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.

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