Transcript Working with Families where Sibling Sexual Abuse has Occurred

Sibling Sexual Abuse
Unique Issues
Emerging Research
Ontario Network of Sexual Assault / Domestic Violence
Treatment Centres
March 25, 2009
Toronto, ON
Bente Skau, MSW, Ph.D.
Heather Barbour, B.Sc., R.S.W.
Nancy Falls, Ed.D.
Presentation Outline
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Contextualizing sibling sexual abuse
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Research
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Why should we care?
What are our values?
Redefining success as it relates to reunification
Examine the factors that enhance and detract from
successful reunification
Findings from ongoing research examining families where
sibling sexual abuse has occurred
Treatment
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Setting the stage – decision points
Highlight unique treatment issues
All that we
don’t
Know About
Sexual
Behaviour
Among
Siblings
Prevalence
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Finkelhor (1979) found that 15% of girls and
10% of boys had sexual contact with a sibling
Adler and Schutz, 1995; Smith and Israel,
1987; & Wiehe,1990 suggest that prevalence
rates for sibling sexual abuse are greater
than parent/child sexual abuse.
Why we want to know…
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Prevention!!!
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Helps to shape
assessment
Helps to shape
treatment
Helps to create good
reunification plans
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Value of Sibling Relationships
Based on the work by Groza, Maschmeier,
Jamison, & Piccola, 2003
Siblings and Out-of-Home Placement: Best
Practices
“Most children grow up with siblings. The
time they spend together in their early years
is often greater than the time they spend with
their parents. This relationship often lasts for
a lifetime, longer than most marriages and
parent-child relationships”(Dunn, 1985).
Sibling Sexual Abuse
A Double Edged Sword
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In families where they have experienced multi-problems,
sibling attachment is greater than the attachment shown by
siblings who have not experienced such difficulties.
(Lamb & Sutton-Smith, 1982)
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In multi-problem families siblings learn to depend upon and
cooperate with each other as a mechanism of coping.
(Hochman, Feathers-Acuna, & Huston, 1992)
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By the end of preschool years older children serve as
subsidiary attachment figures for their younger siblings.
(Stewart and Marvin,1984)
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Older siblings assist younger siblings in school transition by
acting as a role model and by giving information about the
experience.
(Stewart and Marvin, 1984)
Provides emotional support to adults in later life.
(Cicirelli,1982; Hegar, 1988)
EARLY FRUSTRATIONS
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NO CLEAR ROAD MAP
OPPOSING NEEDS OF VICTIM, OFFENDER
AND FAMILY
PROFFESIONALS NEED TO RECONCILE
THEIR OPINIONS/FEELINGS ABOUT
WORKING WITH VICTIMS AND OFFENDERS
HIERARCHY WITHIN MULTIDISIPINARY TEAM
GIVING VOICE TO THE OPPRESSED IS
EASIER SAID THAN DONE
BELIEFS
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REUNIFICATION IS A PROCESS
VICTIM NEEDS DICTATE THE PROCESS
ACCOUNTABILITY AND RESPONSIBILITY ARE
NECESSARY TO MOVE BEYOND SAFETY
ADULT VICTIMS HAVE INFORMED OUR THINKING
RESOLUTION IS PART OF A REUNIFICATION
PROCESS:
RESOLUTION IS THE PROCESS OF RESTORATION,
MAKING AMENDS, MAKING PEACE
FAMILY RELATIONSHIPS ARE CHANGED THROUGH
A RESOLUTION PROCESS
UNIQUE FEATURES OF
SIBLING INCEST
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MAGNIFICATION OF SAFETY ISSUES
CONFUSING RESPONSIBILITY
HEIGHTENED ‘BAD PARENT SYNDROME’
DIVIDED LOYALTIES
COGNNITIVE DISTORTIONS,BELIEFS,
ATTITUDES,AND COMMUNICATION PATTERNS
THAT ARE SHARED AND ENDORSED IN THE
FORM OF FAMILY MYTHOLOGY (SCHEMA)
REUNIFICATION
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RELATIONAL REUNIFICATION
 A therapeutic reunification is completed - the siblings do not
reside together but relational contact is maintained
HABITATIONAL REUNIFICATION
 A therapeutic reunification is completed – contact is a progressive
process which result in the siblings living together
STATIC REUNIFICATION
 A therapeutic reunification is completed - the siblings were not
ever separated and the reunification work was completed in
therapy while the siblings were residing in the same household
NO THERAPEUTIC REUNIFICATION
 The treatment and reunification work was not completed in a
therapeutic setting
A 5-step family therapy protocol to
treat sibling on sibling sexual abuse.
Hodges, C.E. (2002)
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Step One: Report the abuse and separate the
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sibling victim and victimizer
Step Two: Complete evaluations of family members
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Step Three: Begin family therapy
Step Four: Bring sibling victim (s) and sibling
victimizer together in family work
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Step Five: Family therapy termination
Kaplan, Becker, & Martinez (1990)
Journal of Family Violence, 5, 209-214
Mothers of adolescent males who sexually abused a
sibling (n = 48)
vs.
Mothers of adolescent males who sexually abused a
nonfamilial person (n = 82)
Sibling
Nonsibling
Sexual abuse
34%
14%
Physical abuse
44%
25%
Prior individual treatment
38%
15%
Denial of son’s offences
17%
60%
O’Brien, 1991
adolescents with sibling victims (n = 75)
vs.
adolescents with extrafamilial victims (n = 95)
On average, adolescents with sibling victims:
• Offended for longer time periods
• Were more likely to engage in sexual penetration
• Were more likely to have multiple victims
• Were more likely to experience physical abuse
Worling, 1995
adolescent males who abused younger siblings (n =32)
vs.
adolescent males who abused younger extrafamilial
children (n =28)
Adolescents who abused siblings reported more…
• marital discord
• parental rejection
• negative family atmosphere
• dissatisfaction with family relationships
• physical punishment
• childhood sexual abuse
Determining Factors Related to
(Un)Successful Reunification
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Clinical experience
Clinicians survey
Develop Hypothesis of 12 critical factors
We then examined factors and variables of
over 60 families
Identified top 12 factors
(6 Enhancers / 6 Detractors)
Presenting early Findings – data collection is
ongoing
Did the Siblings Reunify?
70%
60%
50%
40%
Families
30%
20%
10%
0%
Yes
No
In Progress
Descriptors of Youth/Child who
was Sexually Harming a Sibling
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88% Male
50% in Special Education
26% have intrafamilial and extrafamilial
victims
24% victimized more than 1 sibling
30% used force or violence during the
offense
10.1 years average age of 1st Incident
Sample
Mothers
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59% have a current mental health difficulty
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68% victim of woman assault
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78% victim of sexual abuse
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79% victim of physical abuse
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25% victim of sibling incest
Sample
Fathers
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25% have current mental health issue
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60% perpetrator of woman assault
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6% victim of sexual abuse
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64% victim of physical abuse
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0% victim of sibling incest
Type of Offense Committed
(the most intrusive noted)
40%
35%
30%
25%
20%
15%
10%
5%
0%
touching
genitals
oral sex
intercourse
anal sex
attempted
anal or
vaginal
intercourse
Rate of Reunification for 56 Families
35%
30%
25%
20%
15%
10%
5%
0%
Did Not
Reunify
Relational
Reunification
Habitational
Reunification
Static
Reunification
Number of Sexual Offenses/Incidents
30%
25%
20%
15%
Incidents
10%
5%
0%
Once
2-5X
5-10X
10-25X
25-50X
Over 50
Number of Sexual Offenses
For Siblings Who Reunified
50%
45%
40%
Relational
35%
30%
Habitational
25%
20%
Static
15%
10%
5%
0%
1-5X
5-25X
Over 25X
Duration of Sexual Offenses
For Siblings Who Reunified
70%
60%
Relational
50%
40%
Habitational
30%
Static
20%
10%
0%
1X- 1 month
1 month - 1
year
Over 1 year
Factors that Enhance Reunification
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Hope/Belief that reunification is possible
(significant at the .01 level)
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Treated within the same agency
(significant at the .01 level)
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All family members supportive and involved
(significant at the .01 level)
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Supervisory system and unified approach
(significant at the .01 level)
No significant relationship found
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Parental acknowledgement /hold the child/youth who has sexually
harmed responsible
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Clinicians familiar with the unique issues
Factors that Detract from
Reunification
No significant relationship found
 Blended families with divided loyalties
 Ongoing victim blaming by the parents
 Lack of support/cooperation by child protection
services
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When the victim’s voice is not heard or does not direct
the process
The lack of separation of the victim and the child/youth
who has sexually harmed
Mental health issues in at least one parental figure
Next Steps?
Treatment
Applying a Collaborative and Staged
Approach to work with Siblings and their
Families
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Decision Points
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Placement
Contact and Communication
Decision Points
Placement Decision-Makers
Placement Options
When to allow siblings to remain
Decided on a case by case
together…
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There is
No
Checklist!
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basis
Often seen in historical
abuse
Seen more in younger
children
Collaboratively decided
Risk level
Safety must be established
Supervision
Voice of the victim
When the benefits outweigh
the potential harm
Contact and Communication
Decisions
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Criteria for communication
Criteria for contact
Decisions
Criteria for Communication between
Siblings
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No communication during the assessment
Extent and timing of communication is victim
driven
Communication is different than contact
Start with parameters of communication
The discussion of the sexual offending
behaviour is a graduated process which
begins with letter writing and works towards
an apology session
Early Questions
From Victim to Offending Youth
 Are you angry I told?
 Do you want to see me or are you mad that I
told?
 Do you want to see me again
 Are you working hard to get the sexual abuse
out of the brother relationship with me because I
miss all of the good parts of our relationship?
 Are you talking to your counsellor about the
abuse?
 How are you doing?
Questions for Offending Youths
Counsellor
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Is my brother working hard in his counselling
because he did not work hard at school. How do
you know if he is listening to you?
How is my sister doing - does she miss me?
Does Tony talk about missing me?
Do you know my brother Trevor?
Are my parents getting treatment because they
need to?
Middle Treatment Related Questions
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If I said no or stop would you listen to me now?
Do you know that bothering your older brother is
regular and that doesn’t cause sexual abuse?
What do you think?
Do you think of touching me if I’m bothering
you?
Do you think my bothering you is a test?
Could sexual abuse happen again?
Do you have new safety rules?
Is being mean now the same as a long time ago
when he was mean and sucked penis.
Questions for Parents
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What would help you trust me again?
Will you ever stop being angry for what I did?
Are we still a family?
Future Focused Questions
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How are we going to talk about this in the
future?
Are you going to tell your wife/husband about
what happened?
What about being with my kids?
Criteria for Contact
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No contact during the assessment
The nature, extent, and timing of the contact is
victim driven
Parental supervision and support is considered
Supervised externally structured social contact is
different than therapeutic contact that is co-created
by clients
A graduated approach to contact is recommended
(from supervised community visits to overnight
home visits)
Negotiating family events and holidays
General issues to work through
before first Therapeutic Contact
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Safety
Meeting Context
Meeting Content
Acknowledgement of abuse occurring
A commitment that the abuse will stop
Will of both siblings
Competent supervisor
Communication
Home Environment
Prior to 1st Contact
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Acknowledgement of abuse occurring
A commitment that the abuse will stop
Will of both siblings
Competent supervisor
The Apology Letter
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It is a process to write
The apology letter is an offender treatment
exercise that addresses:
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Victim empathy
Taking the perspective of the other
Taking responsibility
Summary of change and a narrative of their new
identity
Prevention plan
Example
First Draft
Dear Joe
Sorry about making you play with my penis. I will never
do it again. I was stressed and that’s why I did that. I
have learned from my past and will never do it in the
future. I learned that what I did was wrong and I am a
new guy and I need more chances to prove it to you.
Final Copy
I am writing this letter to say I am sorry for what was done in the past and I hope you accept
this letter of apology. I hope you choose to read this letter but it is your choice. I am glad
that you told about the sexual abuse. I believe that it took a lot of courage to talk to the
CAS about this and I am not angry with you at all for telling. You are not responsible for the
abuse. I alone am responsible for what happened. Because you told I was able to get the
help that I needed not to ever do that ever again.
I am sorry I made you touch my penis. It was wrong and I am so sorry for the harm that it
may have caused you. It was wrong to betray the trust you had in me as your older brother.
I was very confused and stressed before because of all that was happening. I was being
teased at school every day and I had no friends. Our parents divorce was very difficult and
mom’s new boyfriend did not want me around. I took that stress out on you and that is not
fare and I know that is no reason for what I have done and I have realized that now. I have
learned from my past. I am trying hard to talk about my feelings and not get so stressed. I
have completed the diversions program and am continuing my counseling. I have learned
to control my anger and have been doing better in school and got a job. I am truly sorry
about what I did and I know it caused you harm and mental trauma and it will never ever
happen again. I follow my new rules and have five ways to deal with stress so that I would
never commit another offense. My plan includes biking and swimming and walking the dog
because that helps me stay calm. I talk to mom and dad now and I have some friends that
also keep me busy. I no longer look at pornography and know sexual safety rules.
If you want me to answer any questions that you have I can do that. I hope we can have a
future together as brothers but I will understand if you do not want that. If you need help I
will be here. I plan to do everything I can to maintain a non- offending future.
Potential Reunification Outcomes
Habitational
Static
Relational
No Therapeutic Reunification
Unique Treatment Issues
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Safety
Sex and Sexuality
Parenting
Safety = Hope
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Knowledge of one’s safety allows for the
possibility of hope.
Sexual abuse is the loss of personal power.
The creation of safety allows for the
restoration of power.
When you are empowered, then you are in a
position to define your future.
The recognition of the victims voice is the
vehicle that allows for the
redefinition/transformation of the future.
SAFETY PLANNING
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Creation of safety rules is victim driven
All family members must agree to abide by the rules
Safety planning is a process beginning with rigid,
well defined rules and moving toward more flexible,
co-created rules
Rules need to encompass home, community, and
extended family visits
Rules need to describe supervision requirements,
touch, privacy, access to sexual materials, and
sexual conversations in the home
SAFETY RULES ON HOME VISIT
Example 1
1. No violence
2. Mom must be present to supervise always
3. Supervision on computer always
4. No alcohol
5. No smoking in apartment while I’m visiting
6. Brother’s friends cannot be at apartment
during visit
Safety Rules
Example 2
1. No talking about the abuse when I’m at
home
2. Mom has to see us if we are in the same
room
3. No going upstairs together
4. Have to ask for a hug
5. No wrestling
Special Issues in Treatment
Sex
and
Sexuality
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Brought to the forefront
in the family
Must be addressed in
family treatment
Issues to Examine in Assessment
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History of sexual abuse in family
History of sexual offending in family
Pairing of sex and violence in family
Sexual Environment in the home
The family approach to sex education
Sexually explicit material in the home
The Language of Sex
Identity and Sexuality
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The stigma attached to “sex offender”
The meaning attached to “sexual abuse
victim”
What about “sibling incest”?
It doesn’t have to be black or white
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Sex in context is good
Normal part of
development for
everyone!
Working with families where sibling
incest has occurred - Final comments
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The work is complex requiring specialized
clinical knowledge, skills, and experience
Need to use a collaborative and staged
approach
View reunification differently
Where there is hope, there are possibilities
References for working with families where sibling incest has occurred
Alexander, P. C., & Schaeffer, C. M. (1994). A typology of incestuous families based on
cluster analysis. Journal of Family Psychology, 8, 458-470.
Bischof, G. P., Stith, S. M. & Whitney, M. L. (1995). Family environments of adolescent sex
offenders and other juvenile delinquents. Adolescence, 30, 157-170.
Bass, Linda B., Taylor, Brent, A., Knudson-Martin, Carmen, & Huenergardt, Douglas.
(2006). Making sense of abuse: Case studies in sibling incest. Contemporary
Family Therapy, 28 (1), 87-109.
Caffaro, John, V., & Conn-Caffaro, Allison. (2005). Treating sibling abuse families.
Aggression and Violent Behavior, 10, 604-623.
Canavan, Margaret, Meyer, Walter, J. & Higgs, Deborah, C. (1992). The female
experience of sibling incest. Journal of Marital and Family Therapy, 18,(2), 129-142.
Cyr, Mireille, Wright, John, McDuff, Pierre, & Perron, Alain. (2002). Intrafamilial sexual
abuse: brother-sister incest does not differ from father-daughter and stepfather-stepdaughter incest. Child Abuse & Neglect, 26, 957-973.
De Jong, Allan, R. (1989). Sexual interactions among siblings and cousins: Experimentation
or exploitation? Child Abuse & Neglect, 13, 271-279
Groza, V., Machmeier, C., Jamison, C., Piccola, T. (2003). Siblings and out-of-home
placement. Families in Society: The Journal of Contemporary Human Services, 82 (4),
480-492.
Haskins, C. (2003). Treating sibling incest using a family systems approach. Journal of
Mental Health Counselling , 25 (4), 337-350.
References for working with families where sibling incest has occurred
Falls, N.A. (2001). An empirically derived typology of families of adolescents who commit sexual
offenses. Unpublished doctoral dissertation, O.I.S.E. / University of Toronto, Toronto.
Hodges, C.E. (2002). A 5-step family therapy protocol to treat sibling on sibling sexual abuse. In M.C.
Calder (Ed.), Young people who sexually abuse: Building the evidence base for your
practice (pp. 376-385). Lyme Regis, England: Russell House Publishing.
O'Brien, M. J. (1991). Taking sibling incest seriously. In Familiy Sexual Abuse: Frontline Research and
Evaluation, Michael Quinn ED. Sage Publications: California.
Phillips-Green, Mary, J., (2002). Sibling Incest. The Family Journal: Counselling and Therapy for
Couples and Families, 10 (2), 195-202.
Rayment-McHugh, Sue, & Nisbet, Ian. (2003). Sibling incest offenders as a subset of adolescent
sexual offenders. Paper presented at the Child Sexual Abuse: Justice Response or
Alternative Resolution Conference, Adelaide, Australia, May 1-2.
Rayment, Susan, & Owen, Nicole. (1999). Working with Individuals and families where sibling incest
has occurred: The dynamics, dilemmas and practice implications. Paper presented at the
Children and Crime: Victims and Offenders Conference, Brisbane, Australia, June 17-18.
Rudd, Jane, M., & Herzberger, Sharon, D. (1999). Brother-sister incest – father-daughter incest: A
comparison of characteristics and consequences. Child Abuse & Neglect, 23 (9), 915-928.
Smith, H., & Israel, E. (1987). Sibling incest: A study of the dynamics of 25 cases. Child Abuse &
Neglect, 11, 101-108.
Wiehe, Vernon, R. (1997). Sibling abuse: Hidden physical, emotional, and sexual trauma (second
edition). Sage Pulications: California.
Worling, J. R. (1995a). Adolescent sibling-incest offenders: Differences in family and individual
functioning when compared to adolescent non-sibling sex offenders. Child Abuse &
Neglect, 19, 633-613.