Community Care and Community Care Inform are examining how evidence informs important areas of practice. In this article, Andrew Durham tackles
Children and young people have in recent years become exposed to increasing amounts of sexual information at an earlier age, and are often confronted by complex sexual and social dilemmas before they have the intellectual and emotional maturity to cope. It is then no surprise that many are showing sexualised behaviours, and demonstrating an awareness of sexual matters much earlier in their lives.
Where children and young people have committed harmful or inappropriate sexual behaviours, there is a professional consensus that there should be a holistic and therapeutic approach to addressing their needs. This approach acknowledges the wider social context of their behaviours and recognises that many of these children and young people themselves have experienced various forms of abuse, oppression and other difficulties in their lives, and that addressing these factors – alongside more specific sexual offence-related aspects – has to be a key component of the therapeutic response.
Within the field of therapeutic intervention for children and young people who sexually harm there are many complex and interacting factors such as family circumstances, secrecy, denial, threats and violence, personality, disability, age and so on. These factors often relate directly to the nature and causes of the behaviour being considered.
Often a young person’s act of sexual violence represents an accumulation or precipitation of these factors. This is why there is no single theoretical model that can adequately address these many complicated and varying circumstances.
In a sense there are unique elements to every new case, which make this a very difficult group to research. Hackett (2004) addresses this problem and also considers the role of subjective judgement concluding that the reflective practitioner uses evidence and theoretical knowledge in alongside critical practice reflection. This is also the approach of the AIM model. Within most programmes of therapeutic work for these children and young people there is agreement and consistency about the value of several key areas of research and theorising:
Finkelhor (1984) introduced the “four pre-conditions” for sexual abuse – motivation to offend; overcoming internal inhibitors; overcoming external inhibitors; and overcoming the victim’s resistance. This is a highly influential conceptualisation that has found its way into many major publications and practice guides in the field of sexual abuse.
Ryan and Lane (1991) applied the sexual abuse cycle to “juveniles” and pre-adolescents – a construct representing cognitive and behavioural progressions occurring before, during and after harmful sexual behaviour. Practitioners often prefer to use the term “pattern of behaviour”, as this reflects less of a sense of inevitability about the behaviour (Durham, 2006). The cycle was previously used in working with adults who sexually offend.
Gil and Cavanagh-Johnson (1993) addressed practice issues for working with younger children, presenting materials to assist practitioners in distinguishing between age-appropriate sexual play and problematic sexual behaviours.
A continuum of sexual behaviours is identified by Johnson and Feldmeth (1993) with four groups or clusters of sexual behaviours – normal sexual exploration; sexually reactive; extensive mutual sexual behaviours; and children who molest. This has been further developed into a six-step accumulating assessment framework:
1 Sexual activity compared to developmental level.
2 Relative power of children.
3 Use of intimidation, force or bribes.
5 Compulsiveness or obsessiveness.
6 Progression (Durham 2006).
Risks and strengths
Gilgun’s (1999) Clinical Assessment Package for Client Risks and Strengths, is ecological in its scope, and identifies five domains which are essential to child and family well-being: emotional expressiveness; sexuality; peer relationships; family relationships; family embeddedness in the community. A child or young person’s resilience – his ability to cope with and adapt to adversity and his ability to mobilise personal and social resources – will moderate his risk factors.
Sometimes risks may override assets, and other times assets may moderate risks. Similar approaches are taken by the AIM framework, which has a concerns and strengths matrix. Longo (2001) refers to “healing and wellness” and argues that humanistic approaches to developing a therapeutic relationship as being essential to the healing and recovery process.
Durham (2003, 2006) follows and expands the holistic path, building on sensitive practice approaches that have been developed in working with children and young people who are survivors of sexual abuse. Taking a holistic approach means balancing risks and strengths in a manner that through offence related work addresses the child or young person’s harmful sexual behaviours, but also build upon their personal competences in being able to achieve a positive and healthy lifestyle that involves meeting needs appropriately and not harming others.
Gender power and sexuality
It is widely acknowledged that most sexual abuse is committed by men or boys. This is reflected consistently in research (Durham 2006) and in Home Office statistics. It is imperative that any theorising or understanding of the phenomenon of sexual abuse reflects this fact, while acknowledging that women or girls also commit sexual abuse.
The social, family and peer context that shapes children’s understanding and beliefs about masculinity and femininity and how this is reflected in behaviour and power relationships are key theoretical aspects in understanding how and why harmful sexual behaviours occur.
Points for practice
A typical intervention programme for a child who has sexually harmed would combine the following elements:
● Explore the child or young person’s statement/description of events and the extent to which he or she accepts responsibility.
● Ensure there is initial identification of the pattern(s) of behaviour.
● Produce an immediate protection plan identifying the level of supervision needed.
● Assess the young person’s sexual history/knowledge – including experiences of unwanted sexual contact.
● Perform a detailed analysis of abusive/inappropriate sexual behaviour – pattern(s), cycle(s), thinking errors, inappropriate sexual fantasies – including the 4 STEPS model (Finkelhor 1984, Durham 2006).
● Challenge any denial and minimisation, and promote acceptance of full responsibility and explore the impact of the behaviour on the victim. This also needs to include an exploration of the child or young person’s own experiences of being a victim.
● Consider sex and sexuality education including and analysis of gender sexuality and power.
● Explore peer and family relationships, experiences and attachments.
● Build the child or young person’s self-esteem and social skills and personal competencies to help them meet future needs (including sexual needs) appropriately.
● Identify further techniques to avoid any relapse into sustained sexual offence-related behaviour.
● Undertake repeated evaluation throughout of the child or young person’s comprehension and retention of the work undertaken.
References and Key Texts
Durham AW (2003) Young Men Surviving Child Sexual Abuse – Research Stories and Lessons for Therapeutic Practice, Wiley.
Durham AW (2006) Young Men Who Have Sexually Abused – A Case Study Guide, Wiley.
Finkelhor D (1984) Child Sexual Abuse – New Theory and Research, New York, The Free Press.
Gil E and Johnson TC (1993) Sexualised Children Assessment and Treatment of Sexualised Children and Children Who Molest, Rockville, MD, Launch Press.
Gilgun JF (1999) “CASPARS Clinical Assessment Instruments that Measure Strengths and Risks in Children and Families” in Calder MC (ed) (1999) Working With Young People Who Sexually Abuse -New Pieces of the Jigsaw Puzzle, Russell House Publishing.
Hackett S (2004) What Works for Children and Young People with Harmful Sexual Behaviours, Barnardo’s.
Johnson, TC and Feldmeth, JR (1993) “Sexual Behaviours a Continuum” in Gil E and Johnson TC (1993) Sexualised Children Assessment and Treatment of Sexualised Children and Children Who Molest, Rockville, MD, Launch Press.
Longo, RE (2004) Paths to Wellness – A Holistic Approach and Guide for Personal Recovery. Massachusetts, Neari Press
Ryan GD and Lane SL (1991) Juvenile Sexual Offending, Massachusets, Lexington.
Araji SK (1997) Sexually Aggressive Children – Coming to Understand Them, Thousand Oaks, California, Sage.
Calder MC (ed) (2002) Young People Who Sexually Abuse – Building the Evidence Base For Your Practice, Russell House Publishing.
Calder MC (ed) (2005) Children and Young People who Sexually Abuse – New theory, research and practice developments, Russell House Publishing.
Department of Health; Home Office (2006) The Needs and Effective Treatment of Young People who Sexually Abuse: Current Evidence, Home Office and Department of Health
Griffin H and Beech A (2004) Evaluation of the AIM Framework for the Assessment of Adolescents who Display Harmful Sexual Behaviour, Youth Justice Board for England and Wales.
Hackett S, Masson H and Phillips S (2005) Services for Young People Who Sexually Abuse – A report on mapping and exploring services for young people who have sexually abused others, Youth Justice Board for England and Wales.
Morrison T and Print B (1995) Adolescent Sexual Abusers, NOTA.
About the author: Andrew Durham is consultant practitioner at Warwickshire Council’s sexualised inappropriate behaviours service
Other information on www.ccinform.co.uk in this area includes:
● A guide to the initial assessment of families of children or young people who have committed harmful or inappropriate sexual behaviour
● A guide to therapeutic assistance for children and young people recovering from sexual abuse