Issues in Mental Health Nursing, 22:573 591, 2001 c 2001 Taylor & Francis Copyright 0161-2840 /01 $12.

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FIRST INCEST DISCLOSURE Julie G. Donalek, RN, DNSc, CS

Department of Nursing, DePaul University, Chicago, Illinois, USA Despite the pivotal importance of disclosure to incest treatment and healing, disclosure has never been studied from the victims perspective. How do incest victims move from keeping the secret to speaking about their abuse? Nine adult women were asked to talk about the rst time they each told about the incest. They often spoke, not of telling in the commonly understood sense (i.e. giving information to someone who understands ones meaning), but instead of a time when some form of knowledge of the incest rst entered an interaction with another person. Colaizzis (1978) phenomenological method was used to analyze the interviews. Seven themes emerged: (1) living in the silencing home; (2) I am totally and particularly alone; (3) my mother, the focus of need; (4) incest as burden; (5) the secret must be kept; (6) disclosure: trying to balance above a chasm; and (7) disclosure as loss: no matter what, I still lose. The themes were then integrated into an essential description of rst incest disclosure. Implications for nursing practice are explored.

Secrecy is intrinsic to incest. While physical and emotional abuse commonly have witnesses, the incest victim is doubly burdened rst with the abuse itself and then with the need to keep the incest secret. The abuser controls the victim with threats, violence, projection of blame, or by normalizing the abuse or rewarding the victim to maintain her silence
The author thanks Lois Halstead, RN, PhD and Mary Johnson, RN, PhD for their assistance in the preparation of this manuscript. Address correspondenc e to Julie G. Donalek, DePaul University, Department of Nursing, 990 W. Fullerton Ave., Chicago, IL 60614.

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(Browne, 1991; Lovett, 1995 ). The victim is often left shamed, confused, fearful, and isolated. Yet, if she is to nd help and healing, she must somehow overcome all of these pressures and speak about her abuse. PROBLEM Childhood disclosure of incest is comparatively uncommon. Sadly, the younger the child is when abused, the more severe the abuse, the longer the duration, and the closer the relationship between victim and abuser, the more the victim believes herself responsible . This leads to the belief that telling would have negative consequences and makes the child less likely to even attempt disclosure (Goodman-Brown, 1994; Mendelsohn, 1991; Sauzier 1989; Sorenson & Snow, 1991; Taska, 1994 ). For those children who do attempt to tell, failure is frequent and an important trauma in and of itself (Boyles, 1997; Everill & Walker, 1995; Gold, 1997; Lange et al., 1999; Roesler, 1994; Roesler & Wind, 1994 ). Understandings of adult disclosure are contradictory. Adult disclosure has been seen as an empowering, health seeking behavior (Laidlow et al., 1990 ). Roesler and Wind (1994 ) asked women survivors about their reasons for rst disclosure . The most common reasons were: (1 ) wanting to heal; (2 ) feeling safe in a relationship; (3 ) retrieved memories; and (4 ) wanting protection from further abuse, all apparent health seeking behaviors. In contrast, McNulty and Wardle (1994 ) described adult women as disclosing incest in the context of crisis and decline. As a woman sees her emotional stability failing, she seeks some rationale for the decline. Childhood incest may be disclosed in an attempt to make sense of a current, adult crisis. The disclosure itself then has the potential to precipitate further decline as suppressed traumatic material surfaces. Current understanding s of incest disclosure continue to be limited. Barriers to disclosure, motivations for disclosure, and characterizations of response form only a part of the disclosure experience. Incest disclosure remains incompletely understood. THE CURRENT STUDY Purpose Help for the incest victim can only come if she is able to talk about her abuse. At the same time, victims feel enormous pressure to keep the incest secret. The purpose of this research was to examine rst incest disclosure from the victims perspective. Boys as well as girls are incestuously abused. This study was limited to women survivors because of

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possible differences in male and female socialization , psychologica l responses to abuse, and potential male discomfort with a female researcher (Holmes, Offen, & Waller, 1997 ). Design This was a qualitative, phenomenologica l study in which unstructured interviews were used to elicit participant narratives of their rst disclosure. This design freed participants to describe their experiences without interference from the researchers potential preconceptions (Streubert & Carpenter, 1995 ). Sample A purposive sample of nine adult, Euro-American women, each of whom identi ed herself as an incest survivor, was recruited for this study (Table I ). Participants ages ranged from 21 60. Six were married, one single, and two were in long-term, lesbian partnerships. Three were abused by fathers, three by brothers, one by a step-father, one a grandfather, and one by her sisters much older, live-in anc e. One endured a single episode of fondling. All others described prolonged, severe abuse extending over months or years. Two participants disclosed to a therapist in adulthood. The other seven disclosures occurred with family members in early adolescence. Method Participants were recruited in a variety of ways. One was referred after a presentation by the researcher at her university. Two were (or had been ) clients of therapists approached by the researcher. Another was a friend of one of the therapists. Two participants responded to notices in church bulletins. Finally, three participants were referred by other participants. Each participant was free to choose any location for the interviews that allowed for quiet and privacy, most often her home or the researchers home. After receiving an explanation of the research, participants gave written consent to be interviewed and to have the interviews audio taped. Participants responded to the instruction Tell me about the rst time that you told about the incest. Open-ended questions and prompts were used to encourage exploration of the experience. Initial interviews lasted approximately 1 11 /2 hours. Two weeks later, participants were again interviewed. The interval allowed participants time to consider any additions, clari cations, or corrections they might wish to make to the

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Person with whom disclosure rst occurred Current age 21 36 0 0 13 18 Marital status Number of children Years of education Mother Therapist Occupation Student Service professional 17 Student Sister 24 0 Mother Therapist Sister Mother Mother Mother 53 40 44 44 35 60 3 3 0 2 1 1 16 16 18 22 16 18 Married Long-term lesbian partnership Long-term lesbian partnership Divorced/ remarried Married Single Married Married Divorced/ remarried Selfemployed Sales Service professional Educator Home maker Service professional

TABLE 1. Research Participants

Participant

Abuser

Age at rst disclosure

1. Abby* 2. Belle

Step-father Brother

15 23

3. Claire

Brother

13

4. Dottie

Father

13

5. Ellen 6. Faith

33 15

7. Gail 8. Helen 9. Ivy

Grandfather Sisters live-in anc e Father Father Brother

12 12 13

Participants were assigned pseudonyms alphabetically in the sequence in which they were recruited for the study.

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rst interview. In the interval the researcher listened repeatedly to the tapes of rst interviews making note of the parts of the description that were unclear. The researcher then went to the second interview open to the participants comments and ready to explore those areas of the narrative needing clari cation. Second interviews lasted approximately one hour. All interviews were transcribed verbatim by the researcher. The researcher completed both a contextual documentation log and a personal response log immediately after each interview. Contextual documentation provides a description of the setting and participants nonverbal communication. A personal response log allows the researcher to continuousl y maintain contact with her own experience of the interview process. Both form important components of the analysis (Rodgers & Cowles, 1993 ). Research with incest survivors presents special ethical considerations since the interview process itself has the potential to create power inequalities and symbolically replicate the abuse, (i.e., the researcher may have power to invade the participants privacy in sexual matters and evoke painful memories; Lincoln, 1998; Rew, Bechtel, & Sapp, 1993 ). Therefore, great care was taken in all phases of the study to maintain an egalitarian environment characterized by sensitivity, mutuality, and participant freedom and control. The researcher has worked for a number of years with both adolescent and adult incest survivors and was particularly sensitive to the needs of these women. If a participant appeared to be under particular stress, she was encouraged to stop and rest, to explore some less stressful part of the narrative, or to withdraw all together. Additionally, the researcher is familiar with counselors and immediate support services within the community and would have made referrals if necessary. Almost invariably, the women interviewed for this research stated that they were willing to return to some the most painful memories of their lives because they hoped that others might learn and bene t. In this way, their experiences could be given value and meaning (Hutchinson, Wilson, & Wilson, 1994 ). Colaizzis (1978 ) phenomenologica l method was used for analysis. Interview transcripts together with contextual and personal response logs were read repeatedly to obtain a sense of the whole interview. The researcher also returned to the audio tapes to reimmerse herself in the narrative. Signi cant statements focusing on aspects of the phenomenon were extracted. These were restated in more general terms. Then underlying formulated meanings were identi ed from the terms. Seven themes emerged from these aggregate meanings and these, in turn, formed the basis for an essential description of the phenomenon (Table 2 ). Throughout the analysis, the researcher repeatedly returned

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Formulated meanings Terri ed of unknown consequences for herself and her mother. Might be killed by abusive, well-armed, insane father Self-loathing, others would share her judgment, take her children. Power to destroy her parents marriage. Didnt want the responsibility Had to keep her mothers good opinion Silence maintained the positive in her relationship with her brother Stop abuse but keep good in relationship with father Desperately lonely, hungry for attention Felt guilt, that she was somehow responsible

TABLE 2. Example of Analysis Theme: The Secret Must be Kept

Signi cant statements

You dont know what hes capable of. Maybe hed kill my mother. He was an excellent shot and he was crazy. Dirt would come out. The world would know. Theyd take my kids away. I would destroy the marriage. I didnt want to be responsible.

I didnt want my mother thinking badly of me. It would take away all the good things we had together. I wanted the Bad Daddy to go away, not the Good Daddy. He came along and provided attention. I had a lot of shame. In some ways I was a participant.

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to the original materials for veri cation of her work. A log was maintained during the analysis to provide an ongoing record of the researchers thinking and the decision making process (Rodgers & Cowles, 1993 ). The rigor of the research was assured by adherence to the characteristics of a trustworthy study as explicated by Lincoln and Guba (1985 ), that is, credibility, transferability, dependabilit y, and con rmability. Credibility, or the degree to which ndings are believable, was assured by regular debrie ngs with a content and methodologica l expert during all phases of the study, by inclusion of suf cient data and description in the nal report and, most importantly, by member checking. Seven of the nine participants were available to review and comment on the essential description. Participant veri cation is the strongest possible means of assuring the accuracy of study ndings (Colaizzi, 1978; Lincoln & Guba, 1985 ). Participants veri ed the accuracy of the essential description. The women responded emotionally. A typical response was I could only read a little at a time. It really described my experience. Transferability, or the ability to apply ndings in other contexts, can only be judged by the research consumer. The provision of extensive data and description enhances the consumers ability to make this decision. Dependability (i.e., demonstration of consistent use of the phenomenologica l method and grounding of the analysis in the data ) and con rmability (i.e., demonstration that an audit of the entire research process is possible ) both rest on the maintenance of complete records of all phases of the research process. The presence of tapes, transcripts, and contextual and personal response, and analytic logs for this research supports the dependability and con rmability of its ndings (Lincoln & Guba, 1985 ). RESULTS Participants were told before the interviews that they only needed to talk about the disclosure itself. Despite this, each woman methodically constructed remarkably similar patterns for rst disclosure. Each began with the silencing culture of her family, her sense of particular isolation in that family, and her intense feelings about her mother. She then spoke of the incest, how it had distorted her life, and the need to keep the incest secret. It was only then that each woman could describe the disclosure itself and its accompanying losses. In markedly different narratives, this same pattern was repeated. In the following sections, pseudonyms are used with verbatim quotes from the narratives.

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Living in the Silencing Home The child was acutely aware of living in a silencing home. In very different ways, the family prevented any authentic, open expression of feelings. Claire described her fragmented family: We dont talk. You know what I mean? We dont talk about things that are important. Helen spoke of the intensity with which her family husbanded its emotions:
I remember having the feeling when I was a little kid that, I thought that our familys feelings were stronger than anybody elses. And that was why we couldnt talk about them because, if we did, they would explode and blow up the planet. I was proud that we had such intense feelings, but [it was] also scary because, if you opened them up, they would explode.

Silencing could have a far more malevolent intent than the shielding of feelings. Faith, who would later be seduced by her sisters live-in anc e, lived in a violent, abusive family:
He [the father] would beat and beat and beat until we would cry. We had to stop then or he would beat us to stop. I never wanted to feel in front of my family. I mean, that was something that was never allowed.

Super cially, these appeared to be very different families. Whether the family maintained reserved perfectionism or, in marked contrast, lived with chaotic violence, the result remained the same. Each woman evoked the experience of living in a family in which members felt silenced. The failure of family communication was described as the foundation for all that followed. I am Totally and Particularly Alone The incest victim felt uniquely isolated, even within families that were silencing to all of their members. Belle felt abandoned by her parents:
I felt when I was younger, in the sense that I had a lot of different problems that my family couldnt help me with. I would try to tell them a lot of different things that were happening with me and they didnt see them as that serious to really address. I felt kind of blown off. I didnt know it as a kid but something was wrong. And I couldnt get my family to like wake up to it.

Claire, the youngest of ten children, described her isolation from her older siblings, They came from a different house. I was sent to boarding school. Faith took a certain pride in her isolation: Ive always been the

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black sheep I have a T-shirt with all these white sheep and one black sheep. Even by the norms of a silencing family, this woman as a child felt isolated and separate, unable to speak freely or receive the support that she so intensely needed. Her sense of isolation led, in part, to her vulnerability. My Mother: The Focus of Need The childs need for her mothers love, closeness, approval, and care reverberated through each story. Participants spoke passionately about their need for their mothers and the pain when that need was unfullled. Abbys mother struggled, with no education and two small children, after being divorced:
She had come from a dysfunctional family. She had a really hard life. I know how hard it had been for her to raise us. She really only married him (the abusive step-father) cause she had wanted for us. We had it rough. I think she wanted a better life for her children.

The need for love was painfully felt in its absence. Both Ellen and her mother had been abused by the same man, Ellens grandfather: My mother always just emotionally abandoned me. My mother was never much there. She always liked to ignore me. Of course, it sucked right into Im bad again. Finally, Helen spoke of her feelings when her mother failed to give her recognition:
Not getting the attention that you need as a child didnt make me get used to not getting the attention I wanted. If I wanted her to come seek me out and ask me something about what I was really feeling, whats really troubling me, if I wanted her to seek me out that way, and she doesnt do it ten times in a row, the eleventh time that she doesnt do it is not easier.

The women shared the same intense desire for their mothers care and attention. The desire was constant, whether met or unmet. Incest as Burden Beyond the abuse itself, the women described the ways in which being victimized affected their lives. The burden took multiple forms: the constant anticipation of further abuse; futile attempts to escape through resistance or fantasy; confusion as to the meaning and importance of

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the abuse and their own sometimes ambivalent responses; and, nally, attempts to live with a facade of normalcy. Gail evoked the feeling of living with a father who was predatory:
Ive lived out in the West and there were seasons for killing deer and wild game. You know, there was hunting season. It was always open season on me. There was no time when I couldnt be accessed. I felt hunted down, cornered.

Victims attempted to protect themselves. Ivy tried to resist: I had my bed up in the corner against the wall and Id curl up as tight as I could in a ball so he couldnt get at me. It was all I could do, just ght to hold myself in a ball. Abby fantasized: I thought about running away a lot. I thought about sleeping with a knife under my bed. I would stab him the next time he snuck into my room. Incest differed from other forms of abuse in that it was kept secret, even from others in the family. Participants spoke of their attempts to understand what was being done to them, judge its importance, and properly attribute blame without any means to verify their perceptions. Belle struggled for many years to evaluate her relationship with her brother. I felt, at times, that I was making a big deal out of nothing. I remember feeling that nobody would really believe me or think that it was any big deal. Since the incest took place in secret, the victim would be forced to inhabit parallel worlds; one of abuse and one of seemingly ordinary family life. Abby described the hypocrisy: It was such a burden, you know, having to play the family role. Having to go to celebrate Christmas with his family when Im disgusted and repulsed, and I had to share a home with this man. The young women had no standard against which to judge what had happened to them. They struggled to make sense of something beyond reason. They sought and often continue to seek relief from this burden. In differing stories, the common theme was the profound way in which the incest altered and distorted multiple other aspects of the victims life. The Secret Must be Kept The women spoke emphatically about the need to keep the incest secret. A number of reasons emerged: a very real fear of being killed; a fear of being exposed as a stigmatized person; having a responsibilit y to protect their mothers and to hold their parents marriage together; or a fear of disclosure of a behavior for which they felt in part responsible.

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Young women who felt some responsibilit y did not want the sexual abuse but needed some other part of the relationship. Several women believed that their abusers were quite capable of killing them. Gail described her father: This was the rural West. There were many, many guns around the house. He was an excellent shot and he was crazy. Ellen saw herself as tainted by the abuse and believed that disclosure could destroy what remained of value to her: To have somebody know that this had happened made me feel like all this dirt would come out and the whole world would know. I connected losing my whole life, losing everything, my kids, my husband, my self-respect [with disclosure]. Helen talked of her concerns for her parents marriage: I was certain that my parents would get a divorce if I told. I didnt, couldnt bear that idea. I had the impression that I had the power to save or destroy that marriage and it was my responsibility to save it. Belle and Faith kept the secret, in part, because of what they needed from the relationship with the abuser. Faith spoke of the complexity of her feelings about the abuse and her sisters anc e: There was not really much attention in my life from really anybody in my family. And he came along and provided a lot of attention. I didnt like what he was doing, but I wanted the food and I wanted the . . . . you know. Belle feared clarifying the meaning of the abuse and losing her brother:
As long as I didnt tell anybody, it was just some confusing thing that had happened and I didnt really have to sort it out. I felt like, if I tell, its going to have a name, like categorized into something. If I tell, shell [the therapist] think my brothers a terrible person and wonder why I would ever want to talk to him again and then Ill lose everything I had with him.

Each woman believed that telling could have cataclysmic consequences. None saw not telling as simply the lack of opportunity. First Disclosure: Trying to Balance Above a Chasm The women described telling as a time when knowledge of the incest rst entered an interaction between the victim and another person. The word disclosure was chosen to represent these experiences, since participants were not always the initiators of the revelation, (i.e., did not always tell ) nor when they did attempt to tell, were they always able to convey their message to the other in the interaction. Disclosure was immediately followed by the young woman frantically seeking to

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exert some control in the interaction, to balance above a metaphorical chasm. A drunken, teenage Abbys confrontation with her step-father unintentionally escalated into disclosure :
I got louder and louder because of my anger, not really caring who was hearing. I know! I havent been sleeping! Cause it was always at night. I pretended like I was asleep. And he got scared. It was like I dont know what youre talking about. I said You know what Im talking about. I know what youve been doing. My mom rushed into the kitchen and her eyes were huge. When she came through the door, I think that she knew.

Gail talked of a treasured time with her mother, alone in the car, and its sudden transformation: She had just decided to go back to waitressing. She had been exhausted doing both jobs before. She was talking to me about wanting to go back. Gail contrasted her mothers taciturn practicality with the mounting panic she herself was feeling:
I was horri ed, because my father, my father regularly abused me when she was out of the house. I dont know if I can ever underline how profound the sense of abandonment was. That she was once again just leaving. So thats why I was especially anxious to say Please dont leave me. It was really a plea, a plea for her not to leave me. Please dont leave me. He hurts me.

Faith and Ellen did not initiate disclosure . Faiths sister confronted her with a note from the abusing anc e: He placed a note on my [Faiths] pillow. He never placed a note before. I dont know what the note said. My sister found it and came up to me and confronted me. What is this note about? What are you doing with him? I remember her anger being so strong. Ellen had been hospitalized for over a year. She continued to be severely depressed and to self-mutilate. Ellens mother revealed to Ellens psychiatrist that she had been abused by her father, Ellens grandfather. The psychiatrist asked Ellen about abuse:
Its like everything exploded inside me. Its like it started in my toes and went up inside my head and just exploded. Should I tell him? Shouldnt I? Do I trust him? Am I going to lose everything? There was just so much con ict. I started shaking. I nally broke down and started crying and said my grandfather had started when I was three years old.

When Abbys mother entered the kitchen during her confrontation with her step-father, Abby realized that her mother had heard:

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When I saw her, I wasnt thinking Whew, good, now its out. I was thinking Did she hear me? I wasnt real sure I wanted her to know. I wasnt feeling relieved. I just know that, when she appeared, I guess I was feeling like Okay, what do I do? Where do I go now? This is a bad thing. Because the last thing that I wanted was to hurt my mom.

Confronted with evidence of her relationship with her sisters anc e, Faith made a futile attempt to minimize the relationship : I was scared to death to say what had been going on. I mean, it was talking when your heart drops. I was never speci c on what he did. I just said he came to visit me in the night, a one time thing. Belle ultimately conveyed to her therapist that the incest had occured. However, Belle titrated telling over a three month period. She felt overwhelmed by con icting feelings: The rst time that I told her, I said that my brother wanted to have a sexual relationship with me. I was feeling at the time that somehow, I was not going to expose myself and not be taken seriously. Gail felt that she could not go beyond He hurts me, but desperately waited for her mothers response: This is about as much of the truth as I could get out. It was just, I was afraid if I said, I dont know if I said any more, it was so unacceptable. I was afraid I might be killed, that I would die. Alone among the research participants, Claire described planning to tell her much older sister:
His (the abusive brothers) wife was going to have children. They were going to be my nieces and nephews. I thought that it might happen to his kids. I wanted to make sure that it didnt happen. It was like If it kills me, I have to do this. I invited my closest sister. She was the most responsible, the most unemotional. So we went to the coffee shop and we were talking and I was trying to get it out but its not coming out because you dont : : : want to say it. Then I told her and she pretty much freaked out, more than me.

Despite being asked to describe a time when each told, many of these participants saw rst telling as a very different event and responded accordingly. Knowledge of the incest, previously a silent presence, was suddenly verbalized but often in a distorted or fragmentary manner. Disclosure was described as lled with intense anxiety, uncertainty, and fear. A consistent discordance existed between the content and emotions victims wished to share (or hide ) and the response of the other person in the interaction.

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Disclosure as Loss: No Matter What, I Still Lose First incest disclosure was shaped by the fear or reality of loss. To keep the secret was to lose. To expose the incest was to threaten needed relationships , in ict pain on loved ones, or experience abandonment by those needed most. Worst still was to attempt disclosure and to receive little or no response. Claire had sought out her older sisters help in confronting her abusive brother. Though her sister listened and supported Claire to some degree, she was unprepared to help: Ashamed, ashamed of her is what I felt, in the sense that I felt like Youre an adult. If anyone in the scenario should be the one to stand up and say that this is wrong, it should be you! She should have helped me. She should have done something. Abbys mother responded decisively to overhearing a drunken Abby confront her step-father. Abby was believed without question and her mother initiated divorce proceedings. Abby did not see this as a happy ending:
It was a dagger through her heart. I knew she would feel responsible because she introduced him into my life. I knew that she would blame herself. Not that she should, but if you just look at How did this happen to my child? I brought this person into my childs life.

When Ellens psychiatrist told her of her mothers abuse by the grandfather, Ellen realized that her mother had made her share a bed with this man: Ever since then, Ive hated my mom. Because, if she knew that he did that to her, and she let me sleep with him for seven years, and she knew what he could do, and she never tried to stop it. Gails plea to her mother Please dont leave me. He hurts me, was met with silence:
I dont know if I can even underline how profound the sense of abandonment was, that she was once again just leaving. There were no questions. She didnt hear it! She just drove. My memory is that I sobbed it out. She just kept driving. Now it was as if a cloud descended on my life and there was no escape.

In Faiths desperately lonely life, her sisters anc e had been the only attention she had ever received: I mean, I lost everything at that one point in time. The abuse would stop. The attention would stop. I think, at that point in time, having the attention was something that I needed severely. Finally, Ivy described the profound effect of her mothers ridicule and rejection: It just made me question absolutely everything: the way

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I thought; the way I felt; the whole way my brain worked. How can I be a sane human being? I did not want anybody to ever hurt me again like that. No fantasy rescue and resolution of issues followed rst incest disclosure. Some were heard and understood, others denied and ignored. Whatever the response, if any, rst disclosure was always an experience of profound loss. ESSENTIAL DESCRIPTION The family in which incest occured could be violent and chaotic, silent and reserved, or broken and fragmented. The result remained the same. Open, comfortable communication was not possible. Even by the norms of the family, the young woman felt particularly isolated. The distancing of parents, the young womans feelings of loneliness and depression, a need to appear perfect, or even her refuge in fantasy or scholarship made her feel separated and different within her family. The young woman felt an intense longing for her mothers love, support, protection, and understanding. Mothers were either too burdened, vulnerable, uncaring, abusive, distant, or reserved for comfortable, open communication. Incest was victimization. The abuse permeated the victims life. Beyond the abuse itself, time was spent anticipating further abuse, attempting to make sense of the abuse, fantasizing revenge or escape, or attempting to maintain a facade of normalcy. The young woman felt that she must keep the incest secret. She was convinced that she would not be believed or that breaking the secret would have catastrophic consequences. Disclosure was the sudden opening of a chasm. Initiation did not always come from the victim. She experienced intense anxiety, panic, the desire to ee, uncertainty, or longing for the listeners understanding . Often fragmented, distorted, or minimal intimation of the actual abuse emerged. What was said was not the amount wanted; it was either more or less. The young woman felt that she had lost or was losing control, was being accused, ignored, probed, or denied. She was aware of her attempts to construct, to shape what she had said while simultaneously being acutely aware of the others behaviors and responses. Loss is an exquisitely painful thread woven into the story of rst disclosure. Even successful disclosure , being understood and believed, resulted in the loss of relationships and security. Failed disclosure was even more traumatic. There was an experience of total abandonment and a loss of the fantasy that she would be rescued, believed, and comforted.

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The failed disclosure was perceived as a powerful compounding factor in the victimization. DISCUSSION Family systems theorists have described incest as a means of sustaining a dysfunctiona l family system (e.g., Sheinberg, 1992 ). In contrast, feminist theorists have seen incest as a linear, not a systems issue (i.e., the abuser has power over the victim and the victim has none; Ehrmin, 1996; Jacobs, 1990 ). Participants in this research described families as using not incest but silence or ineffectual communication to sustain the family system. From the participants perspective, family silence was the context in which the incest could occur. Participants placed not only the incest itself, but also the need to keep the secret, their painful, unsatisfying mother-daughte r relationship , and often the rst disclosure experience, in this family systems context. Within this silence, the abuser was able to use threats, power, or manipulation to control the victim. Mothers in incestuous families have been described as either concerned and protective (deYoung, 1994; Ehrmin, 1996; Lovett, 1995 ) or passive and ineffectual (Hubbard, 1989 ). The narratives of these women do not resolve this con ict. Descriptions of the mothers behaviors varied. It was the childs desperate need for her mothers care and concern that remained constant. Beyond the actual experience of the incest itself, participants evoked the ways in which the abuse burdened many aspects of their lives. Their descriptions give a sense of how global the effects can be for a victim. Several participants emphasized that much of the incest burden had to do with their futile attempts to make sense of something as irrational as incest without support from others or the opportunity to test perceptions. Little prior attention has been given in the literature to this internalized struggle as a major part of the incest burden. The degree of structure involved in rationales for not telling is remarkable. Not telling was a highly organized, deliberate response to an often accurate perception of potential consequences. Emphasis in the clinical literature is often placed on the importance of asking about an abuse history as part of a comprehensive mental health assessment (e.g., Seng & Peterson, 1995 ). In view of the intensity with which these victims kept the incest secret, question exists that any would have disclosedeven if asked directly. The narratives of these women give new insights into the struggle involved in victim disclosure.

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Only one participant described her incest disclosure as conveying information to someone who understood and responded. For the others, in very different experiences, a constant theme was the clash between the desire of the victim and the behavior of the other. Narratives were permeated with descriptions of intense feelings of anxiety, desperation, shock, anger, or fear. Participants described frantic attempts to think, nd solutions, attract attention, explain, rationalize, limit, control, and hide. First disclosure was always a highly stressful, unsatisfactory experience. Finally, disclosure was not liberating. Roesler and Wind (1994 ) categorized outcomes of childhood disclosure as generally negative and outcomes of adult disclosure as more positive. The narratives of the women in this study re ected a more nuanced understanding of the outcomes of rst disclosure . As in Roesler and Winds study, the two participants in this study who disclosed in adulthood ultimately had a more positive response than those who disclosed in childhood. Yet all participants experienced painful loss in some form. While the rst disclosure experiences of several participants were ultimately positive in some way (i.e., therapist support or removal from the abuser ), the immediate experience for even these women was dominated by the fear or reality of loss. Participants spoke of the loss of a mothers innocence, and a loss of needed attention from the abuser, security, family, or most profoundly, the loss of the belief that they would be believed and ultimately rescued. No sense of release or resolution accompanied disclosure. Even for those who were understood and supported, disclosure involved profound losses. How common are experiences such as those described in this research? It would appear that at least some survivors come to the nurseclient relationship having had prior traumatic disclosure experiences. Such experiences may discourage or, at very least, in uence further disclosure. Participants described disclosure as often poorly planned and impulsive. Initial disclosure in the therapeutic relationship also may be a small and distorted portion of the actual abuse, conveyed impulsively. The sensitive clinician should be alert to cues, avoid premature interpretation, and premature closure with the client struggling to disclose incest. Clients should be questioned not only about a potential history of abuse but also about prior disclosure attempts. Disclosure experiences appear to be important if not pivotal events for these women. As this research also demonstrates, telling may have a very different meaning for the client than it does for the clinician. The client may mean only that knowledge of the incest entered into an interaction with another individual, not that someone else listened, understood, and responded supportively. Meanings must be further explored.

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It appears that incest disclosure, even with supportive responses, has negative consequences. Nurse-clinicians need to be prepared to recognize and support the ambivalent client and to assist the client in mourning the very real losses associated with past and present disclosures. CONCLUSION Nine remarkable women were interviewed for this research. Each was able to vividly recall an event that had occurred as many as 47 years prior to the interviews. The clarity of these descriptions and the power of these stories re ect the importance of rst incest disclosure in understandin g and assisting incest victims in treatment, resolution, and healing. REFERENCES
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