LOS ANGELES -- Long after Sigmund Freud suggested -- and then backed away from -- the concept that the source of many psychiatric problems in adults was molestation in childhood, therapists are beginning to identify those that follow sexual abuse victims into adulthood.

The shift has been prompted by the increasing number of adults who are seeking treatment for emotional problems and have acknowledged previous episodes of abuse.

From family counselors to psychiatrists to sex therapists, professionals are just beginning to look for symptoms of childhood sexual abuse in adult patients who may have no memory of it, said Joshua S. Golden, co-director of the human sexuality program at the University of California at Los Angeles.

"We have just awakened to the fact that there are a whole range of behaviors that, until now, we have not understood to be caused by childhood sexual abuse," Golden said. "Lots of the problems of people, such as {hospitalized} psychiatric patients and adolescent psychiatric patients, we are now beginning to recognize, are often the results of childhood sexual abuse and other forms of childhood abuse. We are awakening to the fact that these problems" are numerous.

Many factors conspire to keep childhood sexual abuse and its lifelong consequences shrouded in secrecy, even in an age of relative enlightenment, experts say. Among the obstacles: Americans still find any discussion of sex difficult. Society still dismisses children who report abuse and, some experts say, generally regards the feelings of children as unworthy of adult attention. Children who hide sexual abuse often work hard to forget about it so that if and when emotional and sexual problems surface, the cause is buried.

The fact that many adults who seek therapy do not remember abuse is of great importance in trying to assess the prevalence of child molestation, Golden said. While recent surveys have found that 15 to 25 percent of adults report that they were molested as children, those figures represent only those who remember it.

"The more severe the damage, the earlier it occurs, the less likely people are to remember it," Golden said.

Although children are still often ignored, therapists are beginning to listen to adult patients who give clues of sexual abuse deep in their past. That progress has required therapists -- even sex therapists -- to shed their own distaste for dealing with sexual abuse, said Roland Summit, a psychiatrist at Harbor-UCLA Medical Center in Torrance, Calif.

Therapists will find no easy answers in treating these patients, Golden said. Victims of incest or molestation often have inhibited sexual desires and are unable to sustain healthy sexual relationships as adults. A smaller number lean toward promiscuity or become prostitutes, he added.

All the victims "tend to feel that they themselves are responsible for whatever misfortune has fallen on them. That is often the message that is given to them from perpetrators. These people have great difficulty trusting. They tend to be frightened and anxious because they have been traumatized," Golden said.

If the patient is involved in a relationship, the problems usually affect the partner as well, he said.

"The effects of {sexual abuse} ripple out like a stone on a pond. You not only have the effects on the patient, primarily women, but if they are in a relationship, those relationships are going to be affected in profound ways."

Adults often do not report incest or childhood molestation during interviews with therapists. But under hypnosis they recall the abuse, said D. Corydon Hammond, a Utah-based sex and marital therapist.

"Later, in doing hypnosis, we'll uncover incest (that occurred) usually at a preschool age," Hammond said. "I think the figures on incest and child molestation are serious enough. But that is only of conscious, reported rape."

Surveys of childhood sexual abuse taken in the last decade have triggered a new determination among therapists to explore the effects of abuse. In an often cited 1985 survey, a Los Angeles Times Poll found that at least 22 percent of Americans were victims of childhood sexual abuse. One third of them told no one at the time and lived with their secret into adulthood, the survey showed.

However, many victims will divulge their secrets only in an anonymous survey, experts said. Both therapists and victims need to become more comfortable in talking about sexual abuse, Summit said.

"Sex has always been a hard subject for modern humans," Summit said. "It's in this area (of sexual abuse) where we've had the hardest time. We deal with rape as a conversational issue fairly well. Rape is something we understand as an attack. But we don't understand how sex is used to punish people."

Summit criticized society's refusal to listen to children who attempt to tell their secrets and said that adults have simply refused to believe children.

History documents this lesson well, Summit said. The suggestion that children sometimes fall victim to adults' sexual perversions was suggested in 1850 by the Paris physician Amboise Tardieu. Tardieu also recognized that children would not willingly report abuse and would make up stories to cover it up.

"Nobody paid (Tardieu's work) the slightest attention," Summit said. "And it sparked a backlash by others. There came a whole new school of attention as to why children lie and how they gather attention to themselves by lying."

Tardieu's effort "was not only a lost effort but a punitive one because he was put down after his death," Summit said.

In 1896, Freud suggested that sexual abuse of children was the cause of hysterical illness. He also noted that many of his patients remembered the abuse only after therapy.

But Freud, too, was criticized by his colleagues. "His notion that so many kids were sexually abused was . . . greeted with scorn," Summit said.

Perhaps persuaded by the criticism, Freud later called his original theory a mistake. But later, his student, Sandor Ferenczi, also found patients with a history of sexual abuse. In 1933, Ferenczi presented his theories and was also rejected.

The belief that molestation must be the work of a child's warped imagination still exists, Summit said.

"One of the last prejudices we (as a society) are unaware of is the feeling most adults have that children don't matter much, except to their parents," he said.

Society needs a kind of "affirmative action" to make up for the trivialization of children's feelings, according to Summit.

As for adults, most experts agree that healing involves helping the patient remember the abuse and recognize its consequences. The feelings -- if not the memories -- registered in childhood are carried into adult years, he said. Victims of sexual abuse tend to feel helpless, speechless and robbed of their senses, Summit said. The child feels innocent and guilty at the same time and develops unhealthy images about his or her body and sex.

"When you mix issues like love and caring and bonding and bring sex and death into that equation, it's very hard to grow up feeling good about your body," he said.

In therapy, methods that are "invasive and intrusive" must often be employed to get beyond a patient's evasiveness, Summit said. "Until you get to the pain and guilt and shame, you will not free a person."