From
Inside Out to Outside In -
Working With Teen Sex Offenders With A Multimodal Approach
By Kristi Messer MSW, MPH
Children and adolescent sexual offenders tend to repeat behaviors which are familiar, often with little frame of reference for alter-native non-abusive interactions, according to Mark Schwartz, Clinical Director of Masters and Johnson Sexual Trauma Program (Schwartz, 1992). It is therefore important to provide comprehensive treatment which focuses on the original trauma while encour-aging the expression of the intense affect imbedded within these memories. The therapy of choice for Masters and Johnson's Sexual Trauma Program includes a multi-modal approach which integrates the conceptual framework of post-traumatic stress disorder with that of cognitive-behavioral, systemic, relapse prevention, and addictive behavior treatment strategies.
In this approach it is necessary to assess and modify the internal cognitions and belief systems that interfere with one's capacity for intimacy. Successful treatment of sex offenders also requires a focus on teaching supportive social skills which enable the individual to establish and maintain healthy relationships. Dr. Schwartz encourages appropriate social skills by teaching new behavioral skills, reducing anxiety in heter-osexual socialization, restructuring nonserving belief systems, and encouraging the coding of environmental feedback related to improvement in self-esteem (Schwartz, 1992).
Techniques of relapse prevention in treating sex offenders utilize a cognitive-behavioral approach to teaching self-management and self-control with the goal of teaching sex offenders how to anticipate high risk situations and to increase their awareness of choices regarding behavior through the development of functional coping skills. Barbara Scwartz, Program Director of the state of Washington's comprehensive sex offender program, has found that relapse-prevention strategies are particularly helpful when a wide range of support persons,
including family, friends, employers, and probation/parole officers are knowledgeable about the patterns of relapse and can reinforce appropriate supports and interventions (Schwartz, 1992). Washington state's treatment standards for treating sexual offenders are similar in theory to that proposed by Masters
and Johnson. Both propose that treatment goals for sex offenders should include at a minimum the following issues:
- Address deviant sexual urges and fantasies as necessary to prevent sexual
reoffense;
- Educate clients and the individuals who are part of their support systems about the objective risk of
reoffense;
- Teach methods of self-control to avoid sexual
reoffending;
- Consider the effects of past victimization as factors in reoffense potential;
- Modify thinking errors and cognitive distortions where possible;
- Educate clients about the effect of sexual offense upon victims, their families, and the community;
- Assist clients in developing a sensitivity to the effects of sexual abuse as well as empathy;
- Address client's personality traits and personality deficits that are related to reoffense potential;
- Address client's social deficits and inadequate coping skills; and
- Include and integrate the client's family into the therapy process where appropriate
(Washington Administrative Code 246- 930-220, 1991)
It is widely recognized by experts in the field of sexual offenders that sexual deviance is a complex combination of physiological, cognitive, affective, social, cultural, and even spiritual issues" (Schwartz, 1992). This requires the utilization of multimodal, integrated therapeutic techniques which are individualized to meet the complex needs of individual sex offenders. Family Trauma Service's Sexual Offender Treatment Program was developed as a multimodal therapy which combines trauma-based, cognitive-behavioral, and relapse prevention strategies to assess and treat the myriad of issues presented by adolescent sexual offenders. Treatment for sex offenders is accomplished through the provision of individual therapy, group therapy, home-based family therapy, and home-based mentoring. The FTS Treatment approach utilizes many of the techniques previously reviewed, including addressing the core trauma issue, self-monitoring and self-control, social skills, relapse rehearsal, modifying cognitive distortions, coping, and anger management. Family, friends, probation and parole officers, and other community supports are routinely utilized as key persons to reinforce appropriate interventions.
References:
Schwartz, M. F. (1992), Sexual compulsivity as post traumatic stress disorder: treatment perspectives, Psychiatric Annals, 22 (6).
Schwartz, B. K., (1992), Effective treatment techniques for sex offenders, Psychiatric
Annals.
The
Successful Treatment of Adolescent Sexual Offenders.
By Rod Baber, LCSW
Adolescent sex offenders and their treatment were chosen as our first "spotlight program" because this is the primary program around which Family Trauma Services originated. Although FTS began in 1993, several of the staff had worked together in a community based sex offender program for nearly five years prior. From that experience came several realizations that culminated in establishing the core philosophy of our program.
The first realization was that youth who acted-out sexually exhibited many of the same difficulties as other troubled youth. Low self esteem, lack of judgement, poor coping skills and impulse control were traits of youth at risk. Traumatic life events were frequently combined with inadequate support or supervision to produce a child or adolescent who viewed their environment as hostile, their situation as hopeless and their ability to change as none existent. Another realization was that these youth and their families could make significant changes and that low to moderate risk adolescent sex offenders could be treated successfully in the home or community at less cost and with a higher rate of success than incarceration or residential treatment.
A final realization was that the same model used to treat adolescent sex offenders was also effective with children and youth suffering from a variety of acting-out behaviors such as posttraumatic stress disorders, oppositional defiant disorders, conduct disorders, depression and many others.
One of the basic concepts of Family Trauma Sevices' ASO program is the importance of working both internally and externally. By that we mean that youth who act out are driven by feelings and thoughts internally as well as circumstances that are external in their families, friends and community. The success of our program came from combining two effective treatment modalities. Traditional outpatient treatment (individual and group therapy) were combined with intensive home-based services to provide a comprehensive treatment modality that reinforces the strengths in the youth and their families and incorporates the resources available in the community.
The Outpatient portion of the ASO program uses a cognitive/behavioral relapse prevention model originating from the Pathways workbook published by The Safer Society. That and many techniques developed over the years encourage youth to take responsibility for all actions in their life and to understand fully the impact that their behavior has on others and the consequences to them.
Many of the youth in our program have been physically, sexually or emotionally abused. While not allowing this to be used as an excuse or justification for their behavior the ASO program helps youth to cope with these experiences and to find more effective ways to deal with them.
Outpatient therapy (individual, and group) tends to address the internal factors driving behaviors. In a vacuum, however, outpatient therapy is frequently dependent on what the client self discloses. This is frequently not the most reliable information in the beginning of the therapy process as many adolescents don't give their trust lightly and there is a certain amount of testing to see how much you know and how far you will go.
Home-based services reinforces and expands the ASO outpatient program. A masters level therapist (HB-I) works directly with the youth and their family in the youths home and community. HB-I counselors also provide family therapy, case management services and make contact with essential services in the community such as school, jobs and probation . As many of the ASO youth do not have an available father, a bachelors level counselor (HB-II) is also used to provide direct guidance. The HB-II meets regularly with the youth and encourages them to find positive activities, peers and helps them to access community resources such as jobs and help them to achieve program goals.
The FTS team coordinates services within the agency, the community and the family to provide a comprehensive service plan for at risk youth in the community.
Putting
the Pieces Back Together
By Rod Baber, LCSW
The good news was that Jim's alcoholic and physically abusive father left him and his mother when he was four years old. The bad news was that Jim and his mother had a difficult time until Paul, his step-dad, came along when he was six. Paul was a godsend for a six year old boy, He was a big, muscular, fireman and Jim loved to tell the kids at school that his dad was a fireman and that Jim visited the fire station frequently and sometimes got to ride on the fire trucks. Paul was likewise impressed with Jim and they did a lot of things together like sports and fishing.
Jim was an active, bright, sensitive youngster who did well in school without trying hard. Other kids gravitated to Jim's natural leadership abilities and he always had plenty of friends. Things were going pretty well for Jim until "she" came along. She was his half sister, Jenny. Although having a sister sounded like a good idea, Jim wasn't prepared for how it would change things for him. There is often a natural jealousy when sharing the limelight with a younger sibling, but in Jim's case he felt like Paul dropped him off the stage entirely. Not only did his parents spend a lot of time with his new sister, but the trips to the fire station and being included in his step-dad's life ended abruptly in exchange for trips to the park with Jenny. Jim was sent to stay after school each day with Paul's mother, and his older cousins.
Jim liked his grandmother because she gave him some of the attention that he had lost. The problem was the older cousins who picked on him and made fun of him at every opportunity. The verbal taunting that he received from his cousins became more physical when grandmother wasn't looking and they threatened to beat him up if he told.
One day the cousins were much more friendly towards him and shared their toys and included him in their games. They began playing a game that began with taking off their clothes and over a few weeks ended up with both boys sexually molesting Jim repeatedly over several months. Jim didn't know what to do. He was afraid to tell because of his cousins threats but also afraid of what Paul's reaction would be. Jim felt helpless. He never told his parents what happened, but he thought some how they knew and didn't care. Jim's behavior started to change. He became more angry, oppositional and aggressive. Jim complained that he was too old to stay with his grandmother and she said that she could no longer manage his behavior. He convinced his mother that he could come home after school and let himself in.
His sister was now in pre-school and his mother had gone back to work.
This is when Jim's secret life really began. He was always smart enough to make decent grades with little effort. What Jim really wanted, however, was to not feel helpless again. After school he got involved with other kids whose parents weren't around much until about 6:30. He started doing exciting things that gave him a sense of control. He rode his bike fast and jumped ramps that he kept making higher and higher until he graduated to a moped and then his older friend's motorcycle. Jim was always taking chances and pushing the envelope but miraculously never got hurt. Even when he got into trouble he usually was able to talk his way out of it. Accept with Paul, who became more and more punitive. It became a contest between them. Jim was angry because he missed the good times he and his step-dad had before his sister was born and also because he felt that his step-dad did not protect him when he was abused by his cousins. Paul was a big man with a quick temper. Jim didn't confront him directly but there were a lot of little things that he could do to frustrate his step-dad and this gave Jim a sense of power. When loud words and spankings no longer seemed to work his step-dad started taking away the thing that really mattered to Jim; his exciting life after school. His step sister was now in kindergarten and Jim was thirteen. Jim was made to stay home after school and wait for his sister and take care of her until his mother came home.
Jim liked Jenny even though he felt that she had messed up his life. She looked up to him and followed him around where ever he went and did what he told her. Even when he was mean to her she always forgave him. Jim felt frustrated and helpless without his freedom and the excitement he had become used to. When Jim felt helpless he would sometimes remember what happened with his cousins. On a conscious level Jim did not set out to hurt his sister but unconsciously he was looking for a way to regain control of his life and get even with his step-dad. He began to systematically "groom" his sister for what he had in mind. He never forced her or threatened her but he could get her to do things by giving her things, or threatening to tell her father about some minor infraction of the rules. Although he knew what he was doing was not right he had a number of ways that he could justify it in his head.
He blamed it on Jenny, and Paul and convinced himself that he was actually educating Jenny. One day Jenny told a friend who told her mother and then everything unraveled.
Child Protective Services was called and when Jim's step dad found out he put his fist through a wall and said he never wanted to see Jim again.
Jim was arrested and placed in detention. Jim denied the abuse at first, then said it was his sisters fault, then he promised never to do it again. Nothing worked. Jim was placed into a foster home with no other children. He was also ordered into an outpatient adolescent sex offender program in which he had weekly individual and group therapy. He also had a home-based counselor who worked with Jim, his foster family and Jim's mother. He also had a mentor who involved Jim in more positive activities and helped him feel better about himself.
This is usually the part where people begin to see the error of their ways and start to turn their lives around. It wasn't that easy for Jim. First of all his step-dad refused to consider his returning home. Secondly, even though Jim looked good on the surface he still maintained his secret life that he shared with no one. When his normal charm didn't work he became more obstinate and angry. He was placed in two foster homes in which he did well initially but he eventually began pushing the limits and avoided any commitments. Jim kept his world of thrill seeking a secret. He snuck off as much as possible. When confronted he would become defensive or confrontational. Jim had difficulty accepting authority and as a result was in and out of foster care and juvenile shelters for almost a year.
Jim maintained a tough shell that no one could penetrate. People that worked with Jim found him to be intelligent, charming and fun to work with to a point. After that Jim shut down. He covered his pain so well that no one knew what was going on until after it was too late. Jim began to run away when things began going well or when he started feeling attached to his foster parents. He made it all the way to California once and eluded the authorities for over a month. When Jim returned he began to make some changes. He stopped fighting and began to work in his outpatient treatment and with his home-based workers. Jim began to see his pattern and the consequences it was causing him. He started making a concerted effort to develop relationships with others and to trust. Jim became more open about his offense and also the feeling he had about his own abuse. With time Jim began to deal with his loses and make the best of the situation available to him. As he did that he began to meet his goals and other doors opened up to him. He was able to reconcile with Paul and his family although he could not live with them. His interest in school and positive interests grew. Gradually but inevitably the pieces began to fit.
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