A multitude of published books and papers on child sexual abuse (CSA) describe symptoms, long-term effects, and therapy for survivors of abuse. However, the parallels between the nature of the sexual trauma event(s) as originally experienced by the victim and the therapeutic process into which the survivor later becomes engaged have not been reported. This paper attempts to fill that gap and proposes that the concept of a Wall of Fear is the bridge connecting the two. In the first part of the paper, a model of the CSA experience based upon Furniss (1991) will be explained in order to point out the basis for the dissociation and other symptomatology demonstrated by the CSA victim. Following that, the stages of therapy will be mapped out, with special attention to the concept of the Wall of Fear (Oz, 1999) and traumatic memory resolution (abreactions) and with reference to the experience of the original traumatic events. Therapist fear of decompensation will be addressed.

These days, more than ever before, adult women are undertaking therapy with the speci c purpose of coming to terms with a traumatic childhood in which sexual abuse played a major part. Before therapy, most manage to reach some kind of balance in their lives-in their families of origin, at work, in their families of procreation. Upon revelation of the secret and on opening up the subject of their childhood sexual abuse, that fragile balance is upset. During the therapeutic process the abuse survivor confronts her pain and fear, and this task draws energy previously invested in day-to-day functioning, at work and at home or, in more severe cases, in merely getting through the day. This inevitably affects the couple's relationship. This paper describes the impact of therapy for childhood sexual abuse: (1) on the functioning of the adult woman survivor as an individual and as a marital partner; (2) on the spouse's sense of well-being within the relationship; and (3) on the marital system. Three brief, illustrative case examples are presented, and suggestions are made regarding the timing and type of intervention with marital issues.

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While the professional literature deals to some degree with the difficult dilemmas faced by professionals regarding the question of reporting or not reporting child abuse as mandated by law, there is a glaring insufficiency of studies looking at the impact of reporting on the victims and their families. This paper presents six cases of suspected sexual abuse to demonstrate some of the inconsistency in responses to reports within the Israeli system. The authors recommend amendments to the Israeli mandatory reporting law so that the law is not only a societal decree of the absolute prohibition against the sexual exploitation of minors and others incapable of giving informed consent, but also a basis for consistent and skillful professional intervention.

In this paper, the concept of expertise as defined in various professions is applied to psychotherapy and more specifically to the field of childhood sexual abuse. Given the dearth of research in this area, exploration of the issue is accompanied by reviewing the curriculum vitae of a number of recognized experts in the field. The paper concludes with a call for the recognition of childhood sexual abuse as a specialized field requiring specialized training both at the graduate level and in continuing postgraduate education.