Book Reviews -- the Clinical Detective: Techniques in the Evaluation of Sexual Abuse by Aaron Noah Hoorwitz

Hoorwitz, Aaron Noah, The Clinical Detective: Techniques in the Evaluation of Sexual Abuse. New York, N.Y.: W.W. Norton & Co., Ltd., 1992, 303pp., $34.95 hardcover.Hoorwitz' s purpose is to provide the reader with a step by step approach to the process of evaluating sexual abuse allegations and formulating conclusions and recommendations. He argues that competent evaluation of sexual abuse is important for therapists treating problems related to sexual abuse as well as for clinicians providing recommendations to the courts, police, and social service agencies. This work is the result of the author's clinical practice and academic research. Although suggested readings on child abuse are provided, the book forgoes an academic treatment of the subject in favor of practical clinical treatment of identifying sexual abuse. Much of the text, rather than being didactic, informs the reader through clinical dialogues and student-teacher dialogues.This book has three parts, Stages of the Interview Process, Interview Techniques, and Evaluation. In part I, chapter I, Hoorwitz discusses the feelings of disgust many people (including clinicians) have about sexual abuse and how these feelings may color their perceptions and behaviors. He suggests that the first key to improved detection of sexual abuse is empathy. Chapter 2 focuses on whom to inerview first, second, etc. Chapters 3 and 4 describe the interview with the child in terms of a "stage-wise" process. The first stage should establish the purpose of the interview, followed by discussing the lack of confidentiality with children old enough to understand the concept. The third stage is to teach the child how to answer questions so that a mutual understanding and common language exist between interviewer and child. Next, the interviewer establishes rapport with the child. In stage five, the interviewer assesses the mental status, development, and current functioning of the child. A sample crib sheet covers areas in the child's life to ask about and examples of questions to use. In stage six, the attempt is made to elicit a description of the abuse, e.g., where touched, where did it happen. In stage seven, the clinician assesses the effects of the abuse and other events following its disclosure, followed by the eighth stage of inquiry into reasons for any inconsistent or false statements. The last stage is the debriefing process.Part II, Interview Technique, begins with a description and discussion of common errors in interviewing, such as interrogation, indirectness, and patronizing the child. Chapter 6 examines how the clinician establishes mutual understanding, including confronting the client about discrepancies and inconsistent statements. Hoorwitz gives examples of effective confrontations. The next chapter details techniques for eliciting descriptions of abuse. A technique to obtain a detailed statement is oriented toward enabling the interviewer to see the abuse incident as in a movie. Other tools are dolls, drawings, toys and writing. The final chapter in part II presents techniques for amplifying a story's strengths and weaknesses so they are more evident to a third person. These techniques include eliciting confirmable and unconfirmable statements, having the child repeat parts of the story, and asking leading questions to test for consistency. Hoorwitz emphasizes, however, that inconsistent statements do not necessarily indicate the child is lying and that it is important to elicit the reasons for seemingly inconsistent statements, such as a desire to please or cognitive limitations.In part III, Evaluation, chapter 9 examines how the clinician differentiates true allegations and recantations from false ones by considering such variables as the presence of typical trauma symptoms from abuse, consistency between statements, abundance of confirmable statements, and invariant sequences of details. …