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February 8, 2008
Book Review: Working with children and young people who sexually abuse

 

Working with children and young people who sexually abuse:
Taking the field forward

Edited by Martin C. Calder
Publisher: Russell House (July 2007)
Paperback: 302 pages
ISBN-10: 1905541015
ISBN-13: 978-1905541010
$99.95 at www.amazon.com

            Martin C. Calder does an excellent job assembling a group of experts to discuss current developments in the understanding of youths who sexually abuse. In 20 chapters, each author brings literature reviews and current research, ranging from diversity and special needs among sexually abusing youths, typologies, assessment, and deviant arousal to attachment theory and restorative justice. This volume shows how the body of research in the study of juvenile sexually abusive behavior is being enriched by a growing number of scholars and practitioners who are investigating the problem. Underrepresented in this volume are psychopharmacology and the neurobiological effects of abuse and neglect—the impact of trauma on brain development. While both are mentioned, the amount of potential impact on treatment these two areas offer warrant complete chapters to discuss the related research and practice.

Calder’s volume represents an increasing shift away from the previously-recommended relapse prevention approach. This volume encourages us to see youths who sexually offend as troubled children with behavior problems rather than just as criminal sex offenders. This is a divergence from current public policy initiatives (see the Adam Walsh Act) that work to deepen the criminalization of youths who sexual abuse.

While this volume is subtitled “Taking the Field Forward,” it accomplishes this by taking us back to theory and practices used for decades to work with delinquent youths. The cluster of risk factors for delinquency in youths—developmental, social, economic, biological, environmental, and neurological—contributing to the violent and exploitative behavior has been studied for decades. However, this information may be considered new for understanding youths who sexually abuse. It is apparent that the field is turning back to well-understood interventions for troubled youths: resiliency building, strength-based programs, family interventions, reestablishing community support, and recognizing diversity.

The pendulum began to swing away from treating youths who sexually abuse as juveniles with mental health and behavior problems towards treating them as criminalized juvenile delinquent sex offenders. This was precipitated by victim advocates who started to change the politics of sexual abuse and increased awareness of the profound impact that sexual abuse has on victims. Not only did legislation change, but treatment practices and clinical theory changed as well. Psychodynamic theory and process-oriented treatment was replaced with psychoeducation and cognitive/behavioral treatment. This promoted interventions focused on abusive behavior, accountability, and criminal consequences. The opinion that the field needs to readjust the clinical understanding and treatment approaches for youths who sexually abuse back to multi-modal, mental health-oriented, individualized treatment and away from a “one-size-fits-all relapse prevention approach” is well represented in the articles in this collection.

We are advised in this collection to be mindful of the complexity of factors contributing to sexual abusive behavior by youths. Articles by Hackett, Richardson, and others addressing diversity; special needs; emergent personality disorder; the effects of trauma, abuse, neglect, and violence; and the problems caused by disruptions in early attachments, create a wide view of the environment that gives rise to sexual abuse. The articles that discuss the importance of the relational field in treatment, as well as strength and skill-based treatment curriculum, and a restorative justice community intervention also create a wide view of an environment that gives rise to rehabilitation. 

Prescott and others note that youths who sexually abuse are different from adults, particularly regarding developmental flexibility. Adults become less flexible and somewhat more predicable. This has created a problem regarding reliable risk prediction with young people who sexually offend. This understanding, along with the long-standing research that youths who sexually abuse are more likely to go on to commit nonsexual offenses than sexual offenses, supports the notion that we have to return to a broader view of risk factors.

The discussion in the chapters by Leversee, Ryan, and Quayle on assessment, typology, and risk factors suggests that there are several things that have to go wrong throughout a child’s development for him to commit sexual abuse. What is interesting is that when we add up all the findings represented in this volume we could be also be describing youths who get involved in many types of abusive and delinquent behavior, including substance abuse and gang-related abuse. While our research is struggling to predict sexual recidivism for juveniles, we are also noting that we have decades of information about risk factors that contribute to general delinquency and antisocial behavior. We know nonsexual delinquency recidivism is more probable than sexual delinquency recidivism. Our research is leading us to consider the importance of addressing general delinquency risk factors as part of the driving force underneath sexual abuse. The research offered in this volume suggests that juvenile sexually abusive behavior could be seen as a type of delinquent behavior committed by youths with the same risk factors: caretaker abuse and inconsistency, abuse, neglect, trauma, and developmental disabilities—all of which have been outlined in this volume—that also lead to other forms of violence, substance abuse, and antisocial behavior. The material also suggests that if we address these risk factors we will reduce risk for sexual abuse as well as other forms of delinquency. 

Phil Rich’s article on attachment provides this volume with an organizing clinical theory that helps pull together the pieces of the “jigsaw puzzle” that Calder mentions in his introduction. Rich starts with a disclaimer stating that there is no definitive research linking attachment deficits and the commission of sexual abuse. He then suggests that it still appears to be very important even if not yet proven. Here he seems to be drawing on the idea that attachment deficits, which are linked to other forms of juvenile delinquency, may be part of the same dysfunction that contributes to sexually abusive behavior. The article goes on to carefully discuss treatment components designed to address empathy and insecure and disorganized attachment styles.

Each article in this volume makes some mention of the importance of caretaker consistency, supportive environment, intimate attachments, and family/community connection. The treatment models presented in this volume, like MEGA by Rasmussen and Miccio-Fonseca, and Good Lives by Collie et al., have connections to others and attachment at their core. From the view presented in this volume, the field seems to be drifting back to basic treatment values: forming therapeutic attachments to our youthful clients and helping them form trusting, need-fulfilling relationships with others so emotional needs can be met in a relational context rather than through exploitative and violent behaviors.

Several decades ago, mental health clinicians who tried to treat youths who sexually abused with psychodynamic, insight-oriented mental health approaches found that insight by itself didn’t lead to behavior change. In addition there was a lack of emphasis on accountability and victim empathy. Psychodynamic theory and practices were discarded as an ineffective treatment approach. What is offered in Rich’s article is an inclusion of psychodynamic theory without necessarily using insight-oriented practices and without discarding victim empathy. It is implied that a dynamic formulation can inform the clinician about areas of vulnerabilities in his or her clients and target points of intervention using other, more effective methods, without expecting that insight alone will change behavior in the client.

This volume helps opens the field for a wider and deeper understanding of causal factors for delinquent behavior and allows the reader to consider additional factors and interventions in the treatment of youths who sexually abuse. 
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