Treating Children with Sexually Abusive Behavior Problems Guidelines for Child and Parent Intervention This page intentionally left blank Treating Children with Sexually Abusive Behavior Problems Guidelines for Child and Parent Intervention Jan Ellen Burton, PhD Lucinda A. Rasmussen, PhD with Julie Bradshaw, LCSW Barbara J. Christopherson, LCSW Steven C. Huke, MS David H. Justice, MS Contributor First published 1998 by Haworth Press, Inc. This edition published 2013 by Routledge 711 Third Avenue, New York, NY 10017 2 Park Square, Milton Park, Abingdon, Oxon, 0X14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 1998 by The Haworth Press, Inc. All rights reserved. No part of this work may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, microfilm, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cover design by Monica L. Seifert. Library of Congress Cataloging-in-Publication Data Treating children with sexually abusive behavior problems : guidelines for child and parent inter- vention / Jan Ellen Burton ... [et al.] ; David H. Justice, contributor, p. cm. Includes bibliographical references (p. ) and index. ISBN 0-7890-0473-9 (alk. paper). ISBN 0-7890-0472-0 (alk. paper). 1. Sexual disorders in children—Treatment. 2. behavior disorders in children—Treatment. 3. Children—Sexual behavior. 4. Child psychotherapy—Parent participation. 5. Parent-child interaction therapy. I. Burton, Jan Ellen. RJ505.P37T74 1998 618.92,858306—dc21 98-6095 CIP CONTENTS About the Authors vii Preface xi Acknowledgments xiii PART I: GUIDELINES FOR PRACTICE Chapter 1. Sexually Abusive Behavior Problems: Definitions and Current Knowledge 3 Defining Sexually Abusive Behavior Problems 6 Current Knowledge 9 Summary 27 Chapter 2. A Treatment Approach 29 Trauma Outcome Process 31 Using the Trauma Outcome Process in Therapy 49 Summary 55 Chapter 3. Integrated Treatment Planning 57 Assessment for Integrated Treatment Planning 58 Treatment Modalities 75 Assessing Treatment Progress 83 Summary 88 Chapter 4. Parallel Group Treatment 89 Structure of Group Treatment Program 90 Treatment Topics in Children's Group 96 Group Treatment for Parents 104 Combined Groups 106 Summary 106 PART II: TREATMENT EXERCISES Introduction 111 Chapter 5. Accountability 113 Activity: Draw the Offense 113 Activity: Taking Responsibility for Your Problems 116 Activity: Steps and Slides Abuse Cycle 119 Activity: The Hot Seat 126 Activity; Catch That Thinking Error! 131 Chapter 6. Empathy 139 Activity: "Conversation" with the Victim 139 Activity: Letter to the Victim 142 Activity: The Giving Tree 149 Activity: Draw Victim/Own Face 152 Activity: How Would You Feel If... ? 154 Activity: Why My Child Didn't Tell Me 157 Activity: Empathic Responses 160 Chapter 7. Coping with Trauma 165 Activity: Basket of Trigger Feelings 165 Activity: What Happened After You Were Abused? 168 Activity: Who Is Responsible? 174 Activity: How My Family Has Changed 177 Activity: The Fire 179 Chapter 8. Relationship Skills 187 Activity: Anger Thermometer 187 Activity: Trust Target 192 Activity: Trust Exercises 198 Activity: What Makes a Friend 201 Activity: Wheels of Intimacy 204 Activity: Flight Plan for Effective Communication 206 Activity: Blueprint for Boundaries 214 Chapter 9. Sexuality 225 Activity: Body Respect 225 Activity: The Great Big Stop Sign 230 Activity: A Touch Is a Touch 234 Activity: Relapse Prevention "Fire Safety Plan" 237 Activity: Communicating Sexual Values 245 Chapter 10. The Power of the Treatment Team 251 Activity: Collaboration 251 Epilogue 254 References 255 Index 269 ABOUT THE AUTHORS Jan Ellen Burton, PhD, is a psychologist at Valley Mental Health and in private practice in Salt Lake City, Utah. She currently coordinates the sexual abuse program for children and adolescents at Valley Men- tal Health. This program includes both victims and perpetrators. Dr. Burton previously worked with adult sex offenders at the Center for Family Development. In recent years she has made a number of pre- sentations in connection with her work with sexually abused and sexu- ally abusive children. Over the past twenty-two years, Dr. Burton has primarily worked with children, adolescents, and their families. She provides individual therapy in conjunction with family treatment. Dr. Burton believes it is critical to create an environment in which children are able to verbalize their opinions, thoughts, and feelings. If victim issues are not addressed, there is a risk that victimization will lead to perpetration. Jan Ellen Burton graduated from Purdue University in 1975, and has had individual therapy and group treatment experience with adults as well as juveniles. She has worked in the substance abuse and outpatient units at Valley Mental Health and has had experience within the public school systems in Salt Lake City, Utah, and Milwaukee, Wisconsin. In addition, Dr. Burton worked with physically and emo- tionally handicapped children at the Curative Rehabilitation Center in Milwaukee. The 1992 article "Precursors to Offending and the Trauma Outcome Process in Sexually Reactive Children," published in the Journal of Child Sexual Abuse, was an initial attempt to conceptualize responses to victimization as they relate to perpetration. This book developed as a continuation of that early conceptualization. Lucinda A. Rasmussen, PhD, is an assistant professor at the School of Social Work at San Diego State University. She received her doctor- ate in social work in 1995 and her MSW in 1983 from the University of Utah in Salt Lake City. Dr. Rasmussen was a licensed clinical social worker in Utah for over ten years. She coordinated the group treatment program for chil- Vll Treating Children with Sexually Abusive Behavior Problems VIU dren with sexually abusive behavior problems at Primary Children's Medical Center's multidisciplinary Child Protection Team in Salt Lake City. Her clinical experiences include treating child sexual abuse vic- tims and their families as well as adolescent and adult sex offenders. Her interest in understanding how victimization can lead to the devel- opment of perpetrating behavior led to her work with sexually abusive children. In Utah, and now in San Diego, Dr. Rasmussen has helped create and improve treatment resources for juvenile sexual offenders and children with sexually abusive behavior problems. She is currently a member of the San Diego County Network on Sexual Offending and the California Coalition on Sexual Offending. She was previously a founding member of the Utah Network on Juveniles Offending Sexu- ally (NOJOS). She coordinated a nine-day training symposium for practitioners on the assessment and treatment of juvenile sexual offenders. She co-authored two Utah state reports about juvenile sexual offending and helped develop state protocols for the identifica- tion and assessment of juvenile sexual offenders for Utah's juvenile justice system. Dr. Rasmussen has published two articles on child sexual abuse intervention in the Journal of Child Sexual Abuse, She also authored a manual for the Utah Division of Family Services to train foster parents on parenting strategies for managing children with sexual behavior problems. Julie Bradshaw, LCSW, is a clinical social worker currently serving as the Director of the Child Protection Team at Primary Children's Medical Center in Salt Lake City, Utah, where she has worked for seven years. The Child Protection Team specializes in assessing and treating victims of abuse and their families. Ms. Bradshaw received her BA in 1975 and MSW in 1981 from the University of Utah, where she graduated with honors. She majored in psychology as an undergraduate and specialized in the treatment of abused children while in graduate school. Ms. Bradshaw's career, which began in 1974, has included broad experience in the field of social services. She has worked extensively with troubled and delinquent youth within the Youth Corrections and Mental Health systems. She has also worked with abused and neglected children, within the Utah Division of Family Services. Ms. About the Authors IX Bradshaw served as a troubleshooter for the Executive Director of the Utah Department of Human Services, investigating child fatalities, complaints, and consumer concerns. Barbara J. Christopherson, LCSW, is a licensed clinical social worker who has specialized in developing intervention programs and providing treatment for victims of abuse and domestic violence. She received her MSW in 1979 from the University of Utah in Salt Lake City. She helped establish the multidisciplinary Child Protec- tion Team at Primary Children's Medical Center in Salt Lake City and served as the team's director for four years. She also served as president of the Utah chapter of the American Professional Society on the Abuse of Children (APSAC). Ms. Christopherson has act- ively collaborated with other child abuse professionals in Utah and Oregon to improve treatment services for victims of abuse and their families. She has given presentations at numerous local, regional, and national conferences. She is currently in private practice and is a family therapist at the Morrison Center Counterpoint Program in Portland, Oregon. Steven C. Huke, MS, received his bachelor's degree in psychology from Reed College and his master's degree in clinical psychology from the University of Utah. He was a member of the Child Protec- tion Team at Primary Children's Medical Center in Salt Lake City. Mr. Huke has given presentations at regional and national confer- ences on the treatment of youth with sexually abusive behavior problems and sexually victimized children. He is currently a family therapist at the Morrison Center Counterpoint Program and has a private practice in Portland, Oregon. David H. Justice, MS, is a research specialist at Salt Lake Valley Mental Health and an instructor in sociology at Salt Lake Commu- nity College in Salt Lake City, Utah. His research interests are in the areas of medical sociology, the sociology of mental health, and social problems. He has presented papers on the effects of psycho- social stress on chronic disease. His teaching interests include the areas of the sociology of mental health, social psychology, research methods, and the sociology of race and ethnicity, particularly Native American issues.