Good M I
Harvard Medical School.
Psychoanal Study Child. 1994;49:434-64. doi: 10.1080/00797308.1994.11823072.
Despite increased attention within psychiatry and psychoanalysis to childhood sexual abuse, the problem of cases in which sexual abuse is suspected but cannot be verified has received relatively little consideration. Just as underattention to the possibility of molestation as a cause of sexual trauma can fail to address the child's environmental and therapeutic needs, so a premature conclusion that molestation did occur may skew the course of treatment and have adverse medicolegal ramifications. Although the occurrence of molestation may be verifiable, its absence generally cannot be proven. However, some cases of suspected or equivocal child sexual abuse may involve trauma other than frank molestation. In unclear or equivocal situations, extended diagnostic formulation or treatment with attention to reconstruction may lead to an explication of the symptoms that is at least plausible. In this report, cases thought to involve possible sexual molestation are presented to illustrate alternative formulations or constructions of the trauma. A psychoanalytic perspective can be useful in the approach to such cases.
尽管精神病学和精神分析学对儿童性虐待的关注有所增加，但对于那些怀疑存在性虐待却无法证实的案例问题，相对而言却很少得到考虑。正如对骚扰可能是性创伤原因的关注不足可能无法满足儿童的环境和治疗需求一样，过早得出确实发生过骚扰的结论可能会扭曲治疗进程，并产生不良的法医学后果。虽然骚扰的发生可能是可证实的，但其不存在通常无法得到证明。然而，一些疑似或存在争议的儿童性虐待案例可能涉及除明显骚扰之外的其他创伤。在情况不明或存在争议的情况下，进行扩展的诊断性分析或注重重建的治疗可能会得出至少看似合理的症状解释。在本报告中，展示了被认为可能涉及性骚扰的案例，以说明对创伤的替代分析或解读。精神分析视角在处理此类案例时可能会有所帮助。
