Understanding, Assessing, and Rehabilitating Juvenile Sexual Offenders

Phil Rich

• Publisher: Wiley
• Year: 2011
• ISBN:
  9780470931974
• Edition: 2
• Topic: Psychology
• Subtopic: Forensic Psychology
• Index: Psychology

Praise for
Understanding, Assessing, and Rehabilitating Juvenile Sexual Offenders, Second Edition

"The Second Edition of Understanding, Assessing, and Rehabilitating Juvenile Sexual Offenders showcases Phil Rich's experience and mastery of the research and clinical literature. In my view, this is an excellent therapy book and, like its predecessor, will help practitioners to work effectively and ethically with juvenile offenders. It is destined to become a classic."
—Tony Ward, PhD, DipClinPsy; Victoria University of Wellington, Wellington, New Zealand

"Phil Rich is considered one of the world's leading authorities on how best to understand, assess, and treat juvenile sexual offenders, and this Second Edition of his excellent text shows why he is held in such high regard. All theoreticians, researchers, and practitioners whose work brings them in contact with juvenile sexual offenders should definitely read this remarkable book."
—W. L. Marshall, OC, FRSC, PhD; Director, Rockwood Psychological Services, Ontario, Canada

"Phil Rich's book, Understanding, Assessing, and Rehabilitating Juvenile Sexual Offenders, Second Edition offers new and thought-provoking ideas, updates, and information, especially on developmental pathways. This book is one of the few publications on juvenile sexual offending that offers something new and revealing to the field."
—Robert E. Longo, LPC, NCC, ACS, BCIA-EEG, BCN; Serendipity Healing Arts, Lexington, North Carolina

"Phil Rich masterfully fills the gap in the juvenile sexual offender treatment literature with a book that is neither introductory nor narrowly specialized. Seasoned veterans will appreciate his thoughtful and studied approach. Newcomers will find this book a vital go-to resource."
—David Prescott, LICSW, Clinical Director, Becket Family of Services, Falmouth, Maine

"Mind-blowingly brilliant—Rich by name and rich in depth, detail, description, and debate. An instant classic, Understanding, Assessing, and Rehabilitating Juvenile Sexual Offenders, Second Edition is both comprehensive and challenging with its material and messages, yet reassuringly accessible and practical."
—Martin C. Calder, Calder Social Work Training and Consultancy, Leigh, Lancashire, UK

THE LANDMARK TEXT FOR WORKING WITH JUVENILE SEXUAL OFFENDERS AND UNDERSTANDING SEXUALLY ABUSIVE BEHAVIOR IN CHILDREN AND ADOLESCENTS—NOW FULLY REVISED

Thoroughly revised, the Second Edition of Understanding, Assessing, and Rehabilitating Juvenile Sexual Offenders guides mental health professionals through the breadth of assessment and intervention methods available for working with this special population, providing a succinct yet complete survey of the field, the etiological development of sexually abusive behavior in juveniles, and a reliable resource for assessment, treatment, and rehabilitation.

Part I

Understanding Sexually Abusive and Sexually Troubled Youth

Chapter 1

Introduction and Updates

Framing the Ideas and the Tasks

As described in the brief introduction, in the seven or so years that have passed since the first edition of this book, many things have changed in the field of treatment for juvenile sexual offenders, although in some ways these changes have been quite subtle. Actually, it might be more accurate to say that many things have changed in the way that we, as researchers and practitioners, see and understand the children and adolescents with whom we work, the way in which we see ourselves in relationship to the work, and the framework by which we conceptualize treatment and implement treatment interventions.

Seven Years On: Emerging Ideas, Themes, and Models

Reflected in and driven by an expanding and evolving literature, over the past seven years we have seen the consistent emergence of a number of themes within that literature, adding to a new age in the development and, from my perspective, advancement of our thinking and practice. In our approach and in our thinking, we increasingly and now more consistently than ever recognize troubled young people as “whole” people, and we recognize the need for a multifaceted, multidimensional, and multisystemic approach to treatment.

Thus, we not only see our clients as multifaceted and multidimensional, and far more than just their sexually abusive behaviors, but we see the treatment itself as equally complex and far-reaching and more than simply the sum of its parts. There is an increasing recognition that the therapeutic relationship itself is at the heart of treatment and that treatment is not simply technique and the delivery of information. We recognize that, beyond what we teach young people through cognitive-behavioral and psychoeducational treatments, of great importance is the manner in which we approach and see them and the way in which we help them to think about themselves and others. And we recognize the power of developmental experience and social context on the formation of personality, neurological development, social connectedness, social competence, and current behavior.

Although relatively new to our still-developing field, few of these ideas are new to the larger field of mental health treatment in which sexual offender–specific treatment is embedded. Accordingly, the treatment of sexually abusive youth, and to some degree the treatment of sexually abusive adults, has entered the larger arena of psychosocial and mental health treatment. In so doing, it has moved away from the black-and-white world of behaviorally oriented and, to some degree, cognitive-behavioral therapies and simplistic psychoeducational treatment models that formerly permeated the field of adult and juvenile work. Indeed, we see these changes in our attitudes, in our practices, and in our sensibilities. One only need look at the Good Lives Model (Ward, Polaschek, & Beech, 2006),1 which provides an individualized and humanistic mental health approach to the treatment of adult sexual offenders, to see such changes. In addition, the influential work of the practitioners and researchers cited throughout this book has not only helped shape and reshape our thinking and approach to understanding and treating juvenile sexual offenders but has also helped introduce and import state-of-the-art ideas from the surrounding and more general world of mental health treatment.

It is not that we have concluded that our former approach to the treatment of young people with sexual behavior problems was ineffective. In fact, there is no evidence that our former treatment methods did not work, at least based on widely described statistics regarding juvenile sexual recidivism, which are the best and most obvious indicator of treatment effectiveness. On the contrary, although different studies have reported different rates of recidivism, the most commonly reported statistics have consistently illustrated relatively low rates of sexual reoffense among juvenile sexual offenders, rates that frankly are not likely to get much lower. Thus, changes and developments in our field reflect a change in our perspective about and sense of treatment and a shift in our thinking about what it is that makes treatment effective or ineffective as well as the manner in which we think about our clients.

The Treatment Process

With respect to our view about what makes treatment work, we have recently come to believe that it is the treatment process rather than the treatment method or technique that is most effective, or at least central, in the application of method. That is, it is the treatment process that drives effective outcomes in treatment rather than the techniques of treatment or the materials we use. For example, Beech and Hamilton-Giachritsis (2005) write of a change in the treatment of adult sexual offenders from a direct and confrontational style to a model built on supportive and emotionally responsive treatment relationships. Similarly, Marshall (2005) recommends that clinicians adopt a relationally based approach to treatment, writing that the attributes and behaviors of the therapist more greatly influence behavioral change than the techniques and methods of treatment manuals.

These ideas fit with those found in the general literature of psychotherapy, in which we are increasingly recognizing that what the clinician brings into treatment, in terms of attitude and characteristics, strongly affects the outcomes of therapy (Baldwin, Wampold, & Imel, 2007; Kramer, de Roten, Beretta, Michel, & Despland, 2008; Marmarosh et al., 2009). There is, then, an increasing recognition in our work with offenders, adolescent and adult, that the techniques and content of treatment are inadequate on their own and that treatment ideas and tasks are most effectively delivered and worked on through the therapeutic interaction between clinician and client, the environment in which treatment and rehabilitation occurs, and the investment of the client him/herself.

Over time, as more clinicians have come both to recognize the complex needs of the sexually abusive youth they treat and to apply critical thinking to their work, unidimensional models that consider treatment to be essentially psychoeducational or cognitive-behavioral have been increasingly replaced by more clinically sophisticated and complete models that recognize the wholeness and complexity of clients and their needs and the need for multidimensional treatment. Longo and Prescott (2006) write, “Our new century finds growing support for [this] holistic/integrated model of treatment” (p. 37), and emphasize the use of a warm, empathic, and rewarding approach in working with juvenile offenders over a hostile, confrontational, and harsh treatment style that they conclude is ineffective with sexually abusive youth.

A Third Direction

The first edition of this book described this evolving model and way of thinking as a “third direction,” and this third, or newly emerging, direction remains the focus of this second edition, in which sexually abusive youth are understood as our children, in need of understanding, support, personal development, and social connection, not as social pariahs destined to become adult criminals and sexual predators. This third direction moves away from pendulumlike swings between a criminal justice approach and a humanistic orientation, moving instead toward an integrated and complex model free of either end of the spectrum and unfettered by a single pivot point somewhere in the center. This more mature, advanced, and informed third direction promulgates a holistic, multifaceted, and integrated approach to treatment and understands and treats the adolescent as a person in development with patterns of thinking and behavior unique to adolescent development rather than simple shadows of and precursors to early adulthood. It recognizes the troubled, antisocial, detached, and socially abhorrent nature of sexually abusive behavior but works with the emotional, cognitive, social, and behavioral components basic to mental health and the development of sound and resilient individuals.

These relatively new ideas in sexual offender treatment—that we need to build therapeutic alliances with our clients, help instill hope in them, and help them grow rather than simply confront, challenge, and judge them—are welcome and bring the treatment of juvenile (and adult) sexual offenders closer to therapeutic principles and processes already found in mainstream psychotherapy. Beyond the realm of treatment and the treatment process, further linking our understanding and treatment of juvenile sexual offenders to the larger field of mental health is the idea that our clients, the young people with whom we work, are individuals who travel along individual pathways through life.

Heterogeneity and Multifactorial Pathways

Even though they frequently share similar histories and diagnoses, and sometimes prognoses, we now more fully recognize the heterogeneity of sexually abusive youth, described by Caldwell (2002) as “one of the most resilient findings in the research on juvenile sexual offenders” (p. 296). Yet another emerging perspective, then, clearly related to the multifaceted nature of the youth with whom we work is our recognition that sexually abusive behavior neither develops in a vacuum nor follows a simple, one-size-fits-all pathway driven by factors common to every sexually reactive child or sexually abusive adolescent. Accordingly, we now more clearly understand and describe a multifactorial pathway to the sexually troubled and abusive behavior of children and adolescents, along which different individuals develop differently.

Put another way, the root of juvenile sexual offending is multidetermined, involving individual, family, peer, school, and community variables (Letourneau, Schoenwald, & Sheidow, 2004) as well as biology (O'Connor & Rutter, 1996), temperament (Kagan & Snidman 2004), and socioeconomics (Lipsey & Derzon, 1998). Thus, despite the many developmental commonalities and shared features in the lives of sexually troubled youth, the development and enactment of sexually troubled behavior is a complex phenomenon and develops under conditions and through circumstances that are different for each person. Even though the pathway for many sexually abusive youth often starts at a common point, we have learned that we cannot predict the eventual outcome of the pathway because, like smoke drifting into the air, it is influenced by many subtle factors, many of which we are unaware or cannot predict. There are no predetermined pathways that inevitably set into motion any particular behavior, including sexually troubled behavior. Individual pathways are so complex and influenced by so many factors, both subtle and obvious, that it is unlikely that we will be able to define a single pathway, or set of factors or events, that leads to the same behavioral outcome for every individual first stepping along a similar path.

Multiple Pathways to Sexual Recidivism

We have also come to recognize not only a multifactorial pathway to the development of sexually abusive behavior but that multiple factors are also at play in sexual recidivism, an idea clearly reflected in the work of Tony Ward and colleagues in the development of their self-regulation model of offense and relapse (Ward et al., 2004; Yates, Kingston, & Ward, 2008). In turn, this has led us to reconsider our view and use of the relapse prevention plan as the only and best means for combating and managing sexual relapse, a plan that has been increasingly critically scrutinized (Carich, Dobkowski, & Delehanty, 2008; Wheeler, George, & Stoner, 2005), rejected by some (Laws, 2003; Thakker, Ward, & Tidmarsh, 2006; Ward, Polaschek, & Beech, 2006; Yates, 2007), and subject to some recent spirited debate (Carich, Dobkowski, & Delehanty, 2009; Yates & Ward, 2009). This new thinking has helped to shift the balance from what Laws (2001) described as the uncritical acceptance by the treatment community of the relapse prevention model to a more critical and sophisticated mind-set and has added to our expanded understanding and conceptualization of what drives both recidivism and the individuals who recidivate.

The Social and Ecological Environment

Juvenile sexual offending does not develop in a vacuum. Over the past seven years, we have seen an increasing recognition that troubled sexual behavior occurs in a social and developmental context, not absent of interactions with the environment. Again as in mainstream psychotherapy, we have come to see children and adolescents in context, engaging with, influenced by, and contributing to an interacting set of social forces and systems in which we understand that the attitudes, beliefs, social interactions, and behaviors of our children can be more fully understood only in the context of the ecological environment (Bronfenbrenner, 1979; Elliot, Williams, & Hamburg, 1998).

In this systems theory model, there is a constant interaction between individuals and other individuals, between individuals and the systems within they live and function, and between systems. Just as in a physical ecology, all aspects of the environment are linked, mutually interactive, and influential. In adopting a developmental and ecological perspective, we can more easily see the “fit” between the sexually troubled behaviors of children and adolescents and the social environments in which they live, learn, and function and with which they constantly interact. This view—not new to social work, which has long considered it imperative to see and work with the person in situ (in the situation of his or her life), and family systems theories, which understand individuals as members of a family system—has helped to promulgate treatment models such as multisystemic therapy, which work with delinquent and sexually troubled youth in and within their families and communities.

Evidence-Based Treatment

In fact, many of the ideas discussed have been derived from a developing and deepening research base that has grown stronger over the past seven years and with it, a focus and even reliance on research. Tied to this, another clearly emerging theme in our literature and practice is that of evidence-based, or empirically validated, treatment (seemingly pushing aside the prior term, “best practice”). In many ways paving the way for both stronger and more effective practice, evidence-based treatment requires that we account for the therapeutic practice models we develop and apply, provide support for their value, and demonstrate their effectiveness. As we learn how to use this instrument of evidence-based practiced, we must also recognize that it is currently, and may remain for some time to come, a clumsy instrument that is as capable of great harm as it is great good. We must therefore think about what models of evidence-based treatment currently exist, how to develop new models, how such models are empirically validated and upon what evidence they are built, how we conceptualize and measure the variables that we define as evidence, and how we apply such models.

As we consider evidence-based treatment, we must also take into account the ideological perspective embodied in the philosophy of evidence-based treatment by which only particular methods of measurement are considered valid and treatments are considered valid and supported only when they are capable of being measured in the prescribed fashion. Here, Greenberg and Watson (2005) remind us that the dominant view in psychology at the moment is that quantifiable evidence alone counts and that “the fallacy that ‘absence of evidence means evidence of absence’ is currently dominating psychotherapy funding, practice, and education” (p. 113). Similarly, Smith and Pell (2003, p.1460) describe the risk that our search for the “holy grail” of evidence-based practice may overfocus us on empirically based research alone, excluding the search for and use of clinical expertise and judgment. Discussed later and again in Chapter 18, it is important, then, that we remain alert to the possibility that research will become the tail that wags the dog, with “the dog” being the practice of treatment.

Developing Models and the “Allure” of New Disorders

Other themes that have consistently appeared in the literature, as well as the subjects of workshops in conferences and training presentations, are attachment-focused, trauma-informed, and psychoneurological models that further inform us of the complexity of the individual and the inevitable interrelationship between the developing child and his or her social environment. Although these ideas and themes are still developing, one hopes they are with us to stay and will provide the foundation for further growth in our thinking, but they have a downside as well as an upside.

The upside is that these ideas promote an openness, richness, and sophistication in our thinking, and they allow us to see children, adolescents, and adults as complex beings. They allow us to recognize and take into consideration the natural power of the social environment in which children are raised and the developmental process through which they pass while in these social environments, which I described as the “developmental-learning environment” in the first edition of this book. However, we also risk the “allure of rare disorders” described by Haugaard (2004), in which attractive new ideas may become buzzwords, or the “soup de jour,” and begin to lack real meaning, blinding us to larger and still more complex factors and issues and potentially simplifying, rather than furthering, our thinking. It is critical that as we take new ideas on board, we do not throw out the baby with the bathwater. As we expand our thinking, we should build on and integrate new ideas with foundational ideas, synthesizing an evolving set of ideas rather than discarding one set of ideas in favor of another that may turn out to be just as limiting.

Exercising Caution

Schlank (2009) recently described “pendulum swings” in terms of both research findings and attitudes about sexual offender treatment and wrote of “instant excitement” about new ideas that have led to “knee-jerk reactions, with individuals wanting to abandon...

Table of contents

• Cover
• Title Page
• Copyright
• Acknowledgments
• About the Author
• Introduction to the Second Edition
• Part I: Understanding Sexually Abusive and Sexually Troubled Youth
• Part II: The Evaluation of Juvenile Sexual Offenders
• Part III: The Treatment and Rehabilitation of Sexually Abusive Youth
• Part IV: Approaches to and Methods of Treatment
• References
• Author Index
• Subject Index