns of behavior, and encourage personality growth and development" (1980, 1324). Garfield and Bergin define psychotherapy as "an interpersonal process designed to bring about modifications of feelings, cognition, attitudes, and behavior which have proven troublesome to the person seeking help from a trained professional" (1978, 3). Generally, psychotherapy is a one-on-one approach to alleviating emotional and social problems through verbal interaction between therapist and patient.

Research in the past fifteen to twenty years shows that some forms of psychotherapy are effective, at least for some types of problems. Studies examining outcomes report that psychotherapy yields positive results when compared with no treatment, pseudotherapies, and wait-list and placebo treatments (Garfield and Bergin 1978). The well-known Temple study (Sloane et al. 1975) compared the effects of behavior therapy with those of psychotherapy. Two-thirds of the patients were diagnosed as neurotic; one-third were diagnosed as having personality disorders (n = 90). A third group (the control group) consisted of people on a waiting list. Although all three groups showed some improvement, 80 percent of those in the behavior therapy and psychotherapy groups showed improvement. The Pennsylvania study (Rush et al. 1977) was conducted with outpatients who exhibited depressive symptoms. Again, psycho-

therapy had a significant effect, in contrast to pharmacotherapy (involving the use of drugs in treatment). The Malan group, who conducted the Tavistock studies (Malan 1976), concluded that psychoanalytically oriented psychotherapy was very effective with certain types of patients, such as psychoneurotics and those exhibiting psychophysiological problems.

Although there is a history of inconsistency in the results of research on psychotherapy outcomes, most reviews now conclude that the effects of psychotherapy are indeed positive. There are some major flaws in the methodologies used in this research, however, and this is likely the reason for the inconsistency (Morris, Turner, and Szykula 1988). A key problem has been the lack of standardization of intervention techniques. It is virtually impossible to have a standardized form of psychotherapy, and this of course leaves much room for therapist variables to confound findings.

Although the specific technique used is significant, some of the strongest predictors of successful psychotherapy are interpersonal and intrapersonal characteristics of the client. Clients who have high self-esteem may have more positive outcomes in psychotherapy. In their review of research on psychotherapy with children, Barrett, Hampe, and Miller (1978) conclude that response to treatment varies with the nature of diagnoses rather than with the treatments themselves. That is, some disorders show more positive outcomes with particular treatments than do others.

Measuring the effects of psychotherapy on self-esteem raises some unique problems. Most studies of psychotherapy outcomes tend to focus on specific illnesses and the rate of improvement by examining "remission" as an outcome; however, remission per se may not be an adequate measure of changes in self-esteem. Most of the current self-concept measurement scales, such as the Tennessee Self-Concept Scale (Fitts 1965), rely on self-report, which leaves room for reporting bias. The most appropriate method would be to apply some type of standardized measurement at pretreatment, posttreatment, and follow-up.

Regardless of the lack of clarity about the definitions and effectiveness of psychotherapy, it is widely used in many different forms in our culture. Garfield and Bergin note that "from a form of medical treatment for 'nervous and mental disease' in the nineteenth century, psychotherapy in our time has become the primary secular religion, its goals ranging from heightened self-fulfillment, serenity, emotional and spiritual well-being . . . to the traditional objectives of mitigating neurotic and psychotic disturbances" (1978, 17).

Psychological Approaches to Treatment

Various approaches are currently being used in psychotherapy with high-risk and abusive parents. Wodarski (1981) describes five models of treatment for abusive parents. The first, the psychopathological model, emphasizes direct services to parents. Specific goals include development of insight, increasing social skills, raising self-esteem, and building relationships. Second, the sociological model emphasizes change in social values and conditions: increasing the value the community places on parenting, as well as increasing financial and social support for day care and respite care, parent education, housing, recreational facilities, and children's rights.

The third model, called social-situational, is most concerned with the interaction among members of abusive families. Parents are taught how to modify their children's behaviors more effectively, with methods such as time out, positive reinforcement, and explanation. Fourth, the family-systems model emphasizes the organization and structure of the family. This model appears similar to the social-situational one, but the family-systems approach emphasizes inventing new roles for family members and reinforcing the parent as the source of control in the family. Fifth, the social-learning model utilizes behavioral changes in family members, as does the social-situational model, but it emphasizes a more formal social-learning methodology that includes definition of goals, selection of reinforcers, and implementation. Wodarski criticizes all of these approaches as being singular in focus. He advocates a comprehensive treatment approach that includes child management, marital enrichment, vocational skills enrichment, and interpersonal enrichment programs.

Shorkey (1979) describes a similar grouping of interventive methods. In Shorkey's view, the parent's behavior is an important element in the assessment process. Supportive social services are seen as a complement to therapy, with the goal of decreasing family stress and increasing life satisfaction. Finally, evaluation of the treatment is a critical step in all of these methods.

Justice and Justice (1976) provide an outline of models representing the kinds of therapeutic approaches currently used in treating child abuse. The first seven models are called psychodynamic (dealing with the past history of the parent); personality/character (focusing on current traits of the abuser); social learning (increasing parenting skills); family structure (managing the dynamics among family members); en -

vironmental stress; social-psychological (relieving stress factors and changing social norms); and mental illness (which applies to the fewer than 5 percent of abusive parents who suffer from psychoses or other major psychiatric disorders). Justice and Justice have themselves developed an eighth model, the psychosocial, which examines the interactions between the child, the parent, and the environment and which incorporates the seven approaches described above.

Each of the traditional therapeutic approaches has potential contributions to make to the treatment of child abuse. Given the limitations of this chapter, only some brief comments can be made regarding selected theories.

Freud's (1963a, 1963b) psychoanalytic approach to psychotherapy is the theoretical foundation for many therapists who work with abusive and high-risk parents. Freud's structural model of the id, ego, and superego, the stages of psychosexual development, and his ideas regarding defense mechanisms all have useful applications in this area. Freud's most fundamental contribution to understanding the abusive parent is his emphasis on examining the client's past; as Covitz explains, "most therapeutic treatment will involve some analysis of childhood experience and the relationship with parents" (1986, 156). The stages of psychosexual development provide practitioners with a framework to explain the etiology of a parent's psychological state and level of functioning.

Freud believed that psychoanalysis could help clients eventually become more sensitive to their own children: "Parents who have themselves experienced an analysis and owe much to it, including an insight into the faults of their own upbringing, will treat their children with better understanding and will spare them much of what they themselves were not spared" (1932, 150). Many people believe, however, that mere insight into the past will not necessarily lead to a reduction in child maltreatment. The parent must develop new skills, attitudes, and knowledge in addition to the insight gained in the counselor's office. It has not been demonstrated, for example, that parents who develop insight into their past have higher self-esteem or are more effective in enhancing the self-esteem of their children.

Most humanistic approaches in psychotherapy are based on the work of psychologist Carl Rogers (1965), who believed in the individual's natural tendency to self-actualize. Self-actualization is most likely to occur when the person experiences "unconditional positive regard." The therapist's role is to support the client unconditionally as the client resolves the incongruence between subjective (self) and external (others)

reality. As with other phenomenological approaches, Rogers's clientcentered therapy emphasizes building awareness and improving one's decision-making ability in the here and now. Many abusive and highrisk parents did not receive unconditional positive regard from their own parents during childhood. Rogers's humanistic approach provides nurturing for these parents and perhaps helps to improve self-esteem, which is a common need of abusive parents. The goal of self-actualization is also an important addition to the psychoanalytic approaches, which tend to be oriented toward the past rather than the present. Maslow (1971) described self-actualized people as honest and devoted to some calling or vocation. Such people may be less likely to abuse their children; research seems to indicate that unhappy, unemployed, and irresponsible parents tend to be more abusive.

Similar approaches have been developed by other humanistically oriented psychotherapists. Gestalt therapy (Perls 1969) emphasizes increasing the clients' awareness of their current needs and internal conflicts. A number of techniques are used to achieve this awareness, including group psychodrama and the famous "empty chair" individual exercises. The working through of projections and retroflections, as well as other defense mechanisms, is encouraged. Clients are urged to be honest and assertive (Polster and Polster 1973). The self-esteem of abusive parents, as well as that of children who have been abused, is one dimension of awareness that is dealt with by Gestalt therapists.

The rational-emotive approach, as developed by Ellis (1962), assumes that people have the ability to become rational by changing their way of thinking. According to Ellis, changes in thinking lead to changes in behavior and emotions. He believes that this technique works best with intelligent clients who are neither psychotic nor extremely disturbed or confused (Patterson 1973). For Ellis, the outside world (stressful events, children acting out, and so on) is not the cause of emotional and behavioral changes in the client. Rather, the client's own beliefs about the world cause such changes (Association for Advanced Training in the Behavioral Sciences 1986). Ellis tries to help the client change irrational beliefs that create destructive emotional and behavioral reactions such as child abuse. For example, Ellis might choose to show an abused child that her poor self-esteem is based on irrational assumptions about herself and others.

Yalom (1975) noted that group therapy is effective when cognitive learning is combined with self-disclosure and learning through watching

others. Other important elements of group therapy include helping others in the group (altruism), experiencing group cohesiveness, learning that others have similar problems (universality), giving and receiving feedback, expressing feelings (catharsis), and increasing one's hopefulness about life. Group therapy may therefore be particularly helpful with abusive parents, because they often need information about such questions as child development and home safety, as well as needing opportunities to develop themselves. The opportunities for growth in areas such as altruism, universality, and catharsis are also useful to the abusive parent, who is likely to be isolated, to lack social skills, and to have poor self-esteem.

Group therapy is popular with those who provide treatment for abusive parents. Groups are most appropriate for those individuals who have difficulty expressing feelings in individual treatment but can sometimes express sadness and anger readily when they hear other group members express similar feelings (James and Nasjleti 1983). In their work with abusive mothers, Oates and Forrest (1985) helped build the self-esteem of their clients by using lay therapists to provide mothers with practical emotional support. Self-help groups have become common in the treatment of abusers; some child abuse experts consider groups such as Parents Anonymous and Parents United to be quite effective in both treatment and prevention (Giaretto 1982; Lieber and Baker 1977).

In such self-help groups, parents are encouraged to help one another through a mutual support system. The group support system decreases the demands on the therapist to meet the clients' dependency needs (McNeil and McBride 1979). Through group reinforcement, parents can improve their self-esteem by learning that they should not look to their children or therapist to satisfy their needs. Some experts caution, however, that therapists in self-help groups must learn to defer to the clients' needs and beliefs only when it is beneficial to the treatment process (Ryan 1986).

A major advantage in using groups to develop self-esteem is that it enhances socialization skills, as a "community" forms among the group members. Phelan (1987) believes that such a community can provide a sense of common experiences, values, beliefs, and social solidarity for abusive parents and abused children. Another effect of the group process on self-esteem is the way in which group dynamics encourage confession, responsibility for self, and individual psychological growth.

Most adolescent parents may be considered high-risk by definition, for they are actually children raising children. Unfortunately, many adolescent parents come from homes that were abusive (Daro 1987), and thus they are not only immature but also often psychologically damaged as they begin parenthood. Daro names four treatment approaches used with adolescent parents: parent skill training, crisis intervention, job training, and shelter-oriented care. She believes that effective psychotherapy with adolescent parents incorporates interventions meeting all the needs represented by these four approaches. Kaufman (1986) argues that treatment in groups is the preferred form of psychotherapy with adolescents.

This survey of various methods of psychotherapy has identified some specific intervention strategies that are used in preventing and treating child abuse. Each of the psychological approaches described is also potentially useful in the development of self-esteem. More research is required both to determine the circumstances under which each approach (or combination of approaches) is indicated and to determine the relative effectiveness of each approach in treating child abuse cases and in improving the self-esteem of family members.

Techniques Used to Treat Low Self-Esteem

In individual, group, and family treatment, various techniques are used to enhance self-esteem. Some of the goals of treatment include improving the client's capacity for self-mastery, individuation, empowerment, assertiveness, and the use of social support systems. These goals are accomplished through using techniques such as guided imagery, body awareness exercises, problem solving and rehearsing, assertiveness training, role modeling, role playing, peer-group support, and art therapy.

Self-mastery can be achieved through the therapist's use of guided imagery, body awareness exercises, problem solving and rehearsing, sex education, and the practice of defiance and self-protection (James and Nasjleti 1983). Many experts suggest focusing on positive rather than negative behavior to begin building self-esteem. Gambrill (1981) stresses the importance of building on available skills rather than trying to decrease negative behavior. She also suggests increasing self-management skills so clients can feel that they have a greater effect on their environment. It is advisable to focus clients on the positive traits in their families and backgrounds when they first start therapy. Giaretto (1982)

argues that before efforts to increase personal and family growth can succeed, individuals must believe that they and their families are worth the effort. Only from this positive stance can clients focus on the negative aspects of their lives. Porter, Blick, and Sgroi (1982) suggest the use of role modeling, role playing, peer-group support, and positive peer pressure. They suggest that treatment should focus on accountability, behaving responsibly toward one's self and others, and individuation from one's family of origin. Their treatment plan includes structured opportunities for clients to make choices and be responsible for their own actions. Involving the family in the treatment plan is believed to enhance the client's sense of mastery over future plans.

A major consideration in treating clients with low self-esteem is helping them gain some sense of control or power. Thus therapists commonly apply the principles of "empowerment" in such cases. The development of an effective support system is the first step in this process (Solomon 1976). The client must then identify blocks to power and develop strategies to reduce the effects of these indirect and direct blocks. Brickman (1984) "empowers" clients by encouraging them to take a stand, to say no effectively, and to speak up more. In treating an abusive family, she recommends reversing the traditional family roles by first asking the victims to give their account of the family situation. This opportunity for the victim to define the situation increases the child's sense of importance.

Clients also need the opportunity to acquire socialization skills and test the mastery of such skills. Contact with other children or adults is often established through activities such as parents' groups, day care, community programs, mothers' and toddlers' programs, family agencies, preschool co-ops, and postnatal care—activities that can help to build a solid social support system.

In another approach used to counsel mothers who have physically abused their children, Feshbach (1980) enhances the mother's self-concept by teaching her to separate her child's behavior from her own sense of self-worth. The goal is to help parents develop an individuated identity, to differentiate between the success and failure of the child and their own successes and failures. Feshbach states that "to the extent that the parent's self-esteem is independent of the child's behavior, the parent is less likely to react with extreme anger when the child does not conform to parental instructions and expectations" (1980, 55). A parent's unrealistic expectations of a child play an important part in lowering

the child's self-esteem (Oates, Forrest, and Peacock 1985); thus, decreasing the parent's dependency on the child's achievement as a source of self-esteem can in turn have a positive effect on the child's self-esteem.

Children who are abused often feel a loss of nurturance, which can contribute to low self-esteem. Through the use of groups, therapists can provide role models to show parents that they can be nurturing, accepting, encouraging, and loving individuals (McNeil and McBride 1979). Encouraging the parent or caretaker to provide intense nurturing will give the child a greater sense of security (Porter, Blick, and Sgroi 1982).

Low self-esteem can also hinder the appropriate release of anger. Art therapy can help to release feelings of anger and hostility, improving one's self-concept. Art therapy can be a healthy and safe way not only to vent negativity but also to explore alternatives. A child who is depressed and withdrawn can learn to open up through art therapy and ultimately improve self-esteem (Porter, Blick, and Sgroi 1982; Axline 1969; Moustakas 1969).

Assertiveness training is also considered an effective method of enhancing self-esteem. Assertiveness is increased through identifying needs and desires, formulating realistic expectations of self and others, and, finally, developing and implementing adequate plans to accomplish goals. Such training is particularly useful in helping people identify strengths and receive positive feedback when deserved (Sgroi and Dana 1982). Positive reinforcement such as verbal praise for appropriate behavior can significantly increase a person's sense of self-worth.

As noted above, efforts to prevent child abuse through education are an increasingly important part of intervention strategies. Over the past decade, concerns about child abuse led first to development of experimental efforts and then to communitywide prevention programs. These programs, which generally began with elementary school curricula, gradually became designed to include preschool, middle school, and high school students as well. Currently, at least fifteen states have child abuse prevention programs that are supported by state funding.

In California, the enhancement of self-esteem in children is seen as a major goal of child abuse prevention efforts. The California Child Abuse Prevention and Treatment Act (CAPTA) now provides $ 11.5 million each year for child abuse prevention efforts with children from preschool through high school, making CAPTA the largest program of its kind in the nation. Enhancement of self-esteem is a common objective of CAPTA-funded primary prevention programs at all age levels.

Evaluations of Intervention Programs to Increase Self-Esteem and Reduce Child Abuse

Most professionals engaged in treating abusive families would support the premise that low self-esteem is a significant characteristic of such families. Most therapists would agree that improving the self-esteem of members of abusive families, including victims, abusers, and nonabusive parents, is an integral part of the therapeutic task. There are, however, several problems pointed out in child abuse research pertaining to the treatment of self-esteem.

First, although child abuse experts often discuss the usefulness of treatment and prevention efforts, they fail to describe the methodology used to improve clients' self-esteem. The therapeutic objective is often described in the literature simply as "increasing self-esteem" (Oates, Forrest, and Peacock 1985). Guidelines for treatment and intervention rarely provide any details about the specific steps an abusive family needs to take to improve self-esteem. It may be that therapists are indeed working to increase self-esteem, but there is a dearth of knowledge about how this occurs.

Second, research on the effects of therapeutic intervention to increase self-esteem is also limited. Few follow-up studies have been conducted to verify whether treatment and prevention programs actually affect self-esteem. Follow-up studies tend to measure the success of treatment or prevention by measuring the change in one or two variables, such as continued abuse or family reunification (Giaretto 1982). Empirical tests of treatment efforts rarely indicate changes in the self-esteem of clients (Abel, Becker, and Cunningham-Rather 1984; Tracy et al. 1983). Thus, we do not know, for example, whether abuse decreases because abusers develop better self-control, learn techniques for dealing with emotional tensions, or increase their self-esteem.

A third problem lies in the lack of control or comparison groups in studies of child abuse treatment, which makes it very difficult to measure treatment effects. The use of a control group in evaluating child abuse treatment is rare, as it would require the withholding of treatment. Because such a test would be highly unethical, a true experimental design is rarely used in child abuse treatment research.

Finally, many types of interventions are used in treating child abuse; however, the question of self-esteem seems to be addressed only in re-

search that focuses on psychotherapeutic methods. Interventions such as parenting groups, day care services, employment counseling, and financial aid may be very effective both in reducing child abuse and in increasing self-esteem, but we were unable to locate any studies that specifically examine the effect of these kinds of intervention on self-esteem.

The Characteristic to Be Treated

It is not clear that the direct treatment of low self-esteem is the most effective way to deal with the problems of those involved in child abuse. Self-esteem cannot be viewed in isolation from other problems in abusive families. A low level of self-esteem may contribute to or be caused by other problems, such as social isolation, inadequate parenting, a sense of helplessness, poor body image, an inability to trust others, and an inability to express one's feelings. A low level of self-esteem in adolescents has been found to manifest itself in thoughts about suicide, depression, and substance abuse (Porter, Blick, and Sgroi 1982). Parents with low self-esteem tend to draw on their children to meet their emotional needs (Summit 1983). In a review of nine studies, Kinard (1980a) reports that abused children exhibit a sense of depression and unhappiness and a poor self-concept.

People with low self-esteem are often believed to have a poor body image, and this is especially common in abusive families, specifically for victims of abuse (Brickman 1984; James and Nasjleti 1983; Porter, Blick, and Sgroi 1982). Body image can be improved by helping clients overcome inhibitions through discussing feelings of discomfort and inadequacies. Victims' self-esteem can be rebuilt by helping them to reclaim their bodies through nourishing, nurturing, and exercising their physical selves.

Parents' low self-esteem can contribute significantly to other life problems. The sense of worthlessness experienced by many abusers contributes to the act of abuse. The abusive relationship may compensate for a parent's feeling abused or rejected by others. It may serve to restore a sense of power and control to individuals who have felt a lack of control in their marital relationships and childhood experiences. Abusing a child may gratify a need for attention and recognition. It may meet a need for affiliation and temporarily strengthen the adult's sense of identity (Sgroi 1982). Treatment of all these problems will contribute to the building of self-esteem.

Treatment Modalities

Several treatment modalities, such as individual psychotherapy, behavior modification, group therapy, and family treatment, have been used in the field of child abuse. Individual treatment is often the first phase, where victims of abuse are encouraged to identify and express negative feelings they may have about themselves. The self-esteem of all the family members may be even lower when they contemplate how the abuse could have occurred. Feelings of guilt and responsibility can overwhelm any of the family members, including the offender, the victim, and others.

Tsai and Wagner (1978) found that these feelings of guilt contribute to the low self-esteem of women who were sexually molested as children. A six-month follow-up study of the women in their sample revealed that alleviating this guilt resulted in a corresponding increase in self-esteem. It is important to help each family member understand the abusive pattern and how this cycle can be broken. Once an individual has progressed in treatment, the group forum is encouraged as the next step in therapy.

Prevention

Most of the literature on preventing child abuse describes programs designed for children (Helfer 1982; Schmitt 1980; Finkelhor 1986). The main emphasis of prevention efforts is helping children learn to protect themselves from abuse. Programs are based on the principles of "empowerment" and focus on teaching children how to be assertive, how to recognize abusive behavior, how to say "no," and how to detect the potential for abuse.

One can speculate that acquiring these skills builds self-esteem. But one study measuring the effectiveness of prevention found that children who had high self-esteem before intervention derived greater benefits from prevention efforts than did children with low self-esteem (Fryer, Krazier, and Miyoshi 1987). Thus the correlation between prevention programs and increases in self-esteem remains questionable.

Building self-esteem is a recurrent theme in treatment and prevention interventions, but empirical tests of the effects of current programs on self-esteem are minimal. Most of the existing research is speculative and anecdotal. The few studies that have been conducted appear to evaluate only psychotherapeutic interventions and overlook the effectiveness of

other types. This oversight in research continues to pose a problem for child abuse professionals and should be a major focus of future research endeavors.

Conclusion

Having reviewed the social science literature on the relation between self-esteem and child abuse, we find that we can draw only one firm conclusion: that considerably more knowledge is needed to guide development of social policy and programs to deal with problems of self-esteem and problems of child abuse. There is a good deal of literature and research on the subject of self-esteem, and, similarly, there is a sizable literature on the subject of child abuse. Relatively little of this work, however, deals with the connection between the two.

Public concern about child abuse is relatively recent, and there have been continual changes in ideas about the cause of the problem. Many problems of definition arise when one attempts to describe the nature and scope of child maltreatment. Development of interventions and public policies to reduce child abuse is determined, to some extent, by the public's understanding of the problem, by whether a legal, psychological, medical, or social perspective prevails, for example. Thus, if child abuse is perceived as primarily a psychological problem, the public is more likely to support psychotherapeutic interventions; if it is perceived as primarily social, there is likely to be strong support for social service and educational programs. There may also be ideological ties to other social concerns, for example, among some feminists who see child abuse as part of women's oppression.

We have also noted that there are many different conceptions of self-esteem—some primarily psychological and others primarily sociological—all dealing with different dimensions of the phenomenon. As with the concept of child abuse, various perspectives on self-esteem lead us to emphasize one or another policy direction. The sociological perspective tends to support policies and programs that will increase self-esteem by reducing environmental pressures on vulnerable persons (e.g., provision of child care for single teenage parents); the psychological perspective tends to support policies and programs that will increase self-esteem by changing individuals (e.g., counseling and psychotherapy).

Many factors appear to be associated with child abuse: age and marital status of the parent(s), income, employment, and emotional and personal characteristics of both parents and children, among others.

Self-esteem appears to be related to child abuse, that is, abusing parents and abused children tend to have lower self-esteem. But self-esteem is also related to all of those other factors—unemployed parents and poor school achievers suffer from low self-esteem, for example. It is not entirely clear whether the low self-esteem of child abusers precedes (i.e., causes) or follows (i.e., results from) the abusive behavior. Thus, self-esteem may be both a causal variable and an intervening variable with respect to child abuse.

As one reviews the literature, however, one factor associated with child abuse fairly leaps out: we refer here to social isolation . Child abusers tend to be people who are lonely and isolated—single, teenage parents or unemployed, poorly educated people who are, from a socialcontextual viewpoint, out of joint, cut off from opportunities to fulfill appropriate social role expectations, and lacking social support.

Interventions to deal with child abuse range from the societal (changing laws and values) to the social (providing social and practical supports to vulnerable parents) to the individual (psychotherapy to increase self-esteem). Most programs that are explicitly intended to treat child abusers are psychotherapeutically oriented, and some of these programs explicitly attempt to increase the self-esteem of abusing parents.

There is some evidence that such intervention programs do result in reduced child abuse. But there is not any empirical evidence in any follow-up of treated parents that their self-esteem was in fact increased as a result of the intervention. Moreover, we find no research that deals with the effects that nonpsychotherapeutically oriented intervention programs might have on both self-esteem and the incidence of child abuse (for example, finding that a child care program for single teenage parents resulted in increased self-esteem for parents and children and in a reduced incidence of child abuse).

Given the current paucity of knowledge about these questions, we must conclude the following:

• There is insufficient evidence to support the belief in a direct relation between low self-esteem and child abuse.

• Low self-esteem should not be perceived as the primary cause of child abuse, especially in light of other factors such as age, employment status, availability of child care, and economic insecurity.

• There is no solid evidence that counseling and psychotherapy increase self-esteem.

• There is no basis on which to argue that increasing self-esteem is an effective or efficient means of decreasing child abuse (by comparison with other interventions).

• There is strong evidence that the social isolation of parents is a significant factor in causing both child abuse and low self-esteem. Social isolation may be caused by circumstances such as unemployment or being a single teenage parent. This finding suggests the need for social interventions rather than psychotherapeutic interventions. (This does not diminish the possible relevance of self-esteem in the prevention of child abuse. It does suggest, however, that the psychological factor of self-esteem may be changed indirectly, as the result of a social intervention.)

• Policy interventions to reduce child abuse that involve increasing self-esteem should be encouraged and should include interventions at the individual, family, group, community, and societal levels.

• All such programs should be evaluated using systematic methods of research to assess their effectiveness and efficiency.

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