The Risk Factor: Sexual abuse among young people. Dr Andrew Durham and Patrick Ayre comment on a case

CASE NOTES

Practitioners: Dr Andrew Durham.
Field: Young people with inappropriate sexualised behaviour.
Location: Warwickshire.
Client: Tony Cross, 14, who lives with his mother Linda, father Mark, and sister Helen, seven, in a small rural town.

Case History: Linda and Mark are often away from home working late, leaving Tony to look after Helen. Tony’s maternal aunt contacted social services to report that Helen had told her Tony had taken his clothes off and laid on top of her. Helen said that Tony had done this several times before and she had told her parents about this, and they had “told Tony off”. Helen was interviewed on video by the police and social services but she became upset and said she did not want to get Tony into more trouble. But eventually she was able to talk about what had happened and described how Tony had committed sexual acts against her at least five times.

Dilemma: Prompted by Mark, Tony became ostracised by his family and moved into foster care, preventing effective rehabilitative work for the family.

Risk factor: Community-based treatment made Tony a risk to others.

Outcome: Tony has remained physically estranged from his family but now lives ­independently and works full time. There have been no reports of any further sexual offences.

Tony Cross*, 14, had a volatile relationship with his father, Mark. He didn’t think his dad loved or liked him very much. He thought his mum, Linda, did love him but was often in the shadow of his dad, who certainly loved Tony’s seven-year-old sister, Helen. She was “daddy’s little princess”. Tony had felt pushed aside when she came along. Mark also prevented Tony from going out, thinking that he mixed with the “wrong sort of people”.

Mark and Linda worked away a lot and so Tony often took over caring responsibilities for Helen. It was during these times that Tony began sexually abusing Helen. He made her watch pornographic films, got her to masturbate him and give him oral sex, and simulated intercourse with her.

Helen told her parents, which resulted in Mark physically punishing Tony. They then believed the matter was closed. It wasn’t. The abuse continued until an aunt contacted social services after a disclosure from Helen.

“Tony admitted committing the offences to police, saying he did not mean to hurt his sister and that he was sorry,” says Dr Andrew Durham, consultant practitioner for the Sexualised Inappropriate Behaviours Service in Warwickshire. “Tony said he had been watching explicit pornographic films at home, which he had taken from his father’s collection. He believed his father also watched internet pornography, as he had found sites listed in the computer’s history, and that his dad didn’t know enough about computers to know how to delete them.”

After the interview Tony was so distraught he refused to return home, saying that his father would kill him now that he had admitted using the computer and going into Mark’s room, which was strictly forbidden.

“Mark – who initially denied having pornographic films and was furious at Tony for going into his bedroom – said that Tony could no longer live with them at home,” adds Durham. “He said that he was ashamed to call him his son.”

Tony was placed in foster care but continued to attend his school where, despite his perceived low self-esteem, he was reported to be a model pupil. However, Tony was bullied and often called names.

Tony received a programme of therapeutic work looking at both offence-related matters and the wider issues in his family that inevitably influenced his behaviour. Durham says: “Tony committed these sexual offences after extensive viewing of hardcore pornography, causing an intensive build-up of sexual feelings but without the self-confidence to consider entering into appropriate relationships with his female peers.”

At the same time, Tony had an accumulating resentment towards his father over many issues. “In response to the intersection of these factors, Tony began to carry forward masturbatory fantasies towards Helen into sexually abusing her,” explains Durham. “There were some very powerful peer influences on Tony’s behaviour ­reinforced by some of the pornographic material that he was watching, which together suggested that masculinity and sexual behaviour is about being in control and feeling powerful.”

Durham’s work with Tony took him through an examination of these attitudes and representations of masculinity. “He was the victim of quite a violent pecking order he felt that he needed to brag about his sexuality and about having sex with a girl to earn respect and stave off some of the bullying,” he says. “These wider influences alongside the power imbalances at home ultimately directed Tony to feeling able to justify sexually abusing Helen.”

For 18 months, Durham successfully explored with Tony the origins and influences of the power relationships in his life, and helped him to develop new ways of thinking about himself.

Tony remained estranged from his family, who refused to co-operate with social services and moved away, although he has some contact with both sets of grandparents. “Recently he has begun to receive letters from his mother,” Durham adds, “but she has asked him not to let any of his relatives know as his father was not aware that she had been writing and it would cause problems for her if he found out.”

Tony lived in foster care past his 18th birthday, and had many positive experiences, maintaining appropriate friendships and relationships with his peers. He now lives independently there have been no reports of any further sexual offences.

* The names of the family have been changed.

WEIGHING UP THE RISKS

Arguments for risk

● It was clear that there were some defining influences that made Tony commit sexual offences. These would be best treated in the community.

● Tony’s relationship with his father was pivotal. He described Mark as having a violent temper. Mark often smacked him, sometimes across the face.

● The role model that Mark presented to Tony was about the head of the household being in charge and always having his own way someone who cannot be challenged. “These attitudes were tinged with violence – both real and feared by probably all members of the family,” Durham says.

● Tony acknowledged his wrong-doing. He pleaded guilty in court of the offences against his sister and was ordered to sign the sex offenders’ register for two-and-a-half years. He received a community-based order, on the grounds that he would receive specialist therapeutic help from social services.

Arguments against risk

● The parents had failed to protect their child. After the first incident was discovered, despite the punishment and in the absence of any child protection or therapeutic intervention work, Tony’s sexual fantasies towards Helen continued. It was only a matter of time before a further sexual offence was committed.

● Whatever the circumstances of the relationship between father and son, Tony had sexually abused his seven-year-old sister; the apple of her father’s eye.

● This was not a haphazard or a one-off offence. Tony knew his parents would be away; he wouldn’t be found out. He made Helen watch pornographic movies, showing short excerpts to see what she thought. He would keep flicking the film back before eventually leaving it on. He was trying to “normalise” pornography.

● Under the Sexual Offences Act 2003, Tony would have been charged with rape because of the oral penile penetration.

Independent Comment

Sometimes, we are too ready to dismiss an incident that comes to our notice as a minor deviation from normal developmental processes, writes Patrick Ayre. However, a closer look is always required since, as in this case, what we are first told seldom represents more than a small corner of what is really happening.

If we accept the need to intervene, we may assume that the motivations which drive the worrying behaviour are primarily sexual and that some form of sexual re-education will put things right. In his work with Tony, Andrew Durham has discovered how multi-faceted the factors in play can be. Sexually inappropriate behaviour, whether in young people or adults, is often as much to do with the need to exercise power as it is to do with sexual desire.

If Durham had failed to recognise the impact on Tony of his low standing with his peers and with his father, and also of the images of what a real man is to which he was being exposed, it seems unlikely that any attempt to modify his behaviour would have been successful.

This case also offers a challenge to the basic Children Act 1989 assumption that children are normally better brought up in their own families. Without radical change in his father’s attitudes and behaviour, it seems most unlikely that Tony would have thrived at home.

This article appeared in the 28 June ussue under the headline “Victim of a violent pecking order”