In the shoes of a therapist for kids who have caused sexual harm

(For your information: the following stories contain potentially heavy or upsetting material. They are modifications and conglomerations of stories from nearly 200 kids and families throughout North Carolina. The identifying information and situations are fictional and could not be linked to our clients, past or present.)

Caleb, Stage II, Affect regulation and Attachment, Family

Caleb and his dad both report that they have never gotten along. Caleb’s older brother, Shawn, is currently incarcerated for selling drugs. Shawn coerced Caleb into watching pornography from the ages of 5 to 8 with him and would laugh when Caleb said he didn’t like the show or wanted to watch something else. Caleb was really close with his mother who died of cancer three years ago. A year after his mother’s death, he approached a classmate in the bathroom and touched him inappropriately. He has been in treatment for the last 5 months. Since Caleb’s offense, dad confided in you that he wants to be more involved in his son’s life. Caleb is currently living in foster care and he spends his time playing video games during home visits. Caleb’s dad does not want to stop Caleb from playing video games so there is little interaction during home visits. Family reunification is critical for treatment success and it is promising that Caleb’s dad is engaged in the treatment process.

Welcome to our bi-weekly TASK (Treatment Alternatives for Sexualized Kids) Program staff meeting where we discuss case files of our clients. TASK is a treatment model designed to meet the complex, heterogeneous needs of youth who have caused sexual harm. As the newest member of the team, you will be presenting background information for your 4 kids and current barriers you are experiencing in treatment. We will offer guiding questions to develop an action plan that could overcome the barrier. Your current clients are Matthew, Samantha,  Albert, and Rashawn. Go ahead and tell us about how treatment is going:

 

Matthew, Stage V, Risk mitigation, Affect regulation

Matthew, age 17, is in Stage V and has led conversation and offered honest responses to others during group therapy. His primary caregiver, grandma, is supportive and cooperative. She has mastered strategies on how to enforce boundaries for Matthew while still encouraging him. He wants to get a job but his grades are well below average and he is skipping class every few days, a violation of his safety plan. He told you a neighbor offered him a job mowing lawns. You would like him to be able to get a job but know that he has a pattern of starting projects and stopping halfway. You are excited about the overall progress throughout the past year of treatment and want to set him up for success as we approach his program graduation date.

Questions and action steps offered by the clinicians:

Review his safety plan and utilize motivational interviewing. Does he recognize any connection between skipping class and the rigor involved in maintaining a job? What are some of his big goals? What obstacles, like poor grades, might prevent him from reaching his goals?

Does grandma have influence in his life? Is she able to challenge him to attend school?

Has he established supportive friendships since starting treatment?

 

Samantha, Stage III, Conflict resolution and healthy sexuality, Family

Samantha is 13. She called last week during school and told you she felt like she was going to have a panic attack. You deescalated the situation by phone and she was able to function the rest of the day. During this week’s family meeting, you realize that adopted mom and dad are unaware that Samantha has struggled with anxiety. Instead, they are upset that she has not cleaned her room every day and washed the dishes like they had discussed.  They spend the first 20 minutes of the meeting describing everything Samantha has not done since your last meeting. Based on your conversations with adopted mom and dad from early on, they have tightened up their discipline and increased Samantha’s chores considerably. After 40 minutes have passed, mom announces that they caught Samantha with inappropriate pictures on her phone 2 weeks ago. Since then, they have checked Samantha’s phone every night before bed. Lastly, Samantha told them she might be interested in a boy in her class but mom and dad inform you that she is not allowed to talk to him anymore.

Questions to consider:

Have you had a conversation with mom and dad about their perspectives around healthy relationships and attitudes towards sex?

Can you provide mom and dad with specific suggestions about how to handle crises?

At the end of the meeting, inform mom, dad, and Samantha that you are going to work together to review Samantha’s safety plan in the next family meeting. Provide time for all 4 of you to contribute and ask questions. Ideally, a reviewed safety plan will address the insecurity and doubt felt by her adopted parents, provide age-appropriate autonomy to Samantha, and ensure she is progressing towards her stage goals without causing harm.

 

Albert, Stage II, Family, Affect Regulation

Albert lives with his aunt and uncle. He is in Stage II and this is your 3rd family meeting. From the beginning, aunt has requested he be moved to therapeutic foster care, unaware that some of Albert’s mood fluctuations are a result of the family system. Albert has been diagnosed with ADHD and has broken a few dishes and a chair since you started meeting with the family. The uncle drinks frequently and Albert’s outbursts coincide with alcohol related outbursts. Additionally, Albert has a history of abandonment and his parents are no longer involved in his life. During individual therapy, Albert admits he is often unable to control his anger and has had trouble sleeping recently. He has a few friends but no one he is close with. When you try to gauge whether the aunt and uncle have motivation to change, they impatiently bring up the idea of foster care.

Questions to consider:

Are there pro-social opportunities in which Alex can get involved? Would he consider joining a sports team or other intramural activity? How can he gain a sense of belonging outside of home?

Have you tried talking to the aunt and uncle about their lives apart from Alex? Showing interest in them could foster an engaged relationship that would allow them to feel more comfortable participating in the treatment process.

Could there another diagnosis besides ADHD? Could you screen for other signs of depression or bipolar?

 

Rashawn, Stage II, Crisis at school, Trauma

At school this week, Rashawn got angry during class and walked out. He was not cooperating with his teacher and the teacher grabbed him and tried to make him sit down. Rashawn responded by screaming and cursing and nearly punched the teacher. The school called you after Rashawn had calmed down a little bit and was sitting in the principal’s office. Rashawn was verbally and physically abused by an aunt from the age of 7 to 9. He has no other trauma history as far as you know.

Questions to consider:

Is the school and the teacher aware of Rashawn’s safety plan?

Have the teachers had trauma-informed training on how to handle crises?

Does Rashawn recognize when his emotions are escalating?

Does he feel comfortable or able to call you or another support person when his emotions start escalating?

 

After this meeting, you have time with Samantha and her family,  Matthew and his grandma, and with Rashawn, individually. Additionally, you have group tonight so after staffing, you get ready to hit the road to meet up with Samantha. You take a few minutes to make sure you and the other therapist are on the same page about the group agenda tonight. You are excited to hear updates from the kids. Looking forward to a full day!

Thank you for reading more about what the day to day is like for our TASK clinicians. The research projects are still underway. We are currently revising the project plan in order to incorporate more preliminary steps before a more rigorous investigation. The therapists, business team, data team, and countless others have become a cohesive, engaged working group as we bring together our questions, experiences, and expectations for this project!

Inside a Room of Secret Agents at Children's Hope Alliance

The LCSW’s (licensed clinical social workers), QP’s (qualified professionals), and LMFT’s (licensed marriage and family  therapists) are the staff members on the ground with our clients who have caused sexual harm. These TASK (Treatment Alternatives for Sexualized Kids) agents are less known to the rest of the world but celebrity to our kids and the communities impacted by their actions. They meet clients at school, over a basketball game, or with a mouthful of McDonald’s fries. Neither traffic, round-a-about Charlotte city routes, backcountry western Carolina roads, and unlisted addresses prevent them from spending time with the clients’ families. Trashcans, Jenga blocks, and snack packs are their weapons of choice to teach concepts like the difference between consent, compliance, coercion, and cooperation. TTFOFLA(two-three-four-or-five letter acronyms)is their language of choice:

TF-CBT: trauma-focused cognitive behavioral therapy

SA: substance abuse

CFT: child and family therapy

PCP: person-centered plan

DSS: Department of Social Services

DJJ: Department of Juvenile Justice

They encounter stories about clients stealing dirty underwear, experiencing daily emotional abuse, and getting into fights at school. And yet, our TASK staff find ways to laugh and continue to serve kids another day. As a result, our teenage clients and their families trust the agents who jump right into the mess of their real lives. In the short few months since joining the TASK and CHA (Children’s Hope Alliance) team, this physics major has watched people bring hope to hurting children and families when the world can’t always be explained with formulas and algorithms.

An update on our project

The TASK team has been working hard to establish a manual that reflects the diverse experiences of our staff from Charlotte to Guilford. Staffing and time with the kids allow us to watch the TASK model in action. Data collection is underway as we determine what TASK elements are most effective and efficient in bringing change to the lives of our clients’ and families. We are developing research procedures and structures to produce relevant and rigorous results. Those will be presented to our field and related subfields which include child psychology, sexual abuse, trauma care, child development, and juvenile delinquency.  The more research we do, the more excited we are about TASK and its potential to reach others who have caused sexual harm.

Justice is not so simply dealt out: walking with kids who cause sexual harm

My name is Grace Watt. As I transition into my new job, which I will describe later, I have had to ask some complicated and emotionally distressing questions.  The following essay is part of an ongoing, maturing conversation with myself as I process what I am learning and how I might more effectively respond to the issue of sexual offense. This essay contains heavy and unsettling material; humility, an open mind, and hope are a good tools to tackle it all…

Let me begin with a thought experiment:

  1. Think about the worst thing you have ever done to someone.
  2. Go find someone in the room with you right now and tell them about that event.
  3. Have them ask you more specific questions about that experience. Specifically, have them ask you questions about your selfish underlying motives and the way your actions affected everyone around you.
  4. Now, role play the situation; except I want you to take the role of the person you hurt. In that way, you can more fully explore the consequences of your actions and how you made that other person feel.
  5. Only one more step! I want you to take that event, a brief description of the worst thing you have ever done to someone, and put it at the very top of your resume. Be ready to provide full disclosure to all future employers and friends and family about why that situation happened.

It does not matter that there may have been a reason for your actions. Maybe your best friend was shot. Maybe your daddy beat your momma. Maybe you are just doing what your older brother’s friend taught you to do.

That was a sexual offense. You are a sexual offender. A danger to the public;  despised by society. You should not have a job. You cannot be at parks. When you travel, find routes that avoid all schools.  You are disgusting.

With these common responses to people labeled as “sex offenders,”  we should not wonder why it might be difficult for someone to admit to a sexual offense. If they admit they did something, will they find support? Or will they become something less than human with a one dimensional story?

What might be some barriers to changing harmful behavior? How do our natural stereotypes, preconceptions, and attitudes create another insurmountable obstacle for people already trying to tackle the daunting task of change?  Putting ourselves in the shoes of a person who has committed a sexual offense helps us imagine what it would be like if we were defined by the worst thing we’ve ever done; if we had to wonder whether our mistakes were so big that we’re never allowed to move on from them.

The answer is not to go easy on sexual offense. Sexual offense can cause long term and multifaceted damage to the victim; the goal is not to delegitimize the necessary and potentially arduous healing process for survivors of sexual harm.  If you are a survivor of sexual offense, efforts to help offenders should not take away your dignity or self-worth. My hope is that these two separate, but related conversations would prevent further harm and lead to full life for you as a past survivor and also for anyone who might be a past perpetrator.

In order to prevent a person from causing further sexual harm, we must patiently try to understand the dynamics behind minimization of offenses and the mechanisms that could motivate someone to change their behavior. Many people who commit sexual offense might stop hurting others and also avoid the ostracization from friends and family if they knew how to stop the thoughts and situations that can lead them to harming other people.  They might not know how to cope with life because few people beyond mental health professionals have more than a basic understanding of what causes a person to sexually harm others and what could help them change. People who know that they committed a sexual offense may believe there is no hope for love and acceptance if anyone else knew. They might be right until we can better respond and listen without reducing them to their offense.

People who cause sexual harm are not just sex offenders.  Yet, we don’t swing to the other extreme and remove all responsibility by blaming their action entirely on past abuse done to them. They are human and we are all a complicated mix of victim and perpetrator. We all cause harm to others and we ourselves are hurt by others. It would be much simpler if there was one evil person and one victim. Then we could just get rid of the evil person.

As I have spent the past two weeks learning about the development of the TASK Program (Treatment Alternatives for Sexualized Kids), it has become abundantly clear that justice is not so simply dealt out.  The stories and lives of these kids are complex.  When the mug or paparazzi shot of an adult sex offender flashes across the screen, that person is dehumanized and met with little compassion.  As the age of the offender drops below 18, we are often more willing to ask what extenuating circumstances might have led a child to commit an act.

My role at Children’s Hope Alliance

I am working with the TASK program at Children’s Hope Alliance. Children’s Hope Alliance offers a wide range of services beyond TASK including foster care, adoption, and outpatient therapeutic services throughout North Carolina. Since it’s founding date in 1891, CHA has provided hurting children and their families with a safe place to heal and have hope for the future.

TASK is a more recent addition to Children’s Hope Alliance that meets the particular treatment needs of youth who have committed offenses and require sexual harm specific treatment.  In it’s 10 years of existence, TASK has successfully reduced rates of reoffending and allowed kids to have a meaningful relationship with their community and their family. Because there are few effective programs available for this population, we are hoping to expand our program nationally and internationally.  In order to do that, we will demonstrate TASK’s effectiveness and validity by being identified as an evidence based practice. My job is to coordinate this effort and I have just completed my second week in this role.

The Impact Fellowship Program

This opportunity is part of the Impact Fellowship program offered through Davidson College that places it’s graduates in substantial roles at non-profit organizations. The program is allowing us a front row seat in dealing with questions of considerable complexity, urgency, and potential for significant systemic changes in society.  It has been humbling to see that our supervisors have confidence in us as demonstrated by the scope of our projects and our clearance and autonomy.  The daunting nature of this project could lead to anxiety and paralysis. However, I have a renewed sense of power and control in a role like this because I have tools to tackle a project of this scale. Davidson equipped me to problem solve by breaking down large goals, being relentless in finding the necessary resources, and leaning heavily on other people’s collaborative expertise. Instead of fear, the size of my project excites me because  I know it will have substantial and lasting impact.

This is the first taste at how Davidson prepared me to handle real world situations. At the time, I lacked confidence and security because I rarely felt finished and always was more aware of how I could improve than of what I had done well.  I became more convinced I could not handle nor had any control over the problems and tasks required of me.   Yet because I lost a sense of self-understanding and self-empowerment that worked for me as I child, I now have a clearer view  of a world greater than myself. I have increased capacity to understand problems beyond my limited personal experience and skillset. I am more aware of a rumbling, sturdy foundation under my feet, made up of the vast community of people addressing similar problems from different angles with different experiences and expertise.  I step without hesitancy into a battle bigger than myself because I understand that sustained strength must come outside of myself.  In order to face inconceivably difficult problems, I must find a source of inconceivable wonder and hope.

As I undertake this fellowship, I lean upon the resources, wisdom, and support of many others and with that, I am excited to share with you in this adventure.

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