Intrafamilial adolescent sex offenders:

psychological factors and treatment issues

J Grant
D Indermaur
J Thornton
G Stevens
C Chamarette
A Halse
Report to the Criminology Research Council
Grant: CRC 05/03-04

July 2009

This is a project supported by a grant from the Criminology Research Council.

The views expressed are the responsibility of the author and are not necessarily those of the Council.

Intrafamilial adolescent sex offenders*:

Psychological factors and treatment issues

Final Report to the Criminology Research Council

Grant: CRC 05/03-04

March 2008

Grant, J. 1 , Indermaur, D. 2 , Thornton, J. 3 , Stevens, G. 4 , Chamarette, C 5 .,

Halse, A. 6

We agree that the term adolescents who engage in sexually inappropriate behaviour is preferable to
adolescent sex offender because of its emphasis on the behaviour rather than the criminality of the
behaviour. However, most researchers use the latter term and to be congruent with the literature as well
as for parsimony, we use adolescent sex offender.
1
Associate Professor Curtin University
2
Senior Research Fellow University of Western Australia
3
Senior Lecturer Curtin University
4
Lecturer Curtin University
5
Director Clinical Services - SafeCare
6
Research Project Assistant Curtin University

TABLEOFCONTENTS

EXECUTIVESUMMARY

ListofTables

vii

ListofFigures

viii

Acknowledgments

ix

CHAPTER1:

INTRODUCTION

Introduction

CHAPTER2:

ResearchAims

PrevalenceofAdolescentIntrafamilialSexualOffending

Overview

LITERATUREREVIEW

CharacteristicsofAdolescentSexOffenders

Introduction

PriorVictimisation

PsychologicalFactors

FamilyFactors

FemaleAdolescentSexOffenders

Summary

10

TypologiesBasedonPersonalityCharacteristicsoftheOffender

10

TypologiesofAdolescentSexOffenders

Introduction

TypologiesBasedonVictim/OffenceCharacteristics

TheoriesoftheDevelopmentofSexualOffendingBehaviour

Introduction

TheoriesonChildSexOffendingwithaFocusonthe
AdolescentSexOffender

13

14

TheTreatmentofAdolescentSexOffenders

Introduction

16

TreatmentOutcomeResearch

17

CognitiveBehaviouralTherapy

17

ii

IndividualCounsellingandEducation

21

FamilyTherapy

23

MultisystemicTherapy

24

SynopsisofStudies

26

CurrentStateoftheLiterature

27

CHAPTER3:

METHODOLOGY

StudyDesign

28

Participants

28

TreatmentProgram

29

DataCollection

QualitativeMethodology

29

QualitativeAnalysis

30

QuantitativeMethodologyandAnalysis

30

FormalHypothesis

31

QuantitativeDesign

31

QuantitativeAnalysis

31

PsychometricMeasures

31

Procedure

33

DemographicDescriptionofStudyGroup

35

PsychometricPropertiesofStudyGroup

37

QuantitativeDataAnalysis

40

ComparisonofProgramCompletersvsNonCompleters

41

UtilityofKnownTypologiestothisStudyGroup

42

CHAPTER4:

RESULTS

QuantitativeAnalysis

QualitativeAnalysis

ParentIntakeInterviews

43

ParentClosingInterviews

48

AdolescentClosingInterviews

52

CHAPTER5:

DISCUSSION

Introduction

57

CharacteristicsofIntrafamilialAdolescentSexOffenders

57

iii

TheValueofTypologiesofAdolescentSexOffenders

59

TheValueoftheTreatmentProgram

60

Implications

References
Appendices

61

66

75

iv


EXECUTIVESUMMARY

This report presents the findings of research designed to enhance our understanding of
intrafamilial adolescent sex offenders and their treatment. The literature suggests that
multifaceted treatment approaches that include cognitive behavioural, relapse prevention,
andfamilyinterventionsaremoreeffectiveinreducingrelapsethanindividualtherapyalone.
Despitethisevidence,fewfamilybasedprogramsoperateinAustraliaorabroad,andthelittle
availableresearchontheseinterventionstendstobedescriptiveratherthanevaluative.The
presentstudyattemptedtobridgethisgap.
Theresearchutilisedaprospectivedesign,recruitingintrafamilialadolescentsexoffenders
engagedinaspecialisedandmultifacetedtreatmentprogram.Thedesignincludedtheuse
of both standardised measures of treatment targets, and qualitative data derived from
interviewswiththeoffendersandtheirparents.
Theresearchexaminedtheprofileandeffectofpsychotherapytreatmenton38intrafamilial
adolescent sex offenders attending a community based treatment program. Specifically it
examined: 1) levels of psychopathology, coping skills, trauma symptoms, capacity for
empathy,psychosexualcharacteristics,andgeneralpsychologicalsymptoms;2)theprofiles
of the families of intrafamilial adolescent sex offenders and the influence of the family
structure on treatment attrition rates; 3) the value of a community based multifaceted
psychotherapy treatment program to intrafamilial adolescent sex offenders; 4) the
contributionofamultifacetedpsychotherapytreatmentprogramonthefunctioningofthe
adolescents families; 5) the utility of existing typologies of adolescent sex offenders in
understandingacommunitytreatmentsampleofintrafamilialadolescentsexoffenders.
The results reaffirmed some aspects of the picture of adolescent sex offenders slowly
developing from the literature. For example, half of the study group was diagnosed with
some form of psychiatric impairment including, most commonly, Attention Deficit
Hyperactivity Disorder (1 in 4), Post Traumatic Stress Disorder, and developmental delay.
Almostthreeineveryfour(71%)ofthestudygroupreportedbeingvictimsofsomeformof
abuse.Oftentheadolescentoffenderswerethemselvesvictimsofsexualabuse(47.5%).
However,theywerenotanentirelyhomogenousgroup.Atypologyofthestudygroupbased
onelevatedscoresonanextensiveclinicalandpersonalityinventoryindicatedthreedefined
subgroups: i) antisocial; ii) anxious; and iii) narcissistic. This finding was congruent with
previous research on typologies and indicates the need for some individualization of
treatment.
Adolescents in the study group typically came from families where one parent was absent
and/or were step parents. Often, at least one biological parent had a difficult relationship
with various family members including the adolescent offender. Most families reported
difficulties communicating with each other. Relationships between family members were
described as problematic, communication between family members as aggressive or non
existent, and parents had little idea how to deal with inappropriate behaviour or set
boundaries outlining acceptable behaviour. Family members were often openly abusive
towards each other and conflicts were rarely resolved satisfactorily. Rules regarding


acceptable behaviour and personal boundaries were in many cases nonexistent or
inconsistent. Offending adolescents were described by parents as impulsive and isolated
withfewtiestofamilyorfriends.
The study was limited by the small numbers of offenders and an attrition rate, which,
although at the lower end for this treatment population, prevented any statistically
significantevidencebeinggatheredabouttheactualclinicalimpactofthetreatment.The
12to18monthtreatmentprogramrepresentedasignificantcommitmentonboththepart
of the adolescent and his/her family. Changes, as measured by psychometric tests, were
slight and for the most part, not statistically significant. However, parents and adolescent
sex offenders reported changes in the family system at the end of treatment. For the
adolescents,thesechangeswereconfirmedbysignificantchangesinscoresonameasureof
familycohesionandcommunication.
Inaddition,parentsandadolescentsexpressedsatisfactionwiththetreatmentprogramand
the progress made to improve family life. Following treatment, parents reported that
learninghowtodealwiththesexualabusewithinthefamilyandotherfamilyrelatedissues
such as conflict and setting boundaries were the most useful aspects of the program.
Parents also reported that they were better able to cope with conflict and were making a
greaterefforttocommunicateeffectivelywithoneanother.Inturn,mostparentsfeltthat
theirchildrenwerealsocommunicatingmoreeffectively.Generallytheadolescentoffender
was described as more mature, less impulsive, and more likely to have established age
appropriatefriendships.
The adolescents identified talking to someone about their problems and feelings of
acceptance by staff as the main benefits of attending the treatment program. Participants
also reported that they learned some important skills whilst in the program such as self
control,problemsolving,communication,andsocialskills.
Theimplicationsofthisstudyareprimarilythatintrafamilialadolescentsexoffenders:
1. arehighlylikelytobevictimsofsexualand/orphysicalabusewithinthefamily;
2. havealargenumberofcooccurringpsychological,social,andfamilyproblems;
3. areaheterogeneousgroupwithdifferentpersonalityfactorscontributingtothe
offending;
4. requireaholistic,individualized,andcomprehensivetreatmentthatdealsnotonlywith
offendingbehaviour,butwithallcontributingfactors,particularlyfamilydysfunction.
Inconclusionthestudyalsohasimplicationsforpolicyandpracticeimpactingonadolescent
sex offenders. It is suggested that these need to be reviewed, where possible, to
accommodatethedualnatureofthetragedyofintrafamilialadolescentsexoffenderasboth
victim and offender. This is important not only to ensure an appropriate, compassionate,
and effective response to young offenders but also to reduce the likelihood of
intergenerationaloffendingandvictimisation.

vi


LISTOFTABLES

Table1:

OBrienandBerasTypologyofAdolescentSexOffenders

10

Table2:

TypologyofSexualOffendingBasedonVictimandOffence
Characteristics

11

Table3:

AdolescentSexOffenderTypologyBasedonMMPIProfile

12

Table4:

TypologyofAdolescentSexOffendersBasedonCPIProfile

12

Table5:

TypologyofAdolescentSexOffendersBasedonMACIProfile

13

Table6:

OxnamandVessTypologiesBasedonMACIProfiles

14

Table7:

OBrienandBerasSevenKeyFactorsintheDevelopmentofAdolescentSex
16
Offending

Table8:

CognitiveBehaviouralTreatmentStudies

20

Table9:

IndividualCounselling/EducationalTreatmentStudies

24

Table10:

StudiesUsingaFamilyTherapyApproach

25

Table11:

MultisystemicTreatmentStudies

27

Table12:

SafeCareStudyGroup

32

Table13:

ResearchDesign

38

Table14:

SummaryofDemographicDataRelatingtoStudyGroup

39

Table15:

MACIPretestScoresintheSlightlyProblematicRange

42

Table16:

PretestMeanScoresonMSI

43

Table17:

YSRPretestMeanScoresandStandardDeviationsforInternalising,
ExternalisingandTotalScoreScales

44

Means,StandardDeviationsandTestsofSignificancefor
VariablesofFamilyandIndividualFunctioning

44

Table19:

DifferencesbetweenProgramCompletersandNonCompleters

45

Table20:

SafeCareTypologyBasedonMACIPretestScores

46

Table21:

NegativeFeedbackRegardingtheYoungPeoplesProgram

60

Table22:

SuggestedChangestotheYoungPeoplesProgram

60

Table18:

vii


LISTOFFIGURES

Figure1:

Parentintakeinterviews:Domainsandthemeselicited
fromtheparentintakeinterviews

47

Figure2:

Parentexitinterviews:Domainsandthemeselicited
fromtheparentexitinterviews

53

Figure3:

Adolescentexitinterviews:Domainsandthemeselicited
fromtheadolescentexitinterviews

56

viii


ACKNOWLDEGEMENTS

We would like to acknowledge the Criminology Research Council for their funding of this
project,andfortheirpatienceingrantingthenecessaryextensiontotheproject.Inaddition
we would like to thank Curtin University and University of Western Australia for their
supportinconductingtheresearch.
WewouldliketoacknowledgeSafeCare,theagencywherethedatawascollectedfortheir
participationintheprojectfromtheearlydesignstagestothefinalreport.Collectionofdata
puts additional pressures on therapists, administrators and managers that can be
burdensomeinanagency.Inparticular,wewouldliketothankthetherapistsinvolvedfor
theirassistanceincollectionofdataandfortheadditionalworkinvolved,inanalreadyvery
busyagency.
WewouldalsoliketoacknowledgetheverysignificantcontributionsofAmandaThompson,
whoworkedforthreeyearsontheprojectasaresearchassistant.
Finally,wewouldliketothanktheparticipantsandtheirparentsforagreeingtoparticipate
in the project. Without their willing contribution, we would be unable to progress our
understandingofthisverysignificantoffendergroupandtheirfamilies.

ix


CHAPTER1:

INTRODUCTION

The sexual abuse of children has an enormous impact on the child, the family, and the
community (World Health Organisation, 2002). While it is now well understood that sexual
offendingagainstchildrenisacrimeofdevastatingimpact,itisstillnotwidelyappreciatedthat
much of that offending against children is actually perpetrated by other children and, in
particular,brothersofthevictim.Adolescentsexoffenders(ASOs)representthefulltragedyof
childsexoffending,bridging,astheydo,theintergenerationaltransmissionofabuseandthe
complex acting out of early childhood trauma through the victimisation of other vulnerable
children close to them. The ASO is a largely unrecognised problem that defies simple
stereotypesandoftenleadstoaresearchandpolicyvacuumattheplacewhereintervention
and help is most needed. While the literature on adolescent sex offending has rapidly
expandedinrecentyears,thereiscomparativelylittlefocusspecificallyaddressingtheissueof
adolescentsiblingincest.Yet,itisestimatedthatbetween4090%ofintrafamilialabuseoccurs
betweenpeoplefromthesamegeneration(Bentovim,Vizard,&Hollows,1991;Ryan,Miyoshi,
Metzner,Krugman,&Fryer,1996).
Overall,researchontheintrafamilialASOpopulationisverylimited.Researchontreatment
programs and the contribution of that treatment to improved functioning, particularly on
thoseadolescentswhopresentvoluntarilyfortreatment,isevenmorerestricted(J.Grant,
Thornton,&Chamarette,2006;Rasmussen&MiccioFonseca,2007).Inaddition,mostofthe
research on adolescent sex offending does not differentiate between extrafamilial and
intrafamilialoffendersorbetweencommunitytreatmentpopulationsandcustodialtreatment
populations.
Thus,thereisanurgentneedforresearchevidenceonintrafamilialASOs,theirfamilies,and
the impact of treatment programs, especially in the Australian context (Tomison & Poole,
2001). We need to know, for example, how treatment affects different subgroups of ASOs
(Caldwell,2002).Althoughclinicianshavedevelopedataxonomyofessentialtherapeuticaims
forthetreatmentofASOs(Worling&Curwen,2000),littlepublishedresearchhasevaluated
the changes achieved by the adolescents in respect to these targets, or the impact of the
treatmentonthefamily.
Thepresentstudywasdesignedtoaddresssomeofthesedeficits.Themajorpurposeofthe
studywastoprovidearich,layered,anddetaileddescriptionofintrafamilialASOsengagedina
community based treatment program (SafeCare). This analysis was designed to be
comprehensiveandincludetheperceptionsandexperiencesofoffendersandfamilymembers
in relation to treatment, and how treatment had influenced their coping. There were five
specificaimsinthisstudy.

ResearchAims
1. To provide a profile of intrafamilial ASOs, including levels of psychopathology, coping
skills,traumasymptoms,capacityforempathy,psychosexualcharacteristics,andgeneral
psychologicalsymptoms.


2. ToprovideaprofileofthefamiliesofintrafamilialASOsandtheinfluenceofthefamily
structureontreatmentattritionrates.
3. To assess the value of a community based multifaceted psychotherapy treatment
programtointrafamilialASOs.
4. To understand the potential contribution of a multifaceted psychotherapy treatment
programonthefunctioningoftheadolescentsfamilies.
5. TocompareacommunitytreatmentsampleofintrafamilialASOstoexistingtypologies
ofASOsinordertoconsidersimilarities,differences,andimplicationsfortreatment.
In summary, this research aimed to focus very specifically on intrafamilial adolescent sex
offenders(IASOs)engagedincommunitytreatment.Thisshouldhelptoaddressquestions
about this specific population, their treatment needs, their family structures, their
experiencesoftreatment,andwhethertheyaresimilartoothergroupsofASOs.Thestudy
attemptedtoaddresssomeofthegapsinpreviousresearchinordertoaddtotheevidence
about this population. Understanding the population, their families, and how to intervene
effectively with them is critical in order to prevent both current and future abuse from
occurring, as these adolescents move into adulthood and have families of their own.
Interruptingthecycleofabuseearlyandeffectivelywillhelptopreventtheterribleimpact
ofabuseonfuturegenerations.However,weneedtounderstandwhowearetreating,how
they engage in treatment, and how they and their families experience the treatment
process.


CHAPTER2:

LITERATUREREVIEW
Overview

Whiletheliteratureonadolescentsexualoffendinghasexpandedinrecentyears,there
remainscomparativelylessliteraturewithafocusonadolescentsiblingincest.However,
thereisgrowingevidencethatsiblingincestismorecommonthanparenttochildincest.For
example,Bentovimetal.(1991)reportedthat90%ofintrafamilialabuseoccursbetween
peoplefromthesamegeneration.Asmorechildsexualabuseisdiscovered,theextentof
victimisationthatisactuallytheresultofoffendingbyotherchildren(albeitadolescents)will
continuetochallengehowwethinkaboutthisoffenceandhowweshouldrespondtoit.Itis
likelythatifourresponseistobeguidedbytheprincipleofminimisingasmuchdamageand
harmaspossiblewewillneedtoapproachtheissueoftheASOasamatterofpriority.Inthis
literaturereviewwewillattempttoilluminatewhatisknownabouttheprevalence,the
characteristics,andthetreatmentoptionsinregardtoASOs.Essentially,thereviewis
structuredbythekeyquestionsinregardtoASOs:Howmuchadolescentsexoffendingis
there?HowshouldwethinkaboutorunderstandtheASO?Whatcausesadolescentsex
offending?AndhowcanwetreattheASO?Thereviewoftheliteraturepresentedherethus
providesanoverviewoftheprevalenceofadolescentsexualoffending.Thisisfollowedbya
descriptionoftheknowncharacteristicsofASOsandtypologiesthathavebeenproposed.
Thenfollowsabriefoverviewoftheexplanationsortheoriesofadolescentsexoffending.
Finally,thereviewconcludeswithanoverviewoftreatmentinterventionsincludingareview
ofthetreatmentoutcomeliterature.
Atthispointitisimportanttoprovideseveraldefinitions.IntheASOliterature,theuseof
thetermintrafamilialisgenerallyappliedtosiblingrelationships(Cyr,Wright,McDuff,&
Perron,2002).Siblingsincludebiological,step,half,adoptedandfosterrelationships
(RaymentMcHugh&Nisbet,2003;Worling,1995a).Bydefault,extrafamilialrefersto
individualswhoarenotsiblings.Forexample,RaymentMcHughandNisbetdefinedASOsin
theextrafamilialcategoryasthosewhooffendedagainstpeeragedandadultvictims.
However,SafeCarehavetakenawiderdefinitionofintrafamilialtoincludeotherblood
relationshipssuchascousinorniece/nephewaswellasclosefamilyfriendandneighbour.
SafeCareusesthisbroaderdefinitionofintrafamilialbecausefamilyfriendsandneighbours,
forinstance,areofteninpositionsoftrustwithinthefamilysystem.Further,communities
suchasAboriginal,applyabroaderdefinitionofkinship.ItisimportanttonotethattheASO
literaturerarelydifferentiatesbetweenintrafamilialandextrafamilialoffenders.Where
possible,emphasiswillbeplacedontheintrafamilialdata.
PrevalenceofAdolescentIntrafamilialSexualAbuse
Estimatingtheprevalenceofintrafamilialsexualabuseisobviouslyadifficulttaskgiventhe
secrecysurroundingtheissue.Itiswidelyacknowledgedthatreportedcasesofchildsexual
abusemakeupasmallproportionoftherealincidencerate(Nisbet,2000).Conservative
estimatesindicatethatoneinthreegirlsandoneinsixboysexperiencesomeformofsexual
abusebeforereachingadulthood(Dunne,Purdie,Cook,Boyle,&Najman,2003).Itisalso
estimatedthatbetween3050%ofthesesexualoffencesarecommittedbyadolescent
perpetrators(Ryan&Lane,1997).Further,itisestimatedthat40%ofabuseiscommittedby


anadolescent,biologicalrelative(Ryanetal.,1996),withsiblingincestsuggestedtobethree
tofivetimesmoreprevalentthanfatherdaughterincest(Cole,1982).
Attheveryoutsetresearchinthisareaischallengedtodistinguishsexualbehaviours
betweenchildren/adolescentsthatmaybeexperimentalandthatwhichisabusive.The
questionofwhatbehaviourconstitutesabuseisvitalsothatwecanseparatenonharmful
sexualexperimentationfromdamagingvictimisation.Inthecurrentresearchtheemphasisis
onharmful,exploitative,andabusivebehavioursometimesdefinedasinvolvinga
developmentalagedifferencebetweentheabuserandthevictim.Inregardtocriminal
convictions,WesternAustraliandataindicatethatadolescentsaccountedforapproximately
12%ofthetotalsexualoffenceconvictionsrecordedfor1998(Allan,Allan,Marshall,&
Kraszlan,2002).Naturallythisfigurewillvarynotonlywiththeunderlyingrateofadolescent
sexoffendingbuttheabilityofasocietytodetectandrespondtotheseoffences.Itisfairto
concludethatatpresentthevastmajorityofsuchoffendingbehaviourdoesnotcometothe
noticeofanypublicauthority.
CharacteristicsofAdolescentSexOffenders
Introduction
ASOsareaheterogeneousgroupandmaybedifferent,insignificantways,fromadultsex
offenders(Hunter&Lexier,1998;Nisbet&Seidler,2001;Prendergast,2004).Inparticular,
theyappeartodifferfromadultsexoffendersinlevelsofpsychopathologyandparaphilic
arousal.Thereisevidencethatadolescentswhooffendsexually,particularlyfemalesand
prepubescentmales,appeartohavegreaterdevelopmentaltraumaandfamilydysfunction
thantheiradultcounterparts(Hunter&Becker,1994).Further,researchsuggeststhatASOs
sharemoresimilaritieswithnonsexualoffendingadolescentsthandifferences(Hoghughi,
Bhate,&Graham,1997).ThissectionreviewsthereportedcharacteristicsofASOsderived
fromAustralianandoverseasliterature.
PriorVictimisation
SexualAbuse
AcommonlycitedaetiologicalfactorforASOsistheirownhistoryofvictimisation.Indeed,
severalstudieshavelinkedpriorvictimisation,andinparticular,sexualabuse,toadolescent
sexualoffending(Boyd,Hagan,&Cho,2000;Gray,Pithers,Busconi,&Houchens,1999;
Veneziano&Veneziano,2002;Worling,1995b).Obtaininganaccuraterepresentationof
priorvictimisationratesisadifficulttask,influencedbythetraumaticnatureofthe
victimisationexperienceandthelikelyimpactsuchadisclosurewouldhave.Linkedwiththis
issueisthetimingofthedisclosure.Inareviewofseveralstudies,Worling(1995b)found
thatcomparedtopretreatmentdisclosurerates,thedisclosureofpriorsexualvictimisation
ofASOswassignificantlygreaterfollowingparticipationintherapeuticintervention(22%
and52%respectively).Evidently,theexistenceofasupportivetherapeuticenvironmentin
fosteringdisclosureofpriorvictimisationisimplied(Worling,1995b).Furthermore,this
finding,basedonalargesampleof1,268maleASOs,suggeststhatmanyinvestigationsmay
actuallyunderestimatevictimisationrates.Acautionarynote,however,isthelackof


distinctionbetweenthetypesofASOsparticipatinginthesestudiesandtheprecisenature
oftheirvictimisationexperiences.
Anadditionalconsiderationisthepossibilitythatoffendersmayreportsexualvictimisation
inordertomitigatetheirownoffendingbehaviour(Barbaree&Langton,2006).Ryanetal.
(1996)foundinasampleof1,600ASOs,thatalmost4in10reportedpriorsexual
victimisation.ManochaandMezeys(1998)investigationfoundthatalmostathirdofASOs
reportedahistoryofsexualabuseandJamesandNeil(1996)reportedthatlessthanonein
fiveASOsintheirstudyreportednohistoryofabuse.
Priorvictimisationhasbeenlinkedwiththeageofonsetofdisclosedsexualoffending
behaviour(Murphy,DiLillo,Haynes,&Steere,2001).TheseauthorsreportedthatASOswho
hadbeensexuallyvictimisedbeganoffendingatanearlieragecomparedtoadolescentswho
didnotreportpriorvictimisation(basedonadolescentsselfreports).Similarly,Taylor
(2003)reportedthatparticipantswhoexhibitedinappropriatesexualbehaviourbeforethe
ageof12weremorelikelytohaveanallegedhistoryofvictimisation.
AlthoughthemajorityofstudiesexaminingpriorvictimisationamongASOsoftenfailto
differentiatebetweendifferenttypesofoffenders,severalinvestigationshavespecifically
addressedintrafamilialASOs.Forexample,OBrien(1991)comparedadolescentswho
offendedsexuallyagainstasiblingtoextrafamilialASOsandthosewhooffendedagainstan
adultorpeer(nonchild).OBrienfoundthatincestoffendersreportedahigherrateof
sexualand/orphysicalvictimisation(42%)comparedtotheothergroups(40%and29%
respectively).Consistentwiththisfinding,Worling(1995a)alsofoundasignificantlyhigher
numberofsiblingincestoffendersreportedahistoryofsexualabuse(38%)comparedto
adolescentswhooffendedoutsideoftheimmediatefamily(16%).Anothermorerecent
studyconductedbyRaymentMcHughandNisbet(2003)foundsignificantdifferencesof
priorsexualvictimisationbetweensiblingincestandextrafamilialASOs(38%versus16%
respectively).
Priorvictimisationhasalsobeenlinkedtothegenderofthevictims.Taylor(2003)foundthat
adolescentswhooffendedagainstmalesweremorelikelytohaveahistoryofsexualabuse
thanthosewhooffendedagainstfemales.OBrien(1991)foundthatASOswhowere
sexuallyabusedbyamaleoffenderweremorelikelytooffendagainstamale(68%)
comparedtothosewhowerevictimisedbyfemales(7%).Hesuggestedthismayreflecta
processofconditioning,wherebytheoffendersownabusemayleadtofeelingsofarousal
andfantasiesofsexualinteractionwithothermales,reinforcedthroughmasturbatoryacts
andsexualbehaviours.Worling(1995b)foundthatASOswhowerethemselvesvictimswere
morelikelytovictimisemalechildren(75%)thanfemalechildren(25%).Incontrast,Benoit
&Kennedy(1992)foundnosignificantassociationbetweenthenatureoftheoffences
committedbyASOsandtheirownvictimisationexperiences.
PhysicalAbuse
Thelinkbetweenpriorphysicalvictimisationandsexualoffendinginadolescencehasbeen
establishedinseveralstudies(Adler&Schutz,1995;Boydetal.,2000).Consistentwiththe
figuresonsexualvictimisation,40%ofASOsreportedexperiencingpriorphysicalabusefrom
familymembersand/orpeers(Benoit&Kennedy,1992).Studieshavelinkedsexual


offendingduringadolescencetophysicalvictimisationoftheoffender(Ryanetal.,1996)and
witnessingdomesticviolence(Grayetal.,1999).
PsychologicalFactors
ASOsareadiversegroupoftendiagnosedwithcomorbidconditionssuchasconduct
disorder,attentiondeficithyperactivitydisorder(ADHD),antisocialbehaviour(Prendergast,
2004;Shields,nodate),andsocialskillsdeficits(Awad,Saunders,&Levene,1984).
Specifically,psychosocialdeficitsweremostnotableinoffendersofyoungervictims(Hunter,
Figueredo,Malamuth,&Becker,2003).Specificdeficitsincludedsocialincompetence,
anxiety,depression,andpessimism.
Ingeneral,studieshavefoundthatASOshavehigherlevelsofinternalisingandexternalising
behaviours,conductdisorder,behaviouralproblems,ADHD,andpoorersocialand
interpersonalskillsthancontrolgroups(Hummel,Thomke,Oldenburger,&Specht,2000;
James&Neil,1996;Letourneau,Schoenwald,&Sheldow,2004;Sheerin,2004;Taylor,2003;
Zolondek,Abel,&NortheyJr.,2001).SpecificallyOBrien(1991)foundthatsiblingincest
offendersweremorelikelytoexhibitvariousbehaviouraldifficultiesassociatedwithconduct
disorder,comparedtoextrafamilialASOsandnonchildsexoffenders.However,other
studieshavefoundthatthesetraitsareassociatedwithgeneraloffending,includingsex
offending,ratherthanadolescentswhoaresexoffendersonly(Butler&Seto,2002;Caputo,
Frick,&Brodsky,1999).Academicdifficultiesareoneofthemostconsistentproblems
associatedwithASOs(Epps&Fisher,2004).EppsandFishersuggestedthatlearning
difficultiesweremoresevereamongstASOsthannonsexualoffenders.
Grayetal.(1999)foundthat96%of612yearoldsintheirstudywhohaddisplayed
inappropriatesexualbehaviourhadbeendiagnosedwithconductdisorder.Incontrast,
Shields(nodate)compared52ASOswith800nonASOs.ASOswerejustaslikelyasthe
controlgrouptodisplayantisocialbehaviour,tohavebeenexpelledorsuspendedfrom
school,and/ortohavepriorconvictions.Variousstudieshavefoundthatupto50%of
adolescentoffenders(sexualandnonsexual)sufferedfromemotionalproblemsorhad
receivedpsychiatriccare(Awadetal.,1984;Manocha&Mezey,1998;O'Halloranetal.,
2002;Taylor,2003).Themostcommonlyreportedbehaviourswerelying,stealing,lowself
esteem,loneliness,impulsiveandaggressivebehaviours,andunhappiness.
Theneedforadolescentstobeacceptedbytheirpeersiswellrecognised(Prendergast,
2004).ManyASOshavedifficultyestablishingandmaintainingpeerrelationships(Awadet
al.,1984;Manocha&Mezey,1998).Socialskillswithinthisgrouparegenerallypoorand
ASOsareoftencharacterisedaswithdrawnandanxiouswithfewfriends(Hoghughietal.,
1997).Theyhavepoorsocialrelations,areoftenisolated,andhavelimitedinvolvementwith
adolescentsoftheoppositesex.Peerrelationships,orlackthereof,mayinfluencethetype
ofsexualoffendingwithisolatedadolescentsturningtochildrentofulfiltheiremotional
needs(Epps&Fisher,2004).
FamilyFactors
Anumberofreviewsandstudieshavefoundthatfamilydysfunctionismoreevidentin
familieswheresiblingincesthasoccurred(Bera,1994;Burton,Nesmith,&Badten,1997;


Hardy,2001;O'Brien,1991;Righthand&Welch,2001;Worling,1995a).Withinthese
familiesthereisevidenceofchemicaldependency,sexualabuseoftheASObyanadult
caregiver,physicalandemotionalabuseandneglect,parentalrejection,parentalexperience
asanabusevictim,singleparenthomes,multipleparentalpartners,steporhalfsiblings,and
negativefamilyenvironment.Prendergast(2004)foundthatpoorcommunicationbetween
adolescentsandparentswasthedefiningfactorinadolescentsexualoffending,oftenwith
parentsunawareofwhattheirchildrenwereupto.BenedictandZautra(1993)foundthat
childsexualabuseismorelikelytooccurinfamilieswhereoneoftheparentsisabsentfrom
thehome.
Acomprehensivestudyof90ASOsfoundthatincestoffendersreportedhigherlevelsof
familydysfunctionthannonsiblingoffenders(Worling,1995a).Theincestoffenderswere
morelikelytoreportahistoryofchildhoodsexualabuse,maritaldiscord,physicalabuse,
rejection,andlesssatisfactionwiththeirfamilyenvironments.Incestoffenderswere
significantlymorelikelytohaveyoungersiblingslivinginthehomethannonsibling
offenders.Worling(1995a)suggestedthatthenegativefamilyenvironmentcoupledwith
theavailabilityofayoungersiblingvictimservedasacatalystforoffendingbehaviours.He
furthersuggestedthataheightenedsexualisedfamilyenvironmentmightalsoprovide
conditionsconducivetosexualoffending.
FemaleAdolescentSexOffenders
TheliteratureregardingfemaleASOsissparseandtheavailableresearchlargelyconsistsof
descriptions and case studies (Grayston & De Luca, 1999; Johnson, 1989; Lewis & Stanley,
2000; MiccioFonseca, 2000). It is difficult to estimate the prevalence rate because female
ASOs are rarely identified by authorities. Offending behaviours are likely to be
underreported by male victims and female offenders can disguise their abuse as normal
caretakingactivitiese.g.,bathinganddressingthevictim(Johnson;Lewis&Stanley).
Female sex offenders seem to begin offending behaviours at a younger age than non sex
offenders.MiccioFonseca(2000)suggestedthatfemalesexoffenderswereeithersexually
irresponsibleandpromiscuous;orbecamesexuallyactiveatayoungage.
AstudyofpreadolescentfemalesexoffendersbyJohnson(1989)foundthattheseyoung
girlsperformedpoorlyacademicallyandsocially.Theydisplayedoppositionalbehaviours
withadultsandwereinvolvedinfiresetting,stealing,andrunningaway.Someresearchers
havenotedahighincidenceofpsychiatricimpairmentinfemalesexoffenders(Green&
Kaplan,1994).GreenandKaplandescribedagroupoffemalesexoffendersasavoidantor
dependentpersonalitytypeswithpoorimpulsecontrol.
Summary
KeyFeaturesofIntrafamilialASOs:

Longeroffencehistoriesandmorelikelytoengageinpenetrativeacts
Morelikelytohavemultiplevictims
Morelikelytobevictimsofsexualabuse
Dysfunctionalfamilies
Psychologicalimpairment

Poorinterpersonalandsocialskills

TypologiesofAdolescentSexOffenders
Introduction
Althoughacknowledgedasaheterogeneousgroup,researchershavegenerallyapproached
alltypesofASOsasasinglegroup.Therehasbeenlittleresearchintothedifferences
betweenoffendersbasedonoffencecharacteristics.Further,therehavebeennostudies
intothetypesofoffenderswhodo,ordonot,continuetooffendintoadulthood.The
followingsectionoutlinessomeofthetypologiesdevelopedtohelpfocusattentionon
qualitativelydistinctgroupsofASOs.However,itisimportanttonotethatwhilethese
typologiesmaybeusefulforpractitionersorforexploringtreatmentoptions,theyareyetto
beempiricallytested(Veneziano&Veneziano,2002).Thefirstgroupoftypologiesarebased
onvictimand/oroffencecharacteristics,thesecondgroupdifferentiateoffendersonthe
basisofdominantpersonalitycharacteristics.
TypologiesBasedonVictim/OffenceCharacteristics
OBrienandBera(1986)distinguishedbetweentypesofmaleASOsonthebasisofvictim
characteristics(i.e.sibling,childnonrelative,peer/adult,ormultiplevictims).Althoughin
needoffurtherempiricalverification,theauthorsclaimedthistypologydemonstratedgood
interraterreliability.ThetypologyconsistsofsevenoffendersubtypesasshowninTable1.
Thistypologydoesnottakeintoaccountoffenderswhomayfitintomorethanonecategory.
Althoughthistypologyhasnotbeenempiricallytested(Oxnam&Vess,2006)itdoes
highlightsomeoftheimportantdistinctionsbetweentypesofASOs.
Table1
OBrienandBerasTypologyofAdolescentSexOffenders
(Source:OBrien&Bera,1986)
Typology

Characteristics

Motivation

Nave
Experimenter/Abusers

littlehistoryofdelinquent
behaviour,sexuallynave,
offendingissituationaland
isolated

explorationand
experimentation

UndersocializedChild
Molester

sociallyisolated,lowselfesteem, adesireforselfimportance
socialisewithyoungerchildren,
mayusemanipulationorbribery,
victimsusuallyknowntothe
offender

PseudosocializedChild
Molesters

littlehistoryofdelinquent
behaviour,adequatesocialand
academicskills,historyofabuse,

gratificationofsexualneeds
withamuchyoungerchild


offendingmayoccurovera
numberofyears
SexualAggressive
Adolescents

poweroranger
dysfunctionaland/orabusive
families,goodsocialskills,history
ofantisocialbehaviours,
offendingusuallyinvolvesforce
orthreats,victimsmaybe
children,peersoradults

SexualCompulsive
Offenders

emotionallydisengagedfamilies
withrigidroleboundaries,
unabletoexpressnegative
emotionsappropriately,
narcissistictraits,engagein
repetitive,sexuallyarousing
behaviour

autoeroticismwithlittleor
noconnectiontothevictim

DisturbedImpulsive
Offenders

historyofpsychologicalillness,
familydysfunction,substance
misuseorlearningdifficulties,
offendingisimpulsiveandmay
beasingleeventorapatternof
abusiveevents

complex,maybetheresult
ofsubstancemisuse,
disorderedthoughtpatterns
orfailureofimpulsecontrol

GroupInfluenced

nohistoryofdelinquent
behaviour,offendingbehaviour
isaresultofgrouppressurewith
thevictimusuallyknownto
offender/s

grouppressureor
expectations(follower);or
attentionorapproval
(leader).

AcontrastingapproachclassifiedASOsaccordingtotheageoffirstoffenceandthetimingof
offendingbehaviours(Burton,2000).Earlyoffenders,accordingtoBurtonsschema,are
thosethatbeganoffendingbeforetheageof12;teenoffendersbeganaftertheageof12;
andcontinuousoffendersoffendedbothbeforeandaftertheageof12.Continuous
offenderswereinvolvedinallformsofsexualoffendingathigherratesthantheothertwo
categories.Theauthorbelievedthisgroupwasmostatriskoffutureoffending.
AnotherapproachinvestigatedtheoffenceandvictimcharacteristicsofASOs(Langstrom,
Grann,&Lindblad,2000).Langstrometal.basedtheirtypologyprimarilyonvictimand
offencecharacteristicsobtainedfromhistoricalfileinformation.Langstrometal.undertook
aclusteranalysiswhichyieldedfivedistinctgroupingsasshowninTable2.Basedontheir
data,Langstrometal.(2000)foundthatclusters1and2weremorelikelytoreoffend
sexuallycomparedtoclusters3,4,and5.Howevertheseestimateswerebasedonsmall
samplesizes(n=46).


Table2
TypologyofSexualOffendingBasedonVictimandOffenceCharacteristics
(Source:Langstrometal.,2000)
Cluster

Victim

TypeofOffence

LevelofViolence

One

unknownmalechild

atleastoneactoforal
penetration

lowmoderate

Two

femalepeersoradults,
multiplevictims

noncontactexhibitionist
behaviour

low

Three

unknownfemalevictims

atleastonecontactoffence

moderatehigh

Four

knownchild

multipleoffences,penetration
occurredinmostcases

low

Five

knownadolescentor
adultfemalevictim

includedgenitalpenetration

moderatehigh

Hunteretal.(2003)differentiatedbetweenadolescentswhotargetedeitherpubescentor
prepubescentvictims.Theauthorsfoundthatadolescentswhooffendedagainstpubescent
victimsexhibitedhigherlevelsofaggressiveness.Thosewhooffendedagainstprepubescent
victimsevidencedgreaterdeficitsinpsychosocialfunctioningandweremorelikelytobe
relatedtothevictim.However,thesefindingswerebasedonasmallnumberofadolescents
inthepubescentvictimgroup(n=25)andtheresultswouldneedtobereplicatedonalarger
grouptoclaimsupportforarobusttypology.
TypologiesBasedonPersonalityCharacteristicsofOffender
ThetypologiesdiscussedabovehaveapproachedtheissueofASOsfromthepointofviewof
demographicdata,offendinghistory,orvictimtypebutanotherwaytoapproachtheissueis
toconsiderthenatureorproblemsoftheoffender.Anearlyattemptexaminedthe
MinnesotaMultiphasicPersonalityInventory(MMPI)profilesofASOs(W.R.Smith,
Monastersky,&Deisher,1987).FromtheclusteranalysisoftheMMPIprofiles(seeTable3)
theauthorsidentifiedfourdistinctgroups.
Table3
AdolescentSexOffenderTypologyBasedonMMPIProfile
(W.R.Smithetal.1987)
Typology

DominantCharacteristics

Immature

primarilyshy,overcontrolledandsociallyisolated,tendto
worry

10

PersonalityDisordered

narcissistic,demanding,argumentative,insecure,andresortto
fantasymeasuresasameansofcopingwithproblems

SocialisedDelinquents

welladjustedsociallyandemotionally,tendencytooverly
regulateemotions,andrespondsometimesaggressively

ConductDisordered

impulsive,alienated,anddistrusting,poorsocialskills,tendto
actoutinrelationtoperceivedthreats

Worling (2001) generated a typology for ASOs based on patterns of responding on the
CaliforniaPsychologicalInventory(CPI).Worlingscategoriesalsoconsistedoffourclusters
of offenders (see Table 4). This typology suggested differing aetiological pathways and
treatmentneedsforthefourclusters(Worling).
Table4
TypologyofAdolescentSexOffendersBasedonCPIProfile
(Source:Worling,2001)
Typology

DominantCharacteristics

OffenceCharacteristics

Antisocial/Impulsive

previouslyvictimised,exhibited
externalisingbehaviourproblems

violentoffences,typically
againstoldervictims

Unusual/Isolated

isolatedanddistantfromothers
withmoreinternalisingbehaviour
problems

Overcontrolled/

avoidantinexpressionofemotion

believedtobea
consequenceofshyness

outgoingandconfident,narcissistic
qualities

attributedtoself
centrednessandlackof
empathy

Reserved
Confident/Aggressive

Morerecently,Richardson,Kelly,GrahamandBhate(2004)developedapersonalitybased
taxonomyforASOs,derivedfromclusteranalyticproceduresutilisingtheMillonAdolescent
Clinical Inventory (MACI). Their analysis revealed five distinct subtypes on the basis of the
ASOsPersonalityPatternprofilesontheMACI(seeTable5).However,thesesubtypesdid
notdistinguishbetweendifferenttypesofoffendingbehavioursgivingfurthersupporttothe
heterogeneityofthisgroup(Richardsonetal.,2004).Thesmallsamplesizealsolimitedthe
powerofthisanalysis(Oxnam&Vess,2006).
Table5
TypologyofAdolescentSexOffendersBasedonMACIProfile

11


(Source:Richardsonetal.2004)
Typology

DominantCharacteristics

Normal

minorpersonalitydifficulties(howevertherewasevidenceof
underreporting)

Antisocial

highelevationsonthescalesassociatedwithConduct
Disorderrelatedbehaviours,negativeviewoffamilylife,
disregardforsocialnormsandtherightsandfeelingsof
othersandtowardstheconsequencesofactions,impulsive,
selfindulgentandexcessivelyexpressiveoftheirownneeds
andfeelings

Submissive

excessivedependenceonothers,deferringtoauthorityand
subsumingtheirownneedstothewishesofothers,
significantlevelsofsocialorgeneralisedanxiety

Dysthymic/Inhibited

sociallywithdrawnandisolated,apatheticandlacking
motivationtosocialisewithpeers,moderatetosevere
depressedaffect,asenseoffailure,lackselfconfidenceand
socialanxiety

Dysthymic/Negativistic

evidencedseverelevelsofpsychopathology,chronicand
incapacitatingdysthymicmood,employedintimidation
tacticstoachievetheirneedsandresentedlimitsontheir
behaviour,negativeselfperceptionandlowselfesteem,low
selfcontrolandanoverallindifferencetothefeelings/rights
ofothers,negativeviewoffamilylife

FinallyastudybyOxnamandVess(2006)usedthe12personalitypatternscalesontheMACI
to categorise ASOs. Their original analysis produced a three group solution (N=25) while a
later study produced a four group solution (N=82) (Oxnam & Vess, 2008). Table 6 displays
theprofilesforthetwoanalyses.Forallofthesestudies,groupsizelimitedgeneralisability
butfurtherresearchiswarrantedtoextendknowledgeinthispromisingarea.
Table6
OxnamandVessTypologiesBasedonMACIProfiles
(Source:Oxnam&Vess,2006;2008)

ThreeGroup
Solution
Percentageineach

ClusterOne

ClusterTwo

ClusterThree

ClusterFour

Antisocial

Inadequate

Normal

44%

28%

28%

12


group
FourGroup
Solution

Antisocial

Withdrawn/

Conforming

Passive/
Aggressive

24%

32%

Socially
Inadequate

Percentageineach
group

13%

31%

TheoriesoftheDevelopmentofSexualOffendingBehaviour
Introduction
Thepurportedcausesofadolescentsexoffendingreflectcloselytheliteratureonthe
aetiologyofadultsexoffending.Possiblefactorsincludebiological,developmental
difficulties,theimpactofpriorvictimisation,sociallearning,psychologicaldeficits,
dysfunctionalparenting,anddysfunctionalfamilies.Naturallytheseindividualfactorsthat
havebeenlinkedtoadolescentsexoffendingarenotmutuallyexclusiveandmorethanone
factororsetoffactorsislikelytobepresent.Explaininghowtheidentifiedriskfactor(s)
actuallyleadtoapropensityforsexoffendinghasbeenexaminedbyanumberoftheoriesof
adolescentsexoffendingthatwillbediscussedhere.
Severalmultifactorialframeworkshavebeendevelopedbyvarioustheoristsinanattemptto
provideacomprehensiveexplanationofadolescentsexoffending.Alargeissueinthisarea
isthattherearefewtheoriesthataddressadolescentsexoffendingbehaviourspecifically
(Morenz&Becker,1995;Ward&Siegert,2002);ratherthetheoriesthathavebeenapplied
toASOshavegenerallybeendevelopedwithreferencetoadultsexoffendermodels.Itisa
commonassumptioninthisfieldthatadultmodelscanbeappliedtotheadolescentcontext,
althoughthisviewischangingwithincreasingawarenessofthefactorsassociated
specificallywithadolescentsexoffending.
Theoriesrelevanttounderstandingadolescentsexoffendingareusuallytracedbackto
Finkelhorspioneeringworkontryingtounderstandthemotives(ofadults)involvedin
sexuallyoffendingagainstchildren(O'Reilly&Carr,2004).Finkelhordrewattentiontothe
findingsfromhisresearchthatmanysexoffenderswereemotionallyimmature,hadlowself
esteem,andpoorinterpersonalskills.Therewereoftendevelopmentaldelays,particularly
sexual,andthesetypicallyrelatedtopriorsexualvictimisation.Sexualoffendingwas
thereforeunderstoodasafunctionofaninabilitytomatureanddevelopappropriateskills.
ThiscontinuestobeacommonthemeinothertheoriessuchasMarshallandBarbarees
(1990)integratedtheorywhichisessentiallyoneofdevelopmentandbonding.These
authorsarguedthatthelackofdevelopmentof,orseveredisruptionto,secureattachment
bondswithcaregiverspresentssignificantproblemsfornormaldevelopmentinparticular,
withregardtointerpersonalandintimacyskills.Asaresult,individualslearntomanage
relationshipswithdisruptiveanddemandingbehaviouranddevelopalimitedrangeof
relationshipstyles(Marshall&Barbaree).Thistheoryalsointegratedaspectsofsocial
learningtoexplainthedevelopmentofsexuallyaggressivebehaviours.Itwasarguedthat

13


thechildsaggressivebehaviourisreinforcedandmodelledbyaggressiveparents.Thechild
generalisesthesemaladaptivepatternsofrelatingtootherareasimpedingthedevelopment
ofsocialskillsandtheabilitytomaintainmeaningfulrelationshipswithothers.The
manipulativeandcoercivebehaviourslearnedfromattachmentfiguresarethendirected
towardsothers,forexampleyoungerchildren.
TheoriesonChildSexOffendingwithaFocusontheAdolescentSexOffender
OBrienandBera(1986)wereamongthefirstresearcherstofocusondevelopingatheoryof
adolescentsexoffending.Theirmodelattemptedtodrawtogetherthemanycharacteristics
andfactorsdiscussedintheliteraturethatmayleadtoadolescentsexoffending.Factors
thatsupportedthepropensitytowardssexoffendingincludedfamilyissues(absentparent,
neglect,domesticviolence,andattachmentissues),priorvictimisationoftheadolescent,
poorsocialisation,psychologicalissues,andexposuretopornography.Accordingtothis
theorytherearesevenkeyaspectsofadolescentsexoffending(Table7).Understandingthe
interrelationshipbetweentheseprovidesabasisfortreatmentoftheASO.
Table7
OBrienandBerasSevenKeyFactorsintheDevelopmentofAdolescentSexOffending
(Source:OBrien&Bera,1986)
Factor

Examples

Motivations

Arisefromsocialattitudesandindividualfactorsandmay
includedesireforintimacy,affection,control,affiliation,power
orarousal.

SituationalOpportunity

Accesstopotentialvictimmaybeopportunisticbutafter
successfuloffendingencounterstheadolescentmaycreate
furtheropportunitiestobewiththevictim.

InternalInhibitors
Overcome

Thinkingerrors,minimisation,orexcusesmaybeusedto
overcomeinternaldeterrentstooffending.

VictimResistance
Circumvented

Includesgrooming,threat,bribes,manipulation,orcoercion

SexualAbuseAct

Abusiveactmayresultinreleaseoftensionandsexual
gratification.Iftherearenonegativeconsequencesmayleadto
rehearsalandfantasy.

Fantasy&Masturbatory
Reinforcement

Abusemaybereinforcedthroughfantasyandmasturbation.

Rationalisations/
ThinkingErrors

Statementssuchassheaskedforit/likeditallowfantasyto
continueandovercomeinhibitionstoreoffendinthefuture.
Withnobreakinthecycle(intervention)offendermayreturnto

14


beginningofcycle.
Anothertheorythatattemptstointegratearangeofknownlinkswithadolescentsex
offendingisLanestheoryofthecycleofsexualabuse(Lane,1997).Lanearguedthat
sexuallyabusivebehaviourinadolescentsisamaladaptiveresponsetostressfulevents.A
stressfuleventcreatesfeelingsofpowerlessnessandlowselfesteemintheadolescent,
contributingtofeelingsofhelplessness,andmanifestingintheadolescentbecoming
withdrawnandisolated.Thisvictimstanceprecipitatesexternalisationofblameforany
problemstheadolescentmayhave,andtheadolescentengagesinpowerandcontrol
seekingbehaviours.Retaliatoryfantasiesdevelop,becomingsexualinnatureandthe
adolescentmentallyrehearsestheseoffencefantasiesuntilultimatelytheyareenacted.
Initiallyfollowingthecommissionoftheoffence,theadolescentexperiencesfeelingsof
adequacy,howeverthissoonturnstofearofthenegativeconsequences.Cognitive
distortionsserveasacopingmechanismforthesefears,includingjustificationsand
rationalisationsforoffencerelatedbehaviourstosuppressthenegativeaffectexperienced
asaconsequence.
CentraltenetsofLanes(1997)modelinclude:
1. Sexualabusesexualbehaviourwithoutconsent,mayinvolveexploitation,
manipulation,coercion,force,someprethought,andunhealthyexpression
ofsexualneeds.
2. Controlseekinganddominanceseekingcontroloverenvironmentand
others,dominance,andenhancingsenseofselfadequacy.
3. Attempttocompensatefornegativeaffectivestates.
4. Sexualarousalandanticipationreinforcebehaviourandselfsoothing
mechanism.
5. Cognitivedistortionsdifferentthemespromoteprogressionthroughoutthe
cyclee.g.,negativeselfperceptions,rejection/disrespectfromothers,
justification/rationalisationofcriminal/antisocialbehaviour,misperceptions
ofvictimsexperience,andthoughtsthatsuppressfeelingsofguilt.
6. Addictiveandcompulsivecharacteristicsofbehavioure.g.,compulsions
andimpulsiveurges,needforexcitementanddanger,reliefofunpleasant
internalstates,andmaladaptivecopingskills.
Giventheimportanceofunderstandinghowadolescentsexoffendingcanbetheresultof
priorsexualvictimisationoftheoffenderitisworthalsoconsideringRasmussen,Burtonand
Christophersons(1992)modeloftheeffectsoftrauma.Whilstnotspecificallyfocusedon
explainingadolescentsexualoffendingthemodelisrelevantasitpositssexuallyabusive
behavioursareonepossibleresponsetoatraumaticexperience.Themodelemphasisesthe
underlyingprocesseswhichdifferentiatethosewhogoontoperpetrate,ascomparedto
thosewhodonot.Specifically,theauthorsproposedthreepossibleresponsestotraumatic
victimisation(sexualorotherwise):

15


1. Recoverythechildisabletoexpressandresolveissuessurroundinghis/her
experienceofvictimisation.
2. Selfvictimisationthechildinternalisesthethoughtsandfeelingsassociated
withthetrauma(traumaechoesordistortedmessagesgivenbythe
perpetrator)andmanifestsmaladaptivethoughts,feelingsandbehaviours
towardsself.
3. Assaultthechildidentifieswiththeperpetratorsrationalisations,externalises
thesetraumaechoes,justifiestheabuse,andengagesinabusivebehaviour
towardsothers.
Rasmussenetal.(1992)furtherextendedtheirconceptualisationwithfiveunderlying
precursorsthattheybelievedincreasedthevulnerabilityofthechildgoingontoperpetrate
abuse,asopposedtothosewhorecoveredandthosewhoexperiencedselfdirected
victimisation.Theseincludedpriortraumatisation(physical,sexualoremotional,including
experiencesofearlysexualisation),inadequatesocialskills(resultinginpoorsupport
networks),lackofsocialintimacy,impulsiveness,andlackofaccountability.
TheTreatmentofAdolescentSexOffenders
Introduction
Thechildmaltreatmentliteraturecontainsrelativelylittleinformationpertinentto
assessmentandinterventionwithsiblingoffendersabusedaschildren.(Caffaro&
ConnCaffaro,2005,p.610)
Inthemain,adolescenttreatmentprogramsarebasedonresearchandtreatmentprograms
developedforadultoffenders(Eastman,2004).Currentunderstandingemphasisestherole
offamilydynamics;learning,especiallythroughpriorvictimisation;andcognitivedistortions
andrationalisationsinfacilitatingoffendingbehaviours(A.Grant,2000).Cognitive
behaviouraltreatmentprograms,forexample,aimtomodifysuchthoughtprocesses.A
numberofmethodologicalproblemsareassociatedwiththeASOtreatmentresearch.For
example,muchoftheresearchisnonexperimental.Thesestudiesfailtousestandardised
measuresoftreatmenttargets,andrarelyincludedetaileddescriptionsofthetreatment
interventions(Vizard,Monck,&Misch,1995).Manyevaluativestudiesdonotadequately
discriminatebetweentypesofoffending(rape,paedophilia,incest),thusconfoundingthe
treatmentimplicationsforvariousoffendersubgroups.Studiesutilisingarrestandconviction
ratesasmeasurementsofrecidivismwillclearlysubstantiallyunderestimatesexualoffending
asnotedbyVizardetal.(1995).
Placementofadolescentoffendersintreatmentprogramsenablesprofessionalstoredirect
theirsexualmisbehaviour(Bremer,1992).However,thesexualbehaviouroftheoffenceis
likelytobesecondarytotheabusiveelementinregardtothedamagedone,andthe
developmentalandphenomenologicalissuesrelatingtotheadolescentneedtobethefocus
oftreatment.A.Grant(2000)suggestedthataholistic,developmentaltreatmentapproach
ismostbeneficial.Similarly,G.E.DavisandLeitenberg(1987)recommendedtheuseofa
comprehensivetreatmentprogramconsistingofavarietyoftherapeuticmethodsused
simultaneously.

16


Treatmentprogramsmustalsoconsidertheroleofthetherapist,thegoalsoftherapy,and
therisksofdivulgingsensitiveinformationtostatutorybodies(Hunter&Lexier,1998).
Disclosureofabusivebehaviourcanhaveongoingconsequencesfortheadolescentandmay
leadtocriminalcharges.Denialofsexualmisbehaviourwillnaturallyberewardedbythe
lackofformalchargesthatmightotherwisebelaid.Thesedilemmasgototheheartofsocial
policyconflictsregardinghowtodealwithallsexoffendersbutaresomuchmorepoignant
withASOswhoareoftenbothoffendersandvictims.Fortreatmenttobemeaningfulit
needstobebuiltonbedrockoftrustandfulldisclosureandacknowledgementbythe
offender.However,atthepresentstageofitsevolutionourcriminaljusticesystemappears
illequippedtocopewiththisanddemandsthatanyacknowledgmentbepublicand
punishable.
TreatmentOutcomeResearch
Thelackoftreatmentoutcomeresearchevaluatingtheeffectivenessofvariousapproaches
targetedatASOshasbeennotedbyanumberofauthors(Eastman,2004;Weinrott,Riggan,
&Frothingham,1997).Giventhedearthofresearchthereislittleevidencetosupportany
onetreatmentmethodormodality(e.g.,residentialvscommunitybased)(Ertl&
McNamara,1997;Sciarra,1999).Claimsmadeinregardtotheeffectivenessofdifferent
treatmentapproacheslackasupportingbaseofempiricalresearch.Thislackofempirical
researchisnotsurprisinggiventheconsiderablemethodologicalandethicalchallengesin
conductingthistypeofresearch(Nisbet,2000).Thereissomeevidencethatrecidivismrates
forASOswhohaveundergonetreatmentarelowerthanthosewhohavenot(Worling&
Curwen,2000).However,evenifthesefindingsareaccepted,itremainsunclearwhich
treatmentcomponentsaffectrecidivismrates.
Thefollowingsectionexaminestheavailableoutcomeresearchthathasbeenconducted
withASOs.Manyofthestudiesrevieweddonotincludecomparisongroups,arebasedon
retrospectivedata,evaluateasingletreatmentoutcome,andhavemethodologicalflaws.
Outcomemeasures,wherestudiesareconducted,tendtofocusonrecidivismrates(with
limitedaccuracy)ratherthanothertreatmentgoalssuchassocialcompetence,selfesteem
orsexualknowledge(Eastman,2004).Forthepurposesofthisreviewonlystudiesthathave
clearlydefinedtreatmentprotocols,evaluationmethodologies,andtreatmentoutcomes
wereincluded.
CognitiveBehaviouralTherapy(CBT)
CBTisthemostcommonformoftherapeuticinterventionwithASOsandwidelyused
aroundtheworld(Robson,1999).CBTtargetsparticularcharacteristicsofASOsincluding
sexualarousaltoprepubescentchildren,poorsexualimpulsecontrol,deficitsinvictim
empathyandsocialskills,andcognitivedistortions(Hunter&Santos,1990).CBTemphasises
theeffectofinternaleventssuchasthoughts,fantasies,andperceptionsonbehaviour
(Wood,Grossman,&Fichtner,2000)becausetheseeventsprecedebehaviourandare
amenabletochange.AccordingtotheCBTapproach,insightintooffendingbehaviouristhe
catalystforpositivechange.However,CBTmaynotbeaseffectivewithadolescentsbecause
competingfeelingsofguiltandshamecaninterferewiththeprocessofinsight,
understanding,andchange(Robson).ThemajorcomponentsofCBTbasedtherapiesinclude
cognitiverestructuring,victimempathy,decreasingdeviantsexualarousal,socialskills

17


training,andrelapseprevention.Table8presentssomeofthemajorCBTtreatmentstudies
todate.
Table8
CognitiveBehaviouralTreatmentStudies
Study

Sample

(Hunter&
12male
Santos,1990) offendersof
malevictims
15male
offendersof
femalevictims
(Weinrottet
al.,1997)

(Worling&
Curwen,
2000)

Penile
Satiation
therapy,covert plethysmograph
sensitisation,
groupand
individual
therapy

MajorFindings
33.5%reductionin
arousaltodeviantcues
(femalevictims)
39.1%reductionin
arousaltodeviantcues
(malevictims)

Outpatient
program

Phallometric
measures

Reducedarousalto
prepubescentgirls

Treatment
group

Vicarious
sensitization

Waitlist
comparison
group

25sessions

Adolescent
SexualInterest
Cardsort

Noreductioninwaitlist
grouppriorto
treatment

148
adolescent
sexual
offenders

Treatment
group(n=58)
Comparison
group(n=90)

35adolescent
offendersin
residential
treatment
Nocontrol
group

Measures

69male
offenders

(n=139male;
n=9female)

(Kelley,
Lewis,&
Sigal,2004)

Treatment

SelfPerception
Profilefor
Adolescents

Recidivismrate
Individual,
groupand
familytherapy;
deviantsexual
arousal,
relapse
prevention;

Sexualreoffence(5%vs
18%)
Violentnonsexual(19%
vs32%)

socialskills,
anger
management,
victimempathy
Socialskills
training,covert
sensitisation,
empathy
training,
special
education,
relapse

Significantdifferences
betweentreatmentand
comparisongroups
acrossoffence
categories

Nonviolent(21%vs
50%)
Preandpost
scoresonCBCL
andACLSA

Significantreductionon
socialproblemsand
delinquentsubscales

Changein
incidentreports
byresidential
staff

Improvementin
competencescore
Significant
improvementonsocial

18


prevention

relationshipsand
sexualityandintimacy
subscales

Cognitiverestructuring
CBTassumesthattheindividualholdsfaultythoughts,feelings,orbeliefsthathaveledto
theoffendingbehaviour.CBTlinksfaultythinkingwiththesubsequentbehaviours(Sciarra,
1999).Cognitiverestructuringaimstocorrectcognitivedistortionsaswellasimprovesocial
andcommunicationskills(J.Shaw,1999).Therefore,thefocusintherapyisonthebeliefs
anddistortionsthatpermittheoffendingbehaviourtooccur,suchaspermissiongiving
statementsthevictimwantedto(Becker,1990;Ertl&McNamara,1997;Sciarra).Many
offendersdevelopmythsanddistortionsaboutnormalsexualfunctioning.Forexample,a
commonbeliefisthatchildrencangivemeaningfulconsent.Animportantcomponentof
cognitiverestructuringisanadmissionbytheoffenderofthecognitionsandselfstatements
usedtojustifytheirdeviantsexualbehaviourwiththeaimofchallengingthosebeliefs(Ertl&
McNamara).Withoutaddressingcognitivedistortionsbehaviourchangeisunlikelytobe
longlasting(Print&O'Callaghan,2004).
Deviantsexualarousal
Akeytaskofadolescenceisthedevelopmentofasexualidentity(Smallbone,2006).The
emergingsexualidentityisinfluencedbychildhoodattachmentexperiencesandcognitive
development.Deviantsexualarousalisunderstoodtobeafunctionoflearningthrough
modellingandconditioning.Sexualimproprietyinadolescencehasbeenlinkedtounstable
earlyattachmentbonds,childmaltreatment,andexposuretosexuallyexplicitmaterial
(Epps&Fisher,2004;Smallbone,2006).Further,deviantsexualarousalhasbeenassociated
withhigherratesofsexualrecidivism.Treatment,therefore,involveschangestothese
patternsofarousaltomoreappropriatestimuli.Someresearchersarguethatdeviantsexual
arousalneedstobeaddressedwithASOstoavoidthedevelopmentofparticularsexual
interestpatternsintoadulthood(Print&O'Callaghan,2004).However,thereisnoevidence
tosuggestthatadolescentswhooffendagainstchildrenareprimarilyinterestedinchildren
assexualobjects.SexualarousalpatternsarechangedusingCBTtechniques(satiation
training,covertsensitisation,systematicdesensitisation,psychopharmacologicaltreatments)
andmedication.
Satiationmethodsutiliserepetitionofthedeviantfantasyleadingtoboredomandextinction
(Ertl&McNamara,1997).Satiationmethodsallowforreinforcementofarousalto
appropriatestimuliwhilstsuppressingarousaltodeviantstimuli.Verbalsatiationuses
repetitiveverbalisationsuntilsatiationtothedeviantstimulithatpreviouslyarousedthe
individualoccurs(Ertl&McNamara).Covertsensitisationrequirestheoffendertoimagine
andverbalisefeelingsand/oremotionshe/sheexperiencedpriortocommittingtheoffence.
Theoffenderisthenpresentedwithaversiveimagesportrayingthenegativeconsequences
ofactingoutthesexualoffence.Ethicalconcernshavelimitedtheuseofsatiationtraining
withASOs.Therearealsopracticaldifficultiesincludinglackofmotivationandtheuseof
explicitmaterialwhichmayreinforcethedeviantarousalpatterns.

19


SeveralresearchershaveexamineddeviantsexualarousalinthetreatmentofASOs.Hunter
andSantos(1992)foundthatarousaltodeviantsexualstimulideclinedoverthetreatment
periodwhilstbaselineratestonondeviantstimuliremainedstable.However,nocontrol
groupwasincludedinthestudyandarousalpatternsweretheonlyreportedoutcomes
measuresforthisgroup.
Responsetothesetreatmentmethodshasbeenmixedwithfindingssuggestingthatyounger
ASOsdonotrespondaswellasadultsexoffenders(Hunter&Becker,1994).Thereisno
empiricalevidencedemonstratingtheeffectivenessofthesemethodsorwhichelementsare
essentialforchange(Veneziano&Veneziano,2002).Further,satiationcanbefakedleading
toreinforcementofdeviantarousal(Bourke&Donohue,1996).Thereareethicalconcerns
withtheuseofthesetechniqueswithadolescents,especiallywherethereislittlemotivation
tochange.
Empathy
Anunderstandingofempathyandmoreimportantly,empathydeficitsinsexualoffendersis
notwellunderstoodinthesexualoffendingliterature.Indeed,thisareaofresearchis
hamperedbecausedefinitionsofempathyvaryacrossstudies(Pithers,1999).However,itis
generallyunderstoodthatempathyistheabilitytounderstandthefeelingsofothers
(Seagrave&Grisso,2002).Theabilitytoperceivehowothersfeeldevelopsduring
adolescence.Itisnotunusual,though,foradolescentstobehavelessempathicallyduring
thisphaseofdevelopment.
Developingvictimempathyentailsanacknowledgementofresponsibilityandarticulationof
theconsequencesforthevictim.Theabilitytoempathisewithonesvictimisdifficultto
quantifyasevaluationsaregenerallybasedonselfreports(Ertl&McNamara,1997).There
issomedebateastowhataspectsofempathyarelackingintheindividualandhowitrelates
tosexualaggressionandsexualoffending(Print&O'Callaghan,2004).AstudybyEastman
(2004)foundthattreatedoffendersshowedanimprovedabilitytoidentifywiththenegative
feelingsofothers.However,uponreleaseintothecommunitythisabilitydeclined
suggestingthattherapeuticgainswithregardtoempathywerenotsustained.
Socialskillstraining
ASOsareoftensociallyisolatedandsomelackbasicsocialskills(Prendergast,2004;Sciarra,
1999).Alackofsocialcompetenceaffectsallareasoffunctioning,particularlyinterpersonal
relationships(Worling,2004).ASOsaretaughtcommunicationskillssuchasactivelistening,
howtohandlecriticism,providingnegativefeedback,andassertiveness,particularlywhen
dealingwithantisocialpeers.ThesocialskillscomponentofCBThasnotbeenadequately
assessed(Ertl&McNamara,1997).
ASOsfrequentlyuseaggressivebehaviouraspartoftheirabuseindeedtheabuseisoften
partofamoregeneralcontinuumofaggressivebehaviours.Theprimarygoalofanger
managementisrecognitionofaggressivecues,understandingthedifferencebetween
passive,assertive,andaggressiveresponsestoaproblem,thinkingaboutaproblemfrom
differentpointsofview,workingonlisteningskills,andnoticingthebodysreactionwhen
angry(Prendergast,2004).

20

Grouptherapy
GrouptherapyisanimportantcomponentofmanyapproachesincludingCBT.Group
membershipisorganisedaroundanumberofcommonfactorssuchasage,psychosocial
development,andsexualissues.Grouptherapyprovidesasupportiveenvironmentinwhich
toexploreissuesspecifictoASOs(Bourke&Donohue,1996).Oneofthestrengthsofgroup
therapyisthatitmakesitdifficultforindividualstominimiseordenytheiroffending
behaviourstothegroup(Sciarra,1999;J.Shaw,1999).Asuccessfulgroupcanfostergroup
cohesionandpeeracceptanceduringaperiodofadolescentdevelopmentwhentheseissues
areofgreatimportance(Prendergast,2004).Theinfluenceofthegrouptherapycomponent
ofCBThasnotbeenadequatelyresearchedwithASOs.
Relapseprevention
TherelapsepreventionapproachfocusesonhelpingASOscopewithsituationsthatmight
threatentheircontrolovertheirinappropriatesexualarousal(Ertl&McNamara,1997;
Prendergast,2004).Thisinvolvesidentificationofhighrisksituations,learningcoping
strategiesfordealingwithhighrisksituations,selfmonitoringcontractswithfamily
members,andregularmeetings.Therelapsepreventionapproachdevelopedthroughthe
treatmentofdrugmisusersandhassubsequentlybeenadaptedfortheneedsofsex
offenders(J.Shaw,1999).Itispredicatedontheunderstandingthatabusiveeventsdonot
occuronthespurofthemomentbutaretriggeredbyanumberofcharacteristics
significanttotheindividual.Aswithskillsforcopingwithanaddiction,itisthehighrisk
situationswhichhavebeenfoundtobethekeyfactor.Thustheapproachteachesthe
individualthathis/hercognitiveemotionalstateisaprecursortohis/heroffendingpathor
sexualassaultcycle(J.Shaw;Woodetal.,2000).Anintentionnottooffendisconsidered,by
itself,insufficienttopreventoffendingfromoccurring(Woodetal.).However,thereislittle
empiricalevidenceontheeffectivenessofrelapsepreventionplanswithASOs(Bourke&
Donohue,1996).
IndividualCounsellingandEducation
Individual counselling and education is based on the premise that ASOs need to address
sexual dysfunction (Lab, Shields, & Schondel, 1993). Components of individual counselling
will likely include an emphasis, to varying degrees, on sex education, anger management,
socialskillstraining,empathytraining,relapseprevention,andvictimawareness(Labetal.,
1993).Table9setsoutarangeoftreatmentprogramsthatincorporatedsexeducationinto
thetreatmentpackage.
Table9
IndividualCounselling/EducationalTreatmentStudies
Study
(Mazur&
Michael,

Sample
N=10

Treatment
Sexuality
education,

Measures

MajorFindings

Selfreport
relapsedata

Norelapsereported
despiteopportunity

21


1992)

(1317years)
Nocontrol
group

relapse
prevention

(6monthspost
treatment)

Outpatient
program
Parent
Adolescent
Relationship
Inventory;
CBCLand
PiersHarris
SelfConcept
Scale

Improvedsocialskillsfor
bothgroupsbut
treatmentgroupscores
significantlyhigher

Sexeducation,
victim
awareness,
empathy,
copingskills,
prevention
plans,anger
management

Recidivism
ratepost
treatment

Recidivismratessimilar
forbothgroupsfor
sexual(2.2%&3.7%)
andnonsexual(24%&
18%)offences

Sexeducation,
human
sexuality,
grouptherapy,
anger
management,

Recidivism
rate2years
post
treatment

Recidivismrates58%
reoffended

50ASOswho
had
completeda
treatment
program

Grouptherapy,
sexeducation,
behaviour
management

Recidivism
rates10yrs
postrelease
intothe
community

100ASOs

Grouptherapy, Recidivism
sexeducation, rate
behaviour
management

(Graves,
30ASOs(12
Openshaw,& 19years)
Adams,1992)
n=18
treatment
group
n=12control
group
(Labetal.,
1993)

(Hagan,King,
&Patros,
1994)

(Hagan&
GustBrey,
2000)

(Hagan,Gust
Brey,Cho,&
Dow,2001)

n=46
treatment
group
(low/medium
risk)
n=109
controlgroup
(highrisk)
50ASOsin
residential
treatment
program

50nonsexual
offender
comparison
group

Traditional
therapy,
Socialskills
training
treatment
grouponly

Noimprovementin
problemsolvingability

10%sexualassault

20%reoffendedsexually
60%reoffendednon
sexually

ASOsmorelikelythan
nonsexualoffendersto
commitasexualoffence

22


ManyASOshavelimitedactualsexualknowledgeandawareness.Sexeducationisthus
relevantandmaybeseenasanimportantcomponentofamultifacetedtreatmentprogram.
SexeducationwithASOsisgenerallydesignedtoaddressfaultycognitions(Bourke&
Donohue,1996).Eastman(2004)hadsuccesswiththesexeducationcomponentofa
residentialtreatmentprogram,withsignificantchangeinsexualknowledgerecordedfrom
pretoposttesting.However,therehasbeenlittlementionintheresearchliteratureofthe
useand/orefficacyofsexeducationinrelationtoASOs.
FamilyTherapy
Families are important influences in the lives of adolescents regardless of the quality of
family relationships (Thomas, 2004). A holistic approach to therapy recognises that
adolescentsrespondbestwhensupportedbyfamilymembers(Print&O'Callaghan,2004).
Family therapy targets communications and family support networks and provides sex
educationincludinghowtodisrupttheabusecycle(Sciarra,1999;J.Shaw).Familyandgroup
therapyprovidesanopportunitytodealwithfamilyissuesthatmayhavecontributedtothe
offendingbehaviours.Parentgrouptherapyprovidesanopportunitytodiscussissueswith
parentswhohavehadsimilarexperiencesandfeelings.Siblinggroupsprovideopportunities
to express emotions and deal with the impact of sex offending in the family. For the
offender,thereareopportunitiesforvicariouslearningandmodellingbypeers.Inaddition,
competitionandpeerpressurecanhelpmotivatechange.Table10setsoutseveralstudies
thathaveadoptedafamilytherapyapproach.
Table10
StudiesUsingaFamilyTherapyApproach
Study
(Bremer,
1992)

Sample
193
participants
postrelease,
Nocontrol
group

(Hunter&
Figueredo,
1999)

N=204
Nocontrol
group

Treatment

Measures

Sexeducation,
empathy
training,
cognitive
distortions

Recidivismrate

Sexeducation,
socialskills
training,
cognitive
restructuring,
relapse
prevention,
anger
management

Program
compliance
measuredby
completionof

MajorFindings
6%convictionrate
11%selfreportrate

50%remainedin
programfor12
months

75%ofnondeniersat
Psychopathology intakesuccessfully
completedcourse
Sexual
Maladjustment 25%ofdeniers
successfully
completedcourse
33%expelledas

23


treatmentfailures
Familytherapyisconsideredmosthelpfulwhentherehasbeenincestperpetratedbecause
it is within the family that many of the offenders beliefs, attitudes, and feelings towards
sexualityhavedeveloped(J.Shaw,1999).Familytherapyisparticularlyusefulwherethereis
intergenerationalabuse(Thomas,2004)andtohelpparentsdealwiththeirownfeelingsof
victimisation and stigmatisation. However, this form of therapy poses difficulties for
therapistswhomustengageandworkwithchaoticfamilysystems.Todate,fewstudieshave
examinedtheefficacyoffamilytherapywithASOs(Thomas).
Bremer(1992)investigatedanintensiveprogramforASOs(N=193)whichincludedpeer
grouptreatmentandfamilytherapy.Areasaddressedintreatmentwerepersonal
accountability,victimempathy,thesexualassaultcycle,sexeducation,andpersonal
victimisation.Uponfollowup,convictionrateswere6%forASOsand11%uponselfreport.
Therewerenomeasuresofpsychosocialfunctioningtakenandnocontrolgroup.Thetime
spentintherapyvariedwidelybetweenparticipants.However,thelowrecidivismrate
reportedforthislargegroupsupportsthistypeoftreatmentprogram.
MultisystemicTherapy(MST)
AccordingtoMSTproponents,behaviourproblemsaremultidimensionaland
multidetermined;ASOsareembeddedinmultipledysfunctionalsystems(Swenson,
Henggeler,Schoenwald,Kaufman,&Randall,1998).MSTtargetscharacteristicsoftheASO,
his/herfamily,school,andpeerrelationships;addressingcognitivedeficitssuchasdenial,
empathy,andcognitivedistortions;familyrelationssuchascohesionandparental
supervision;anddysfunctionalpeerrelationships.FamiliesofASOsareoftencharacterised
bydomesticviolence,drugand/oralcoholmisuse,neglect,andotherdifficulties(Borduin,
Henggeler,Blaske,&Stein,1990).Therefore,treatmentprogramsneedtobeflexible
enoughtoencompassthediverseareaswhereproblembehavioursaremanifested
(Swensonetal.,1998).Tomakeeffectivechanges,interventionsmustconsiderchangesto
theadolescentsenvironmentaswellaschangestotheindividual.MSThasbeeneffectivein
arangeofadolescentproblemareas(Borduin&Schaeffer,2001)andalthoughmore
evidenceisneededthereisreasontobelievethatitislikelytobeeffectivewithregardto
theproblemsexualbehavioursofadolescents.Table11setsoutsomeoftheMSTbased
studiesthathavedealtwithASOs.
Table11
MultisystemicTreatmentStudies
Study

Sample

(Borduinet 16male
al.,1990) offenders(mean
age14years)
MSTgroupn=8
Individual

Treatment
MSTprogramme
(cognitivedeficits,
familyrelations,
peerrelations,
school

Measures
Recidivism
rates3
yearspost
treatment

MajorFindings
MSTgrouprecidivism
rate12.5%sexual
offences;25%non
sexualoffences
ITgrouprecidivismrate

24


therapygroupn
=8

(Borduin& 24adolescents
Schaeffer, assignedtoMST
2001)
programme
24adolescents
assignedto
controlgroup

75%sexualoffences;
50%nonsexualoffences

performance)
Individual
counsellingfocus
onpersonal,
family,academic
issues
PersonalisedMST
intervention

Recidivism
rates8
yearspost
treatment

Recidivismlowerfor
MSTvscontrolgroupfor
sexual(12.5%vs41.7%)
&nonsexual(29.2%vs
62.5%)offences

Inamultisystemicapproachtotreatment,interventionstargetproblemareasinthe
individualssystemdeterminedbyindividualandfamilycircumstances.However,generally,
MSTtreatmentstargetdeficitsintheadolescentscognitiveunderstanding,familyrelations,
andschoolperformance(Borduinetal.,1990;Swensonetal.,1998).MSTengagesparents
asagentsofchangefortheirchildren(Swensonetal.,p.333).Therefore,parentshavea
majorroleinthetherapeuticinterventionsimplemented.Theseinterventionsarebasedon
empiricallyvalidatedresearch.Strategicfamilytherapy,structuralfamilytherapy,
behaviouralparenttraining,andcognitivebehaviouraltherapiesareexamplesofthe
interventionsusedinMST.
ThestrengthofMSTisthattheprocessiswelldocumentedandinterventionsforindividuals
andfamiliesareclearlydelineated(Swensonetal.,1998).MSTprovidesanopportunityto
improvetheadolescentssupportnetworkbyutilisingaholisticapproachtointervention
(Swensonetal.).ResearchbyBorduinetal.(1990)suggestedthatparticipantswhoreceived
MSTratherthanindividualtherapywerelesslikelytoreoffendsexuallyorgenerally.They
surmisedthiswasduetothesystemicapproachtotherapyconsideringtheimportanceof
thevarioussystemsintheadolescentslife.TheresearchersbelievedthatMSTissuccessful
becausethefocusoftreatmentismultidetermined,thereiseaseofaccessforclients,
familiesareengagedinthetreatmentprocess,andemphasisisplacedontreatment
adherence(Swensonetal.).Treatmentisofferedtofamiliesatalocationconvenientto
them,consideredanimportantfactorinminimisingattritionrates.
Borduinetal.(1990)utilisedasocialecologicaltreatmentmodeldesignedtomeetthe
multidimensionalneedsofASOs.TheresearcherscomparedMST,whereadolescentswere
treatedwithinthesocialcontext(family,peerrelationships,andschooladjustment)to
individualtherapy(focusedonpersonal,family,andacademicissues).Participantswere
randomlyassignedtoeitherexperimentalorcontrolgroupsbutsamplesizesweresmall(8
ineachgroupatintakeand5bycompletionoftheprograms).Theresearchersfoundthat
therecidivismratewassignificantlylowerfortheMSTgroupforsexualoffences(12.5%v
75%)butnotfornonsexualoffences(25%v50%).Moreevidenceisneededtosupportthe
efficacyofMST.

25

SynopsisofStudies

Ageneralproblemwithtreatmentstudiesisthattheyfailtomeasurecomponents
oftheinterventiontodeterminetreatmentefficacy.Forexample,Labetal.s(1993)study
failedtofindadifferenceinrecidivismratesbetweenasexoffenderspecificprogramanda
generaloffenderprogram.However,recidivismwasmeasuredusingcourtrecordsonly.Asis
widelyunderstood,manyoffences,bothofasexualandnonsexualnature,goundetected.
Further,thestudydidnotexamineoutcomesforspecifictreatmentcomponentsto
determinewhethersuchthingsasvictimawareness,empathy,andsexualknowledgehad
improved.
MazurandMichael(1992)evaluateda16weektreatmentprogramwhichincludedpsycho
educationandrelapsepreventioncomponents.Ata6monthfollowuptherewasnoself
reportedreoffendinginthetreatmentgroup.However,thesmallsample(N=10),lackof
controlgroup,andshortfollowupperiodmakeitdifficulttodrawconclusionsaboutthe
efficacyofthisprogram.
Gravesetal.(1992)comparedatraditionaltreatmentprogram(n=12;8completed)witha
combinationofindividualtherapyandsocialskillstraining(n=18,16completed).
Participantswererandomlyassignedtotreatmentorcontrolgroups.Theresearchers
assessedparentchildrelationships,socialskills,behaviouralproblems,andselfconcept
uponcompletionofthetreatmentprograms.Althoughthesocialskillsofbothgroups
improved,greaterimprovementwasshownbytheexperimentalgroup,particularlyinthe
areasofcommunicatingwithparents,internalisingandexternalisingbehaviours,andself
concept.However,theparentsdidnotagreewiththeresearchersthatexternalising
behaviourshadimproved.Thesmallsamplesizeandvaguedescriptionsofthetreatment
programsmakeitdifficulttodeterminewhichcomponents,or,combinationswere
responsibleforpositivechange.
Individualpsychotherapyhasseveraldrawbacks.Itiseasiertomanipulatethetherapist,
maintaindenial,andtherearefeweropportunitiesforconfrontationofdenialand
minimisation,learningsocialskills,anddevelopingvictimempathyfromothers(Prendergast,
2004;J.Shaw,1999).Therehasbeenconsiderablymoresuccessintheseareasusingagroup
therapyapproach.Further,individualpsychotherapydoesnotaddressotherfactors
(ecological,family)thatmayfacilitateanabusiveenvironment(Swensonetal.,1998).
Therefore,individualpsychotherapyisunlikelytobeeffectiveasthesolemeansof
treatmentforASOs(Bourke&Donohue,1996;Ertl&McNamara,1997).Becauseofitshighly
individualisednature,individualpsychotherapymethodologiesmaynotbegeneralisableto
thecommunitysetting(Bera,1994).
CBTappearstobethemostwidelyacceptedtreatmentprogramforASOsandhashadsome
successinreducingrecidivismrates.Moreresearchisneededtounderstandwhich
componentsaresuccessfulandinwhatways.Moreoutcomemeasuresneedtobereported
whichtargetspecificskillssuchassocialskillsorsexualknowledge.Further,itwouldbe
desirabletoknowwhichgroupofASOs(e.g.,intrafamilialvsextrafamilial)wouldmost
benefitfromCBT.

26


ItisdifficulttodeterminewhichcomponentsofCBT,ifany,areresponsibleforpositive
change.Forexample,thetreatmentprogramevaluatedbyHunterandSantos(1990)
includedverbalsatiation,cognitiverestructuring,covertsensitization,insightoriented
groupandindividualtherapy,familytherapy,socialskillstraining,sexeducation,values
clarification,andrelapseprevention.Following2monthsoftreatmentthe20ASOsinthe
studydemonstratedsignificantdecreasesinphysiologicalarousaltopaedophiliccues.No
controlgroupwasusedandarousallevelsweretheonlymeasureoftreatmentoutcome.
Therewasnomeasurementofchangeforanyspecificskilltargetedinthetreatment
program.Thereforeitisunclearwhichcomponentsoftheprogram,orwhichcombinationof
components,wasresponsiblefortherecidivismrateachieved.
CurrentStateoftheLiterature
ThereareanumberofissuesthatneedtobeaddressedintheASOliterature.First,thereare
methodologicalproblemsassociatedwiththeASOresearch.Forexample,alargenumberof
studiesarenonexperimentalordonotincludeacontrolgroupforcomparison.Theuseofa
controlgroupishowever,acontentiousissueasitisseenasunethicaltowithhold
treatment.Manystudiesdonotprovideadetaileddescriptionofthetreatment
interventions(Vizardetal.,1995).Thismakesitdifficulttocomparetreatmenteffects
betweeninterventionsandtodeterminewhichcomponentsofatreatmentareeffectivein
reducingoffencerates.Furthertothis,thereisalackofstandardisedmeasuresspecifically
forASOstoassesstreatmenttargets(Eastman,2004).
Second,thereisalackofdiscriminationbetween,andoperationalisationof,typesof
offending(e.g.,intrafamilialandextrafamilial)intheliteratureconfoundingthetreatment
implicationsforoffendersubgroups(Tomison,2002).Developmentofatheoryof
adolescentsexualoffendingisongoing.Anunderstandingoftheaetiologyofadolescent
sexualoffendingwillguideassessmentandtreatment.
Finally,currentmeasuresofrecidivismunderestimatethetrueprevalenceofadolescentsex
offending(Vizardetal.,1995).Vizardetal.suggestedthatinterviewingtheoffender,family
members,andprofessionalsprovidedthebestpossibilityofaccuratelyassessingreoffence
rates.Earlydetectionandinterventionprovidesthebestopportunityoftreatingthe
problembeforeitbecomesentrenched.Consideringthatmanyadultoffendersbeginto
offendinadolescencecloserattentiontothedevelopmentofsexualdevianceatayounger
ageiswarranted.Betterinterventionatthislevelmaypreventconsiderabledamage,not
onlytotheoffender,butalsotothevictims.However,thequestionofwhereinthe
developmentcyclethatsexualdevianceisestablishedremainsunanswered.

27


CHAPTER3:

METHODOLOGY

StudyDesign
Given the aims of the research study it was important to develop a design that could
accommodatemultiplesourcesofinformation.Themethodologyalsoneededtoinvestigate
the perceptions and experiences of participants and parents in some depth and with
considerablesensitivity.
Thiswasanexploratorystudythatutilisedmethodtriangulation(Patton,1990).Examining
bothqualitativeandquantitativedatafromanumberofsourcesallowedaconvergenceof
datainordertoprovideadetailedpsychologicalprofileofintrafamilialASOs.Thequalitative
componentsofthestudyweredesignedtoachievearicher,moreholisticunderstandingof
theimpactoftreatment,includingwhichcomponentsworkandwhichdonotworkfrom
the perspective of the participants and their parents. The quantitative aspects were
designed to provide data suggestive of treatment outcomes and a psychological profile of
thepopulation.
Participants
ThestudygroupwasdrawnfromallconsentingmaleandfemaleintrafamilialASOs(1218
years)whoweretreatedintheSafeCareYoungPeoplesProgrambetweenAugust2004and
June2007.Thefinalstudygroupconsistedof38adolescentsandtheirparents(seeTable
12). Ninetyone per cent of all adolescents treated during this period consented to
participate in the study. Participants included adolescents who had come to SafeCare
through different routes including family selfreferrals and agency based referrals from
statutorybodies(e.g.,DepartmentofCorrectiveServices,DepartmentofChildProtection).
Information and Consent Forms were provided to participants and their parents or
caregivers outlining the general purpose and relevance of the study. Selection Criteria
requiredthat:

participantswereintrafamilialsexoffendersagedbetween12and18years;

participants(andtheircaregivers)acknowledgedthesexualoffending;

participantswerewillingandabletocommittotreatmentforsexualoffending;

primarycaregiverswereabletoprovidesupportandparticipationinthetreatment;

participantshadadequatecognitiveabilities;

whererelevant,psychiatricconditionswereadequatelystabilised.

Table12
SafeCareStudyGroup
Numberoffamilies...
whoattendedSafeCare

Total(%)
42

28

participatedinstudy

38(91%)

wholeftstudypriortocompletion

15(39%)

whocontinuedinstudy

23(61%)

whocompletedtreatmentbyJune2007

15(39%)

referredbygovernmentagencies

28(74%)

selfreferred

10(26%)
TreatmentProgram

SafeCare Young Peoples Program (YYP) is a community based family treatment program
that offers specific assessment, treatment, and long term support to families affected by
child sexual abuse. The program specialises in the support and treatment of the child or
adolescentsexualabusevictim,theadolescentoffender,andtheirfamily.YYPprovideseach
family member with individual and group therapy, as well as couple, family, and
reunification sessions when required. The YYP is a multifaceted model that integrates well
recognisedtheory,research,andtreatmentapproachesincludingGiarretto(1982),Worling
(1995a), and Worling and Curwen (2000). The program utilises cognitive behavioural,
psychoeducational,psychodynamicandfamilysystemsapproaches.
DataCollection
QualitativeMethodology
Thequalitativemethodologywaschosentoprovidethedetail,depthofanalysis,andthick
descriptionthatcouldilluminatetheissuesrelevanttopractice.Qualitativeapproaches
wereconsideredusefulbecauseofourfocusontryingtounderstand,fromtheperspective
oftheindividualandinamoredetailedway,thecrucialelementsthatimpactchange
(Patton,1990).Qualitativemethodswerealsoindicatedbecausethestudywasclearly
exploratory(McLeod,2001;Patton).Giventhepaucityofresearchonbothpopulation
characteristicsandthecontributionoftreatmentprogramstothefunctioningofintrafamilial
adolescentsexoffenders(IASOs),triangulationthatincludedqualitativeandquantitative
methodswasusedtoprovidethestrongestandmostdetaileddata.Semistructured
interviewingwasusedinordertounderstandtheexperienceandimpactoftreatmenton
participantsandtheirfamilies,andtocapturethedepthoftheexperience.
Qualitativedatawascollectedinthefollowingways:
1. Semistructured clinical interviews were conducted for participants during the 6 week
assessmentphaseoftheprogram.Theseutilisedtheclinicalinterviewdevelopedforuse
intheassessmentofASOs(Hoghughietal.,1997).Itincludedarangeofquestionsabout
a number of relevant domains, such as nature of offences, a family genogram,
developmentalhistory,historyofabuse,familystructure,andfamilyfunctioning,which

29


are consistent with recommendations for the assessment of adolescent offenders.
Cliniciansconductinginterviewstranscribedanswersontointerviewproforma.
2. Semistructured clinical interviews were used to gather data from the parents of the
adolescent offenders during the 6 week assessment phase of the program. Clinicians
conductingtheinterviewstranscribedparticipantanswersontointerviewproforma.
3. Closing clinical interviews were conducted for participants on completion of the
program.AnadaptationoftheclosingclinicalinterviewdevelopedbyByers(1994)was
usedtoexaminethefollowingdomains:i)perceivedimpactofthetreatmentprogramii)
perceivedprogramimpactonsexualoffendingbehavioursiii)programimpactonfamily
functioning iv) general value of the program v) views about what elements were most
helpfulandwhichwereleasthelpfulvi)viewsaboutelementsoftheprogramthatwere
most memorable and challenging vii) views about their relationships with both their
groupandindividualtherapists.Interviewswereconductedbymembersoftheresearch
team(taperecordedandtranscribedverbatim)followingNHMRCethicalguidelinesfor
humanresearch.
4. Closing clinical interviews were conducted with parents of the participants on
completion of the program, also based on an adaptation of the Byers (1994)
semistructuredinterview,thatexploredthefollowingdomains:i)parentalexperienceof
the treatment program ii) program impact on sexual offending behaviours iii) program
impactonfamilyfunctioningiv)theirviewsaboutthegeneralandspecificimpactofthe
program on their sons/daughters v) their views about which elements of the family
intervention program were most helpful and which were least helpful. vi) views about
their relationships with both the agency and therapists. Interviews were conducted by
researchers,taperecordedandtranscribedverbatim.
QualitativeAnalysis
Interpretive Phenomenological Analysis (J. A. Smith, 2001) was used to analyse the data,
allowing for both thick description and thick interpretation (Denzin, 1989). Interpretive
PhenomenologicalAnalysisisdesignedtogainunderstandingoftheparticipantsexperience
ofanevent.Itincorporatesbothaphenomenologicalandaninterpretativeframework(R.L.
Shaw,2001).Becauseitisdatadriven,itenablesexplorationofparticularexperiences,while
allowingemergenceofunanticipatedthematicmaterial(R.L.Shaw).
Members of the research team constructed an initial map of domains based on an
immersionapproachtoanalysis.Thatis,interviewswerereadmultipletimestogainasense
of overarching domains, before formal coding transpired. The entire research team then
overviewedthedomains andthemesforanalysisofthedifferentvariablesexploredinthe
interviews and revised the themes. The QSR NVivo 7 program for qualitative analysis was
used to formalize coding and analysis. Domains and themes were somewhat revised as
formalcodingproceeded.
QuantitativeMethodologyandAnalysis
Thequantitativesectionofthestudycomprisedthreeparts:

30


1. AdescriptivestudytoprovideapsychologicalprofileofIASOsandtheirfamiliesbased
onabatteryofpsychometricassessments.
2. Acomparativestudy,usingtheMillonAdolescentClinicalInventorytoascertainwhether
acommunitytreatmentsampleofIASOsweresimilarordifferenttoexistingtypologies
ofASOswhichoftenincludecustodialpopulationsandextrafamilialsexoffenders.
3. Aonegrouprepeatedmeasuresdesign,whereinparticipantswereadministeredaseries
ofpsychometricinstrumentsrelevanttoprogramtreatmentgoals,toascertainwhether
resultsweresuggestiveoftreatmenteffectiveness.
FormalHypothesis
Frompretesttoposttestandfrompretesttofollowup,therewillbeincreasesinlevelsof
empathy, social/coping skills, and family functioning, and corresponding decreases in
symptoms,cognitivedistortions,andpsychopathology.
QuantitativeDesign
Thequantitativepartofthestudywasdesignedtoprovidedescriptiveandquasi
experimentaldataaboutthistreatmentgroup.Althoughrandomisedcontrolledtrialsare
oftenthepreferredexperimentaldesign,itwasnotpossibletosafelyorethicallyutilisea
controlgroupwiththistreatmentpopulation.Oncetheseadolescentshavebeenidentified
andreferredfortreatment,itwouldhavebeenunethicaltodelaytreatment,because
youngerchildrenwereatriskoffurtherabuse.Thus,waitlist,notreatment,orplacebo
controlgroupswerenotanoption.Nonequivalentcontrolgroupswerealsoconsidered
problematicbecauseofthebatteryofpsychometricmeasuresutilised.Giventhepaucityof
researchandrelativelyrecentdevelopmentofpracticeinthisarea,thisstudywasclearly
exploratory.Thus,triangulationwasusedtoprovidemethodologicalrigourforthestudy.
QuantitativeAnalysis
Theformalhypothesiswastestedforeachofthefiveoutcomemeasuresbyconductingone
tailedrelatedsamplesttestscomparingpretestscorestoposttestscoresandpretestscores
tofollowupscores.Becausethefalsealarmrateacross10ttestswaspredictedtobehigh,
a Bonferroni correction would normally be applied to the pertest alpha level in order to
reducethenumberoffalsealarms.Becausethiswasanexploratorystudy,however,we
were prepared to tolerate a high false alarm rate in order to reduce the probability of
missingarealinterventioneffect.Anuncorrectedpertestalphalevelof.05wastherefore
usedforeachttest.
PsychometricMeasures
Areviewofpotentialpsychometricmeasuresappropriatetothispopulationwasconducted
through an investigation of the existing research literature as well as conversations with
experienced clinicians in the area. The following measures were selected as most
appropriate in terms of both screening the population, providing a psychological profile of
the sample, and measuring any changes that might occur as part of treatment. Measures

31


werealsochosenonthebasisofthesymptoms,behaviours,andfunctioningtargetedinthe
treatmentprogram.

FamilyofOriginScale(FOS)(Hovestadt,Anderson,Piercy,Cochran,&Fine,1985)
The FOS is a 40item instrument designed to measure levels of family functioning,
focusing on the key concepts of autonomy and intimacy. The total score is used as a
general measure of satisfaction with family relationships. It has been shown to have
excellent internal consistency and testretest reliability with adolescents (Manley,
Searight,Skitka,Russo,&Schudy,1991)andhasbeensuccessfullyusedwithadolescent
siblingincestoffenders(Worling,1995a).

AdolescentCopingScale(ACS)(Frydenberg&Lewis,1993)
The ACS allows adolescents to examine their use of 18 distinct coping strategies (e.g.,
worry, seek social support). The ACS includes 80 items that take 25 minutes to
administer and score. ACS items demonstrate moderate testretest reliabilities and
factoranalyticresearchsupportstheconstructvalidityofthetestdesign(Frydenberg&
Lewis,1993;1996).TheACSisthemostcomprehensiveinstrumentofitskindandthe
firsttobedevelopedinanAustraliancontext.

TraumaSymptomChecklistforChildren(TSCC)(Briere,1995)
TheTSCCisaselfreportmeasureofposttraumaticsymptomsappropriateforusewith
childrenages817years. The TSCCincludes54itemsandyieldstwovalidityscales,six
clinical scales (e.g., posttraumatic stress, dissociation), and eight critical items (e.g.,
suicidality,expectationofsexualmaltreatment).Itisquicktoadministerandscore(25
minutes). The TSCC is standardized on a large sample of racially and economically
diverse children, provides norms according to age and gender, with validity well
established(Fricker&Smith,2002).

InterpersonalReactivityIndex(IRI)(M.H.Davis,1983)
The IRI is a 28 item selfreport measure of empathy that assesses perspective taking
ability,empathicconcern,fantasy,andpersonaldistress.TheIRIisincreasinglyutilizedin
adolescentempathyresearchandhasrecentlybeenusedtodistinguishbetweensexual
offending and nonoffending adolescent males (Burke, 2001). Research supports the
reliabilityandconstructvalidityofthistest.

MillonAdolescentClinicalInventory(MACI)(Millon,1993)
TheMACIisa160item(truefalse)selfreportinventorywrittenata6thgradereading
levelanddesignedtogiveacomprehensivelookintothemaladaptivepersonality
characteristicsoftroubledteens.TheMACIincludes12personalityscales,9clinical
indices,and8expressedconcernscales(e.g.,identityconfusion,bodydisapproval).
MostadolescentswillcompletetheMACIin20minutes.Researchsupportsthe
reliabilityandvalidityoftheMACI(Millon&Davis,1993).TheMACIhasbeenusedto
discriminatebetweensexoffendingandnonoffendingadolescents(Mattingly,2000).

Multiphasic Sexual InventoryJuvenile Version (MSI) (Nichols & Molinder, 1984)

TheMSIJVisa21scaleinstrumentdesignedtoassessthepsychosexualcharacteristics

32


ofsexualoffenders.TheMSIincludesscalesassessingsexuallydeviantbehaviours,acts,
cognitive processes (e.g., distortions, justifications, beliefs), and deceptive styles (e.g.,
denial,dishonesty).ResearchsupportsthereliabilityandvalidityoftheMSI(Kalichman,
Henderson, Shealy, & Dwyer, 1992), which has been commonly used with adolescent
offenders(Hunter&Becker,1994).Only4scalesoftheMSIJVwereused:i)treatment
attitude, ii) justifications, iii) cognitive distortion, and immaturity, and iv) child molest.
This decision was taken because the clinicians were extremely concerned that the
sexuallyexplicitdetailinsomeofthescaleshadthepotentialtointroducesexualideas
or fantasies that did not previously exist in the population (e.g., questions about
bondage,crossdressing,orsadomasochisticpractices).

BriefSymptomInventory(BSI)(Derogatis,1979)
The BSI is a 10 minute 53 item selfreport symptom inventory designed to assess
psychological symptom patterns on nine dimensions (e.g., depression, anxiety, and
hostility) and three global indices of distress. The BSI has been used with adolescent
communitypopulationsanddemonstratessensitivityinmeasuringchangeintreatment
outcomestudies(Derogatis&Lazarus,1994).
Procedure

Duringaninitialintakeinterviewattendedbyboththeadolescentandhis/herparents,all
referralssatisfyingthesubjectselectioncriterionwereinvitedtoparticipateinthepresent
study.Informationsheetsoutliningthestudy(AppendixA)andconsentforms(AppendixB)
weregiventoparticipantsandtheirparents.Bothpartiesneededtoconsenttobeincluded
inthestudy.ThestudywasapprovedbytheHigherResearchEthicalCommitteeatCurtin
UniversityandtheBoardofSafeCare.
Consentingparticipantsthencommencedasixsessionassessmentphase.Duringthe
assessmentphaseparticipantswereadministeredabatteryofpsychometricinstruments
andtheircaregiversapsychometricmeasureoffamilyfunctioning(seeTable13).
Participantsalsounderwentasemistructuredclinicalinterview(Hoghughietal.,1997)and
theircaregiversparticipatedinanintakeinterview.
Immediatelyfollowingassessment,clientscommencedanindividualisedtreatmentprogram
lastingninetotwelvemonths.ParticipantscompletedtheBSIatintake,exit,andeverythree
monthsduringtreatment.Attheconclusionoftreatmentsubjectscommenceda
reassessmentphase.Duringreassessmentsubjectswereagainadministeredthe
psychometrictestbattery(andtheircaregiversthefamilyfunctioningmeasure),andthe
participantsandtheirparentswereseparatelyinterviewedwithasemistructuredclosing
interview.

33


Table13
ResearchDesign
Pretreatment
AssessmentPhase

AdolescentCopingScale

TraumaSymptomChecklist

InterpersonalReactivity
Inventory

MillonAdolescentClinical
Inventory

MultiphasicSexual
Inventory

Treatment
Phase

Posttreatment

BriefSymptom
Inventory

administered

everythree
months.

AdolescentCopingScale
TraumaSymptomChecklist
InterpersonalReactivity
Inventory

MillonAdolescentClinical
Inventory

MultiphasicSexualInventory

FamilyofOrigin

FamilyofOriginScale

BriefSymptomInventory

BriefSymptomInventory

ClinicalInterview
Adolescents

Closinginterviewfor
adolescents

Closinginterviewforparents

ParentalIntakeinterview

34


CHAPTER4:

RESULTS

QuantitativeAnalysis

DemographicDescriptionofStudyGroup
The study group consisted of 38 participants (35 male, 3 female) who had committed a
sexualoffenceagainstasibling,familymember,orfriend.Table14providesasummaryof
the relevant demographic details. The age range of index offence was 418 years with a
mean age of 12.95 years. Several participants were not referred for treatment until a
considerabletimeaftertheoffendingcommencedandinthecaseofthe4yearoldwhowas
referredatage15,hehadcommittedhislastoffenceatage12.
Table14
SummaryofDemographicDataRelatingtoStudyGroup

Characteristic

MeanScore/Percentage

AgeatReferredOffence

12.95yrs

TypeofOffence

Penetrative

63%

Touching

37%

AgeofVictim

6.37yrs

NumberofVictims

1.34

39%

GenderofVictim

Male

Female

50%

Both

11%

RelationshiptoOffender

Sibling

61%

Cousin

21%

Niece/Nephew

2%

FamilyFriend/Neighbour

16%

PriorVictimisationofOffender

PhysicalAbuse

18%

SexualAbuse

42%

MultipleformsofAbuse(includingsexual)

5.5%

ExperienceofDomesticViolence

5.5%

35

Unknown

29%

PsychologicalCondition

PTSD

10%

ADHD

26%

AspergersSyndrome

2%

IntellectualImpairment

2%

DevelopmentalDelay

8%

OtherPsychologicalDisorder

2%

Descriptionofsexuallyinappropriatebehaviour
Thesexuallyinappropriatebehaviourthatledtotheinitialreferralfortreatmentcovereda
range of behaviours from fondling breasts and genitals over clothing to vaginal and anal
penetration. There was little difference in the spread of ages between participants who
committedtouchingorpenetrativeoffencesalthoughtheyoungestoffendercommittedone
ofthemostseriousoffences.Moreparticipantscommittedpenetrativeoffences(63%)than
touchingoffences(37%).
Itwasdifficulttodeterminethenumberofoffencesandvictimsforthestudygroup.Most
participantsstatedthatthecurrentvictimwastheirfirst.Therewereatotalof51victims,
withthenumberofvictimsperparticipantrangingfrom1to4.Themeanageofthesexually
abusiveadolescentsappearedsimilartothatreportedintheliterature.
Victims
Thetreatmentprovidedisforintrafamilialsexoffenders,therefore,allofthevictimswere
known to the offenders though the victims were not necessarily related to the offenders.
However, 84% of victims were a blood relative with the largest number of victims being
siblings.Theremainderofvictimswereeitherneighboursorchildrenofclosefamilyfriends.
All of the victims were younger than the offending adolescent. In 24% of cases the age
difference between victim and offender was less than 5 years; often used as a guide to
differentiatingabusefromsexualexploration.Themaleoffendersweremorelikelytooffend
against a female victim (51%) than a male victim (37%) or both male and female victims
(12%). Due to the small number of female offenders it was not meaningful to report data
separately.
Priorvictimisation
Most offenders reported prior victimisation, with almost half (47.5%) of the participants
beingvictimsofsexualabuse.Ofthosewhodidnot(11),sixhadreceivedlessthan4months
oftherapy.Itispossiblethatpriorvictimisationmaybedisclosedatalaterdate.Threeofthe
four adolescents who offended against both genders, were victims of domestic violence.
Mostoftheparticipantswhohadmultiplevictims(67%)werevictimsofsexualabuseplus
eitherphysicalabuseordomesticviolence.

36


Individualcharacteristics
Half of the participants had been diagnosed with a psychological condition. The most
commondiagnoseswereADHD(26%)andPostTraumaticStressDisorder(PTSD)(10%).
Familycharacteristics
Mostofthestudygrouphadexperienceddisruptiverelationshipswithparentsorparental
figures.Only21%ofparticipantscamefromanintactnuclearfamily.Thirteenpercentlived
withfosterparents;12%livedwithanonparentrelativewiththeremainder livinginstep
families.Seventyfourpercentofparticipantseitherhadnocontactorminimalcontactwith
atleastonebiologicalparent.
PsychometricDescriptionofStudyGroup
Eachparticipantwasadministeredanumberofpsychometrictestsaccordingtothe
scheduledescribedearlier.Theresultsofthettestsarereportedinalatersection.Following
isabriefdescriptionofeachpsychometrictestwithpretestmeansforthestudygroup.
AdolescentCopingScale(ACS)
TheACSallowsadolescentstoexaminetheiruseof18distinctcopingstrategies(e.g.,worry,
seek social support). The measure provides three different coping styles: Solving the
Problem, Reference to Others and Nonproductive Coping. The participants (N = 38) at
pretestweremorelikelytousesolvingtheproblemtocopewithdifficultiesthaneitherof
the other two coping styles. However, this coping measure was used only some of the
time. In addition, although mean scores were similar to published community sample
scores (Frydenberg & Lewis, 1993) in terms of strategies that were productive or used
referenceto others,they wereconsiderablyhigher than thenorminusingnonproductive
copingstrategies.
BriefSymptomInventory(BSI)
The BSI is a 53 item selfreport symptom inventory designed to assess psychological
symptompatternsonninedimensions(e.g.,depression,anxiety,hostility),andthreeglobal
indices of distress. The global severity index has been used in a number of studies as an
indicatorofoveralldistress.Ascoregreaterthan63isconsideredapositivecase.Themean
scoreforthestudygroupwas49.73(SD=12.45).
FamilyofOriginScale(FOS)
TheFOSisa40iteminstrumentdesignedtomeasurelevelsoffamilyfunctioning,focusing
onthekeyconceptsofautonomyandintimacy.Thetotalscoreisusedasageneralmeasure
ofsatisfactionwithfamilyrelationships.Whilst therearenonormativescoresfortheFOS,
theoriginalresearchwasbasedon278Texancollegestudents(Hovestadtetal.,1985).The
mean total FOS score for this group was 147.0 for black students and 144.1 for white
students.Themeanscoreforthestudygroup(n=36)was138.06(SD=21.64).Thistestwas
alsoadministeredtoparents(n=20)atintake.Themeanscorefortheparentswas131.80
(SD=29.92)indicatingthatadolescentsviewedtheirfamilyoforiginslightlymorefavourably
thandidtheparents.

37


InterpersonalReactivityIndex(IRI)
TheIRIisa28itemselfreportmeasureofempathythatassessesperspectivetakingability,
empathic concern, fantasy and personal distress. The pretest total score for the IRI was
53.22(n=37).Althoughtherearenonormsforthismeasure,thestudygroupoverallmean
andsubscalemeanswerenotsignificantlydifferenttoapublishedstudywithanAustralian
adolescent control group (mean = 56.02) (Moriarty, Stough, Tidmarsh, Eger, & Dennison,
2001).
MillonAdolescentClinicalInventory(MACI)
TheMACIisa160item(truefalse)selfreportinventorydesignedtogiveacomprehensive
look into the maladaptive personality characteristics of troubled teens. The MACI includes
12personalityscales,9clinicalindices,and8expressedconcernscales.Nomeanscoresfor
the study group fell in the clinically significant range. However, several variables scored
betweenBR60andBR75denotingproblematicareas.Theseelevatedscoresarepresented
inTable15.
Table15
MACIPretestScoresintheSlightlyProblematicRange

Variable

Mean

StandardDeviation

Unruly

67.75

16.77

Oppositional

60.06

19.32

SexualDiscomfort

61.28

22.37

FamilyDiscord

72.84

15.56

ImpulsivePropensity

68.38

19.54

DepressiveAffect

64.81

28.11

MultiphasicSexualInventoryJuvenileVersion(MSIJV)
The MSIJV is a 21 scale instrument designed to assess the psychosexual characteristics of
sexualoffenders.Only4scalesoftheMSIJVwereusedwiththiscohort:treatmentattitude,
justifications,cognitivedistortionandimmaturity,andchildmolest.Therearenonormsfor
these scales. Participants are placed in a category according to their scores on each scale.
ThestudygroupresultsaredisplayedinTable16.

38


Table16
PretestMeanScoresonMSIJV

Scale

MeanScore(SD)

Category

9.19(5.23)

MinimalizedSexualOutlet

3.69(1.69)

MaynotbeMotivated

ChildMolest

TreatmentAttitudes
CognitiveDistortions

AndImmaturity5.13(2.96)

CognitiveDistortions/

Immaturity

Justifications

3.75(2.72)

JustifiesSexualDeviance

TraumaSymptomChecklistforChildren(TSCC)
TheTSCCisaselfreportmeasureofposttraumaticsymptoms.TheTSCCincludes54items
andyieldstwovalidityscales,sixclinicalscales,andeightcriticalitems.Scoresover65are
clinicallysignificant.Scoresbetween60and65aresuggestiveofdifficulty.Sexualconcerns
and its subscales scores over 70 are considered clinically significant. The TSCC was
administeredto36participants.Nomeanscoresfellintheclinicalrange.
YouthSelfReport(YSR)
The YSR obtains self reports of the competencies and problems of 11 to 18 year olds. The
YSRcontainsexternalisingandinternalisingsubscalesplusInternalandExternalscalesanda
Totalscore.ScoresarereportedasTscores.Tscoresabove70areintheclinicalrangeand
scoresbetween67and70areintheborderlinerange.FortheTotalscorethecutoffis6063
for the borderline range with scores above 63 in the clinical range. Pretest scores for the
studygrouparepresentedinTable17.Thetotalmeanscoreforthestudygroupfellinthe
borderlineclinicalrange.
Table17
YSRPretestMeanScoresandStandardDeviationsforInternalising,ExternalisingandTotal
ScoreScales

Scale

Mean

StandardDeviation

Internalising

59.58

10.85

Externalising

59.92

9.29

TotalScore

61.87

10.25

39

QuantitativeDataAnalysis
Due to the number of participants, a small number of t tests were conducted to analyse
changeoverthe12monthtreatmentperiod.Forallinstruments,excepttheMACIandFOS,
complete data were available for 15 cases in the pre and posttest groups. For the MACI,
datawereavailablefor13casesineachgroup.FortheparentandadolescentFOSpretest
comparisons20caseswereavailableineachgroup.
Thestatisticalsignificanceofpreandposttestdifferenceswereevaluatedusingaseriesof
1tailedrepeatedmeasuresttests.Themeans,standarddeviations,andtestsofsignificance
forfamilyandindividualfunctioningvariablesaredisplayedinTable18.Testsforviolations
ofhomogeneitywerenotsignificant.
Table18
Means,StandardDeviationsandTestsofSignificanceforVariablesofFamilyandIndividual
Functioning.

PretestScores

PosttestScores

Variable

MeanSD

MeanSD

FamilyFunctioning

FOS(adolescent)TotalScore

135.20 19.15

146.4016.53

2.465*

FamilyDiscord(MACI)

69.69

16.55

67.08

11.03

.458

IndividualFunctioning

EmpathicConcern(IRI)

15.93 4.14

14.33 3.88

1.141

PersonalDistress(IRI)

10.07 5.13

8.67 5.13

1.044

ImpulsivePropensity

65.15

(MACI)

Unruly(MACI)

69.38

AttentionProblems(YSR)

60.737.56

18.45

61.85

22.28

18.99

63.92

.607

21.39

58.337.27

1.255
1.082

Note:M=Mean,SD=StandardDeviation.

*p<.05

40

FamilyFunctioning
Withrespecttofamilyfunctioning,therewerenosignificantdifferencesbetweenparentand
adolescent total FOS scores at pretest. The adolescent participants viewed their family of
originmorefavourablyatpretest.However,thereweresignificantdifferencesbetweenpre
andposttestadolescenttotalFOSscores,
t(14)=2.465<.05.AtposttesttheadolescentFOSscoresweresignificantlyhigherthanat
pretest. There were no significant differences between the pre and posttest adolescent
scoresforfamilydiscordontheMACI.
IndividualFunctioning
Withregardtopersonalfunctioning,therewerenosignificantdifferencesbetweenpreand
posttest scores on any of the variables tested (empathic concern, personal distress,
impulsive propensity, unruly, and attention problems). It should be noted that the mean
posttestscoreforattentionproblemswasbelowtheclinicalrange(6063)forthismeasure.
Thepretestmeanscorewasintheclinicalrange.
ComparisonofProgramCompletersvsNonCompleters
Comparisonsweremadebetweenparticipantswhocompletedthetreatmentprogramand
thosewhodidnot.Treatmentcompletionwasdefinedasthoseparticipantswhocompleted
at least 12 months of therapy plus pre and posttesting. Program completers (n = 23) and
noncompleters(n=15)werecomparedonanumberoffactorsincludingoffenceandvictim
characteristics, prior victimisation, and family characteristics. Table 19 summarises the
differencesbetweenthetwogroups.
Table19
DifferencesbetweenProgramCompletersandNonCompleters

Characteristic

Completers

NonCompleters

7(30%)

8(53%)

GenderofVictim

Male

Female

12(52%)

Both

4(18%)

9(39%)

5(33%)

7(47%)

OffenceType

TouchingOffences

PenetrativeOffences

14(61%)

10(67%)

7(47%)

PriorVictimisation

SexualAbuse

PhysicalAbuse

4(17%)

9(39%)

3(20%)

41


MultipleAbuse

DomesticViolence

2(9%)

Unknown

8(35%)

3(20%)

15(65%)

12(80%)

TotalExposedtoPriorVictimisation

2(13%)

FamilyofResidence

IntactFamily

8(35%)

FosterFamily

2(8%)

3(20%)

NonParentRelative

1(4%)

3(20%)

StepFamily

10(43%)

9(60%)

UtilityofKnownTypologiestothisStudygroup
AclusteranalysisoftheMACIresultsatthebeginningoftreatment(n=32)wasundertaken.
Ityieldedasomewhatdifferentprofiletoprevioustypologies.Thistypologyisshownin
Table20.
Table20
SafeCareTypologyBasedonMACIPretestScores
Group

ElevatedScoresonSubscales

Antisocial

Anxious

Narcissistic

Unruly,oppositional,familydiscord,delinquent
predisposition,impulsivepropensity
Anxiousfeelings,depressiveaffect,familydiscord,
sexualdiscomfort
Dramatizing,egotistic,familydiscord

%ofsample

41%

37%
22%

42


QualitativeDataAnalysis
ParentIntakeInterviews
Introduction
Mostparents(n=21)reportedthattherewerealreadyproblemswithinfamilyrelationships
priortodisclosureoftheadolescentsoffence.Theyalsoreporteddifficultieswithparenting
and communication patterns within the family. At the time of disclosure, the prevalent
issuesforallparentsrelatedtotheanger,guilt,andshametheyfelt.Mostparentsexpressed
aneedforsupportoftheadolescentoffender,thevictim,andotherfamilymembers.They
struggled to understand and make sense of the offence and expressed concern about the
quality of their relationship with the offender. In many cases disclosure also led to
reemergence of issues related to a family history of past sexual abuse. After disclosure,
parentalconcernsfocusedmoreontheneedtoaccessthesupportnecessarytoenablethe
adolescent to move forward. Some parents also needed to talk about the inappropriate
behaviour,tounderstandthereasonsfortheoffenceandtoestablishthecapacitytotrust
theiroffendingchildagain.Figure1displaysthedominantdomainsandthemeselicitedfrom
the parent intake interviews. The parents interviewed spoke about their experiences of
treatmentandanyissuesorproblemstheyhadwiththeserviceprovided.
Figure 1 Parent intake interviews: Domains and themes elicited from the parent intake
interviews.

43


Note:/indicateaneffectbetweenthemes/domains;indicatesanassociation
betweenthemes/domains.
PriortoDisclosure
FamilyRelationships
One third of parents interviewed described their families in positive terms, while the
remainder described families that could be categorised as being either volatile or
disengaged.Forthosewhodescribedtheirfamilyinnegativeterms,mosthadoneorboth
biologicalparentsabsentfromthefamilyunitand,generally,contactwiththenoncustodial
parent was intermittent. In addition, the relationship between the separated parents was
oftenstrainedoropenlyabusive.Insomefamilies,bothbiologicalparentswereabsentand
care was provided by relatives or family friends. In one instance, a foster parent was left
withababyshethoughtshewouldbemindingfortheevening:
Likeshe(mother)lefthimtobabysitwhenhewas2monthsandIvehad
himeversince.
A number of families with nonsupportive extended family members spoke about their
difficultieswithsadness.Thefollowingisatypicalcommentreflectingthis:
Ourfamilyisabrokendownfamily.Theres7ofusnoonetalkstono
one.
Inthesefamilies,anintergenerationalpatternofbrokenrelationshipswascommonly
reported.Ofthoseparentswhoreportedsoundfamilyrelationships,mostrecognisedtheir
(offending)childsmistakesbutreportedanacceptancebyfamilymembers:

Noonehasjudged(X)forit;everyonehasbeenveryunderstanding.

ParentingandCommunicationSkills

Someparentsquiteopenlyadmittedthattheyneededhelpwhenitcametotheirparenting
skills:
ImnotstrictenoughwithhimAndIdont,Idontenforceorhaventinthe
past,enforcedconsequencestoactionsandthingslikethat.Wherehis
motherisverystrictwithhim.
Attimes,someparentsreportedbeingatalossastohowtoprovidetheirchildrenwithrules
andregulations,withseveralparentsfindingitdifficulttoenforcefamilyrulesconsistently.
Otherparentsadmittedthattheirindulgentparentingstylewasanattempttomakeupfor
the difficult life the children had lived so far. Some of these parents had their own issues
with drug addiction and domestic violence. SafeCare was often seen as a place where the
adolescentcouldbestraightenedoutandparentswouldbegivenanopportunitytolearn
moreeffectiveparentingskills.
Thelackofeffectivecommunicationwasanimportantissueformostparentsinterviewed.In
manyinstances,familymembersfelt theyneededtooverpowerotherstohaveavoice.In
some cases, there was a dominant family member, usually the adolescent offender. A
numberofparentsstatedthattheirchildrenshoutedateachotherinordertocommunicate.

44


Manyparentsexplainedthattheywereeitheratalosstochangethispatternofrelating,or
did not believe that this form of communication was problematic. It appeared, based on
parentinterviews,thatchildrenoftendidnotlistentoparentsandmanyparentsreported
thattheyhadnowayofcontrollingthesituation,exceptbybeinglouderandangrierthan
thechildren.
Mostparentsinterviewedreportedthatconflictsusuallywerenotresolvedwellwithintheir
familiesandthattheytendedtoclosedownargumentswithoutprovidinganyopportunity
for a negotiated resolution. The most commonly used conflict resolution technique was a
formoftimeoutwheresiblingsspentsometimeapart.Oftenparentsdidnotstepinuntil
theargumentshadescalatedtophysicalviolence.Alternatively,someparentsadmittedthat
attimesitwaseasiertosayImthebossandthatstheendofitratherthanworkonthe
conflictbetweenthesiblings.
Disclosure

Emotions

Familiesnotonlyhadtodealwiththeoffendingadolescent,siblingvictim,andothersiblings
butalsotheirownfeelingsofguilt,shock,andangersurroundingtheoffendingbehaviour,
oftenwithlittleornofamilysupport.Atthistime,someparentslearntthattheiradolescent
wasnotonlyaperpetratorofasexualoffencebutalsoavictim.Allparentsreportedbeing
unsurehowtomoveforwardorwhototalktoaboutthisissueatthetimeofdisclosure.

HistoryofAbuse

Forsomeparents,afamilyhistoryofabusewasrepeateddespitetheireffortstoavoidthis.
These parents experiences of prior abuse were not generally known about within the
immediatefamily.Theparentsbelievedtheywereprotectingtheirchildrenfromthefamily
history of abuse by remaining silent and were shocked to find that it had been repeated.
Often the adolescent offenders were themselves victims of abuse but this was not always
knowninthefamilyuntilafterdisclosure,sometimesmonthslater.
Oneofthemorecommonfearsamongparentswasthatthecycleofsexualabusewouldbe
repeated generation after generation, especially if it had occurred within the parents
generation. Foremost, parents wanted this behaviour to end and felt that SafeCare could
providethemwithboththeknowledgeandtheabilitytopickuponcuesthatsomethingwas
notrightinthefuture:
LikeIfoundoutthingsthatIdidntknowaboutthecycleofabuseandall
thatkindofstuffanditmadememuchmoreaware.

ParentAdolescentRelationship

Disclosure of the abuse strained the parent child relationship and led to divided loyalties,
especiallywhenthevictimwasamemberoftheimmediatefamily.Insomecases,families
found themselves divided between the victim and offender. This was especially true when
theoffenderandvictimweremembersofastepfamily.Theseparentswereconflictedabout
how to deal with the situation. They did not want to abandon their offender/child whilst

45


understandingthattheymustdealwiththeinappropriatebehaviour.Thissometimesledto
parentsaligningthemselveswitheitherthevictimortheoffender:
Isometimesthinkthatmyhusbandthinksthatits(X)andIandhesonthe
outer.
AfterDisclosure
Answers
Allparentscametotreatmentwantingtoknowwhytheoffendingbehaviouroccurred.An
explanation, theyfelt,wouldprovidesomereliefandpossiblytheknowledge topreventit
happening in the future. Some parents also questioned how their adolescent victim could
become an offender. In their minds, the trauma of being a victim should be enough of a
deterrenttopreventsomeonefrombecominganoffender:
Ineedtounderstandthereasonwhyachildthatisavictiminhislifegrows
intoapredator.

Trust

Most parents struggled with the issue of trust, openly questioning whether they or other
familymemberscouldevertrusttheadolescentagain.Theywerefearfulthattheadolescent
couldnotbetrustedtobehavecorrectlyinthefuturealthoughtheyhopedthiswouldbeso.
TheseparentshopedthatSafeCarewouldbeabletoprovidethemwithsomeguidance.

Talkingaboutinappropriatebehaviour

Mostparentsfounditdifficulttotalkwiththeiradolescentsaboutwhathadhappened.In
particular,theseparentshadproblemsexplainingthebehaviourorthereasonsforit.They
also found it difficult to find the right words to use when talking about the inappropriate
sexual behaviours to anyone. Not many parents spoke directly about inappropriate sexual
behaviour. Only three parents were able to use terms that directly related to sexual
offending. Most parents used words such as "it"; "doing things"; "bad choice"; or "done
wrong":

Theyre(siblings)awarethat(X)hasmadesomebadchoices

Someparentswereunableorunwillingtotalkto theiradolescentabouthis/heroffending
behaviours.Somefeltthatthiswouldorshouldbedealtwithbythetherapists.Othersdid
notknowhowtoapproachthesubjectwiththeirchild.
Movingforward
Onceparentshaddealtwiththeinitialshockofdisclosuretheyfocusedonwhatwasneeded
toimprovethesituationforboththeadolescentoffenderandthefamily.Atthispoint,most
parentsbelievedthattherewaslittletheycouldpersonallydotochangethesituation.When
probed about family issues the view was that these issues had little or no impact on the
adolescent offending against a family member. Instead, they felt that changes to the
adolescent,particularlyintheareaofsocialskills,wouldhavethedesiredresults:
Heneedstogetonbetterwithotherpeople,heneedstomakefriends.I
dontthinkhehasanyfriendsatschool.

46


Relapseprevention
All parents interviewed were more aware of the need to know where their children were
and what they were doing. They spoke of the need to be vigilant with safety issues
concerning their adolescent and also the need for their children to learn about personal
boundariesandhowtokeepthemselvessafe.
Some parents also spoke about boundaries for their adolescents and the importance of
maintainingtheseboundariesinordertopreventfutureoffending.Theseboundarieswere
either discussed in relation to the reasons they suspected led to the offending in the first
place(poorimpulsecontrol)orinappropriatesexualactivityspecifically.
SafeCare

HowthefamiliesspokeaboutSafeCare

On the whole SafeCare was spoken about in a positive light. Despite the length of the
programandthedifficultiesgettingintouchwithSafeCareinitiallyallparentsweregenerally
happyandrelievedtobeapartoftheprogramme:
Imgladwerehere,becausewewouldhavebeenstuck.Wedidntknow
wheretoturnwhenwediscoveredwhatwediscovered.

Problemsandissues

Although, generally, families were happy with SafeCare at the initial interview, several
comments were made about problems with the service. These mainly concerned lack of
availability of services and the difficulty in getting in touch with an appropriate service
immediatelyafterdisclosure.Severalparentsfoundthatthetimesclinicianswereavailable
werenotsuitablewhentherapysessionswerebeingscheduledforschoolagedchildren.Of
someconcernwastheamountoftimeittooktogetintouchwithSafeCareinitiallyandthe
difficulty finding someone who knew about SafeCare or could put them in touch with an
appropriate counselling agency. One parent suggested that an anonymous hotline would
have been useful when disclosure occurred. Several parents were concerned that their
children were seeing someone for therapy and they had little idea of what transpired
betweenthetherapistandtheirchild:
Iguesstheopennesswith(X).Idontknow,understandtheconfidentiality
andthey(therapists)wonttalktousaboutwhatisdiscussedwith(X),but
justsomesortofprogress...briefing.

47

ParentClosingInterviews
Introduction
8 parents (2 male, 6 female) were interviewed at approximately 12 months into the
treatment program. Of these 8, six families had completed the program with 2 families
remaining in the program. All parents reported some personal changes as a result of
attending the treatment program. For most parents there were improvements in
relationships between family members as well as communication patterns and parenting
skills.Mostparentscommentedonperceivedchangesintheadolescent.Finally,allparents
discussed SafeCares program including their experiences in group therapy, relationships
with therapists, and whether they would use SafeCares services in the future. Figure 2
displaysaflowchartofthedomainsandthemeselicitedfromtheparentexitinterviews.
InfluenceonParents
Mostparentscommentedpositivelyonpersonalchanges.Theseparentsexpressedagreater
awareness and understanding of how their role as a parent had influenced family
functioning, both positively and negatively, in the past. They reported that this greater
awarenesshadimprovedtheirparentingskillsandtheirabilitytocopewiththedemandsof
raising a family. This sentiment was echoed by a number of parents who found that the
parents group, in particular, provided an opportunity to learn and discuss parenting skills
withpeoplewhowereexperiencingsimilarproblems:
ButIthinkitdoesgiveyoudefinitelygivesyoumoreparentingskillsorskills
inlife
Allparentsspokeprimarilyoftheirreliefoncetheylearntthattheywerenottheonlyfamily
todealwithadolescentsexoffending.Parentgrouptherapysessionsprovidedaforumfor
discussing these feelings of isolation, learning how other families were coping with this
problem, and providing a sense of normality they were normal families dealing with an
extraordinaryproblem.
Trustingtheadolescentoffenderwasanimportantissueformostparentsandonethatalso
linked with treatment. If the parents thought the treatment had been effective they felt
moreconfidenttrustingtheiradolescent.However,withknowledgeofsexoffendingandthe
factthatithadalreadyhappenedintheirfamilythistrustwastemperedwithcaution.

48


Figure2
Parentclosinginterviews:Domainsandthemeselicitedfromtheparentexitinterviews

Note:/indicateaneffectbetweenthemes/domains;indicatesanassociation
betweenthemes/domains.
ParentsViewsofAdolescent
At the end of the program most parents felt there had been some important advances in
their family life, children, and the familys ability to cope with difficult situations. These
parents reported a number of positive changes in the adolescent including greater
confidence and sociability, greater empathy, less impulsivity, and more awareness of how
onesactionsimpactonanother:
Yeahhesjustmore,Idontknow,hebehavesproperlynow.Fitsinto
society,Ithink.
Mostparentswereabletoseetheiradolescentasnormaldealingwiththeupsanddowns
of adolescent development. This was particularly true when parents, in hindsight,
commented ontheiradolescentgoing throughaperiodofbeingwithdrawn(asaresultof
the offending behaviours and/or their own sexual victimisation). They spoke about being
abletoseparatethechildfromthebehaviourratherthanviewthechildasthebehaviour.

49


Animportantissueforallparents,atintake,wasfortheadolescentoffendertounderstand
andacceptresponsibilityforhis/herinappropriatesexualbehaviourandeitherapologiseor
insomewayatoneforwhathe/shehaddone:
Wellhesdonetherightthing.Byadmittingwhathesdonewrongand
stickingtohisprogramme.
FamilyFunctioning
Anumberofparentsdescribedtheatmosphereathomeasmuchcalmerattheendofthe
programwithamorepositiveattitudetowardsfamilylife:
Quitepeaceful,itsquitecalming.Itsrelativelynormalyouknowitsnot
reallyconfrontational.
Forsomefamilies,relationshipsbetweensiblingshadimprovedandthiswasattributedtoan
attitudechangebytheadolescentoffender.Forotherparentstherewasnochangeinfamily
life and family members who were antagonistic towards each other 12 months previously
werestillunabletogetalong.Someparentsweremoresanguineaboutfamilyrelationships,
acknowledgingthatnomatterwhat,relationshipsdochangeovertime.
Mostparentsweremakinganefforttotalkmoreoftenandmoreeffectivelywithboththeir
partners and children. Greater effort was made to keep in touch with their children even
though their adolescents were, at times, unresponsive. In general, parents reported that
communicationbetweenfamilymemberswascalmerandmoreconstructive.Mostparents
were less likely to describe situations where siblings screamed at each other to be heard.
Communication was used to keep in touch with how their children were going. These
parents explained that their more open style of communication, in turn, helped their
childrentocommunicatemoreopenlywiththem.
Communication skills were used to convey family rules and regulations. One parent
commented that he was clear, in his own mind, on family guidelines but was uncertain
whetherhehaddiscussedthesewithhischildren.Notallparentswereabletobreakdown
the barriers to open communication. Some parents struggled with communication and
expresseddifficultyunderstandingadolescents.
Finally,allparentsunderstoodtheneedtokeeptheirchildrensafe,includingtheadolescent
offender.Someparentsmentionedduringtheintakeinterviewsthattheadolescentswere
oftenimpulsive,doingthingswithoutthinkingabouttheconsequences.Thus,mostparents
weremorelikelynowtohaveclearbehaviouralguidelinesthatwerecommunicatedtotheir
children. However, boundaries were linked with trust; if the parent did not trust the
adolescentthentherewerestricterrulescurtailingfreedom.
Allparentsenteringtheprogramwantedtoknowwhythesexualoffendingoccurredandat
theendoftreatmentparentswereoftenstillaskingthisquestion.Somecontinuedtosearch
foranswers,whereasothersfelttheyknewwhytheirsonhadoffended:
IguessIwouldhavelikedtoknowwhyheoffendedandIstilldontknow
that.AndIwouldhavelovedreassurancethathesnotgoingtodoitagain,
andwecanthavethat.

50


SafeCareEvaluation
All parents reported being satisfied with the treatment provided for their families. In
particular, the parent group was universally approved by all the parents who were
interviewed, although a couple of parents had reservations about the adolescent offender
and victim groups. On the whole, group sessions allowed parents to share ideas and
problemsandtobewithothersinsimilarsituations.Mostparentsreportedimprovements
bothpersonallyandforthefamily:

Ihavebeenveryhappyallthewayalong.

Negativecommentsbyseveralparentsfocusedontheissueofconfidentialitybetweenthe
adolescent and his/her therapist. Parents were provided only with general information
about the adolescents progress. However, issues of particular concern, either from the
therapistorparent,wereaddressedatfamilyconferences.Oneparentfeltthatthemixof
participantsforboththeadolescentoffenderandvictimgroupswasnotappropriate.
Changes to the program suggested by parents centred on administrative issues. Several
parentsmentionedproblemswithstaffinglevelsandthedifficultiesofgettingappointments
outofschoolhours.Theyacknowledgedthatfundingrestrictionslimitedtheavailabilityof
staffmembers.Oneparentfeltthattheinformationprovidedwasinadequateandcametoo
lateintothetreatmentprogram.Inreality,thisisthecaseformanyparentsastheyareina
state of shock for several months and find it difficult to take in information. Two parents
commented that they had to travel long distances to get to SafeCare. SafeCare is the only
optionavailableandsomefamiliestravelledfromcountryareastoreceivetreatment.

51

AdolescentClosingInterviews
Introduction
Participants (n = 12) who had completed 12 months of a community based sex offender
treatment program were asked questions relating to service delivery, treatment progress,
and family functioning. Most participants reported improvements in family and/or peer
relationships, expressed optimism about the future, and all stated that they would not
reoffend sexually in the future. Figure 3 presents a flow chart of the domains and themes
elicitedfromtheadolescentexitinterviews.
Figure3
Adolescentclosinginterviews:Domainsandthemeselicitedfromtheadolescentexit
interviews

Note:/indicateaneffectbetweenthemes/domains;indicatesanassociation
betweenthemes/domains.
PerceivedImpactofTreatmentProgram
All participants spoke about perceived changes in self control (impulsivity), taking
responsibilityfortheiractions,andemotionalchanges,especiallyfeelinglessangrytowards
others.However,therewaslittleevidenceofimprovementintheareaofempathyandover

52


one third of participants felt that there had been no personal changes. Some participants
wereabletonameemotionsandcontrastthewaytheyfeltpriortotreatmenttotheway
they felt and reacted to emotions after treatment. They reported feeling happier within
themselvesandgettingangrylessoftenthantheyusedto:
Ivecalmeddownabitandnotgottenintoasmanyfights,listentopeople
more.
Theseparticipantsattributedthiscalmnesstotheopportunityofdiscussingproblemswitha
thirdparty.Atfirst,thetherapistfulfilledthisrole,howeverbytheendoftreatment,10of
the participants felt that there was at least one person in their family they could talk to if
they needed help. All participants were able to describe ways to calm down in stressful
situationssuchasbikeridingorremovingthemselvesfromthesituation. Further,some of
theparticipantsreportedthattheywerenowabletotakeresponsibilityfortheirmistakes.
ProgramImpactonFamilyFunctioning
Therewasamixedresponsefromtheparticipants,somewhofeltthatrelationshipswith
parents,siblings,andpeershadimprovedwhereasothersfeltthatchangesinrelationships
wereminimal.
Withfamily
Some of the participants talked about how their relationships with family members had
improved since starting the treatment program. These participants stated that talking to
familymembersandbecominginvolvedinfamilylifehelpedtoimproverelationshipswithin
thehome.Theybelievedtheyhadabetterunderstandingofhowtheirparentsandsiblings
felt about the offending behaviours. They reported that they communicated more
effectivelywithfamilymembersandwereabletotalktotheirparentsiftheyneededhelp
withtheirproblems:
Mumislikereally,cosshehatedmeforawhile.Atthestart,butnowwere
gettingalongbetter,soyeah.Soitslikebroughtuscloser.
Further, most participants reported that relationships with peers had also improved. A
number of participants stated that they had developed new friendships over the past 12
months,particularlyatschool.Theyreportedbeingmoresociallyactivebothatschooland
outofschoolhours.
Changes in family relationships were also reflected in the ways conflicts were resolved.
Some participants were able to articulate effective strategies they used during times of
conflict with parents and siblings. However, participants who felt that family relationships
hadnotimprovedalsoreportedthatconflictswerenotresolvedsatisfactorily.
InsightintoOffendingBehaviours
Most participants were reluctant to discuss their offending behaviours in any detail
expressingshameandembarrassmentaboutwhattheyhaddone,andfindingitdifficultto
discuss their offending behaviours with a stranger. However, they credited much of their
understandingoftheiroffendingbehaviourstotheirtherapists.

53


All participants reported feeling isolated upon disclosure of their inappropriate sexual
behaviourstoathirdparty:

IthoughtIwastheonlypersonthatdidstufflikethat.

Mostparticipantsreportedthattheygainedinsightintotheiroffendingbehavioursthrough
discussingwhathappenedwiththetherapists.Althoughsomestatedthattheyknewpriorto
engaging with SafeCare that their behaviours were inappropriate they felt that they were
unlikely to change without intervention of some description. However, not all participants
felttheyhadanunderstandingofthereasonswhytheyoffendedinthisway.
Whenaskedhowtheyfeltabouttheirvictims,noneoftheparticipantsappearedtoprovide
an empathic response. Where the victim was a sibling, their attitudes towards the person
couldnotbedisentangledfromnormalsiblingrelationships:
Sohowdoyoufeeltowardsyoursister(victim),howdoyoufeeltowards
hernow?

Idontknow.Idontreallytalktoheranymore.

No?

Ineverreallytalkedtohertostartwith.

Howdoyoufeeltowardsher?

Dontknowshesjustthere.

Relapseprevention

Each participant was asked specifically about his/her relapse prevention plans. Eight were
abletoarticulateatleastonestrategyheorshecoulduseifnecessary.Thestrategiesmost
often identified by the participants involved some form of distraction from thoughts of
offending. This was in the form of either physical removal from the situation or using
something to distract ones thoughts, such as playing a computer game. Other strategies
included talking to either a family member or therapist. For three participants the idea of
returningforanother12monthsoftreatmentwasconsideredaconsiderabledeterrentfrom
offending.Onlyoneparticipantstatedthathehadnorelapsepreventionplans.
GroupTherapy
Although most participants found it difficult to engage in group therapy initially, citing
shameandnervousnesswithstrangersasthemajorobstacles,allfeltthattheymadesome
importantprogressduringgrouptherapy.Eachparticipantwaseventuallyabletotalkabout
his/heroffendingtotheothergroupmembers:
Cosyouwerekindoftalkingwithpeoplewhohadprettymuchdonethe
samething.
All participants found it beneficial to share experiences and feelings with other group
memberswhohadhadsimilarhistories.Talkingaboutoffendingingrouptherapyprovided
someparticipantswiththeunderstandingthatwhattheyhaddonewaswrong,bylistening
toothermembersstories.

54


Only two participants made negative comments about group. The first participant has
intellectualdifficultiesandfoundithard,attimes,tofollowtheconversations.Thesecond
participanthasAspergersSyndromeandfounditdifficulttoparticipateinagroupsituation.
SafeCareEvaluation
Mostparticipantsfeltpositivelyaboutbeinginvolvedintheprogram.Thepositivefeedback
centredontheacceptanceofallparticipantsbystaffmembersandthehelptheyreceived
throughthetreatmentprogram.Formost,theopportunitytotalkabouttheirproblemswith
people who understood what they were going through was the most important aspect of
theprogram.
Negative comments centred mainly on missing school and the need for more detailed
information at the beginning of the treatment process. Table 21 displays the negative
commentsmadeabouttheSafeCareprogram.
Eightparticipantsthoughtitwasnecessarytoattendthetreatmentprogram.Twofeltthatit
wasokaytoattendbutstatedthattheycouldhavestoppedoffendingontheirown.Twofelt
thattheydidnotneedtoattendatall.Thoseparticipantswhofeltitwasnecessarytoattend
treatmentfeltthattheywouldbeunabletostopoffendingwithouthelp.Nineparticipants
stated that they learnt something from attending SafeCare. Foremost, participants learnt
that sexual offending is wrong. However, a number of participants stated they had learnt
specific skills such as self control, problem solving, communication, and social skills. One
participantstatedthathehadlearntnothing.
Table21
NegativeFeedbackRegardingtheYoungPeoplesProgram
Comment(Numberof
complaints)

Quote

MissingSchool(3)

ItwasalsoapaininthebumbecauseIkeptmissingouton
classesthatIreallyliked.

Programmenot
explained(3)

Notexplainedtome,Ididntknowwhatwasgoingto
happenthroughouttheyear.

Travel(3)

Itisabitofahasslegettingfromschoolstraighthere,given
thetimeperiods,thedistance.

Testing(2)

Maybethetestsalittlebit.Theywereabithard.

Alittlebithardinwhatway?
Inlikethequestionformsandthecertaininstructionsyou
give,theyreabitconfusingattimes.
IndividualTherapy(1)

Ididntreallylikecomingtotheindividualsessions...Ididnt
getanythingoutofthem.Thoughtitwasjustawasteof

55

time.

NoFunActivities(1)

Therewashardlyanythingtodoanditsprettylike
whyamIcomingallthewayfromwhereIlivedownhere?

Finally,mostparticipantswerehappywiththeprogramandcouldnotthinkofanythingthey
would like to change. Table 22 presents those alterations that were suggested by the
adolescentparticipants.
Table22
SuggestedChangestotheYoungPeoplesProgram
Nochange

Easier
Questions

MoreGroup
Sessions

ArtTherapy

More
Information

56


CHAPTER5:

DISCUSSION

Introduction
The current study aimed to explore the needs of IASOs and the potential contribution of
communitybasedtreatment.Intheprocessitalsoreaffirmedmanyfeaturesofthepicture
of ASOs slowly developing from literature on ASOs worldwide. The current study had five
specific aims: to develop a psychological profile of IASOs; to gain an understanding of the
families of IASOs; to assess the value of a community based multifaceted psychotherapy
treatment program on IASOs and their families; and to consider the utility of existing
typologiesofASOsforthegroupofIASOsreceivingcommunitytreatment.
This discussion begins by considering some of the characteristics of the study group and
their families. It then examines the value of the proposed typologies, the value of the
communitytreatmentprogram,andfinallytheimplicationsofthisstudy.Theimplicationsof
this study can be seen largely in terms of implications for treatment and policy including
criminaljusticeresponses.
At the outset there were several limitations to this study that should be noted. The data
analysed was based on a small group of participants attending a community based
treatmentprogram.Asnocomparisongroupwasuseditisnotpossibletofullyunderstand
howtheprogramaffectedgroupprogress.Norisitpossibletomaketoomanycomparisons
with other research as few studies differentiate between intrafamilial and extrafamilial
ASOs.Further,suchasmallgroupreducestheabilitytodetectsignificantpreandposttest
differences.Allparticipantsinthisstudyvolunteeredtotakepart.Theremaybesignificant
differences for those families who declined to participate in the study. The attrition rate,
althoughnothighforthisarea,wasalsoofconcern.Almost4inten(39%)familiesdidnot
completethe12monthtreatmentprogramandattendancebysomeclientswassporadic.It
wasparticularlydifficulttokeeptheIASOengagedintheprogramwhenthefamilywasnot.
Theseproblemsunfortunatelyreflectthenatureoftheproblembeingdealtwithbutpose
particularproblemsforresearchinthisarea.
CharacteristicsofIntrafamilialAdolescentSexOffenders
Traumaandpsychologicaladjustment
Themost commonlydescribedfactorsassociatedwithadolescentsexualoffending include
separation from a parent, prior victimisation, social isolation, psychopathology, and
behavioural and school problems (Veneziano & Veneziano, 2002). These factors were all
evidentinananalysisofthestudygroup.
Inlinewiththeinternationalliteraturediscussedearlieralmostthreequartersofthestudy
group(71%)reportedbeingvictimsofsomeformofabuse.Almostathird(29%)ofthestudy
group was exposed to aggressive socialisation through exposure to domestic violence and
physicalabuse.Afurther47.5%werevictimsofsexualabuse.
Halfofthestudygroupwasdiagnosedwithsomeformofpsychiatricimpairmentincluding,
most commonly, ADHD (1 in 4), PTSD, and developmental delay. The rate of ADHD is
estimated to be 12 times higher than that of the rest of the adolescent population of the

57


state 7 .ManyparentsoftheIASOsinthestudygroupspokeoftheiradolescentsasloners,
with few peer aged friends and difficulties establishing peer relationships. Many of the
adolescents in the study group were described as impulsive with poor problem solving
techniques. Reflecting the literature, the adolescents were typically impulsive, aggressive,
lackedinterpersonalskills,andhadfewpeeragedfriends.TheIASOs,generally,behavedin
anaggressivemannertowardsotherfamilymembers,especiallysiblings.
Thefamilyenvironment
ThefamilyenvironmentsoftheIASOswereusuallydisorganisedandunstable,characterised
byparentalabsenceandrejection.ThreequartersoftheASOsweremembersofblendedor
stepfamilies.Lessthanaquarter(21%)ofthestudygroupcamefromintactfamilies,atthe
timeofreferraltoSafeCare.Parentstypicallydisplayedanauthoritarianparentingstyleand
haddifficultycopingwiththedaytodaydemandsofparenting.Uponinterviewitbecame
apparentthatanumberofparentsmaintainedpoorpersonalboundariesanddemonstrated
ineffectiveconflictresolutionskills.
The stories of abuse and subsequent treatment disclosed by the adolescents and their
familiespotentiallyprovideinsightintohowthefamilysysteminteractswithsiblingsexual
abuse.Asdiscussedearlier,intactfamiliesweretheexceptionratherthantheruleinthe
studygroup.Often,atleastonebiologicalparentwaseitherabsentfromthefamilyorhada
difficult relationship with various family members, including the adolescent offender. The
adolescentwhowasreferredfortreatmentwasoftencharacterisedasthefamilytrouble
makerimpulsiveandwithfewpeeragedfriends.Ontopofthis,disclosureoftheabuse
usually resulted in a number of conflicting emotions, with parents sometimes wishing to
protectthechildvictimaswellasthechildoffender.Atthetimeofreferral,familieswere
often in crisis and were unsure of how to proceed to provide the necessary help for their
families.
Thelackoffamilysupportwasevidenttotreatmentstaffinanumberofways.Forexample,
a number of participants were not accompanied to treatment and these parents had
minimal contact with SafeCare. As discussed in the literature review, parents of ASOs are
often unable to meet the emotional needs of their children; a number of parents did not
attendSafeCarecontendingthattheproblemwassolelytheadolescentstodealwith.For
manyofthesefamilies,theoffendingbehavioursoftheadolescentwereseenasaproblem
onlyfortheadolescent,andtherewaslittleunderstandinghowfamilyfactorscouldimpact
onchildbehaviour.
Many families did not recognise the difficulties they were facing until disclosure of the
offending behaviours occurred. At interview, some parents described their families as
normal, despite a number of family problems including intergenerational sexual abuse,
parental rejection, and fractured family relationships. Some parents described family
environments that were tense and combative, with little connection between family
members or extended family. Family life was characterised by warring siblings and
conversations often degenerated into unresolved arguments. Ongoing conflicts were

7 Western Australia Health Department data for 2003/04 reported that 2.2% of
adolescents aged between 2-17 years were prescribed stimulant medication for the

58


commoninmostfamilies.Communicationstylesinthefamilieswereusuallyadversarialand
negativewithargumentsrarelyresolved.Arguingsiblingswereoftenseparated,theconflict
wasignored,onechildwasblamed,orparentsshoutedtoclosedowntheargument.
Insummary,inmostfamiliesofadolescentspresentingfortreatment,relationshipsbetween
familymemberswerenotclose,communicationbetweenfamilymemberswasaggressiveor
non existent, and parents had little idea how to deal with inappropriate behaviour or set
boundariesoutliningacceptablebehaviour.Inthisenvironmentoffendingadolescentswere
described by parents as impulsive, with few ties to family or friends. Families were often
isolatedwithfewresourcestocallonintimesofcrisis.
TheValueofTypologiesofAdolescentSexOffenders
Although acknowledged as a heterogeneous group, researchers have generally grouped all
typesofASOstogether.Therehasbeenlittleresearchintothedifferencesbetweenoffenders
basedonoffencecharacteristics.
The two major types of typology of ASO that have been proffered are those based on
personality/psychopathology on the one hand and those based strictly on the criminological
features of the offending behaviour, on the other. The latter category of typologies (e.g.,
Burton, 2000; Langstrom et al., 2000; Hunter et al., 2003) largely examine how the age of
onset and age of victim relate to the severity and nature of the offending behaviour. The
earliesttypologieswerethosebasedonclinicalfeatures.Forexample,OBrienandBera(1986)
provided a typology consisting of seven offender subtypes grouped mainly according to the
levelofsocialisationandimpulsivitydisplayedbytheoffender.
There have been a number of typologies published which are based on the
personality/psychopathologyoftheASO(Oxnam&Vess,2006,2008;Richardsonetal.,2004;
W.R.Smithetal.,1987;Worling,2001).TheclusteranalysisoftheMACIinthepresentstudy
indicated a threegroup typology consisting of antisocial, narcissistic, and anxious groups.
Although each analysis has produced somewhat different typologies, there appear to be
commonalities across the groupings. There is clearest agreement that there is an antisocial
group (antisocial, conduct disordered, passiveaggressive, socialized delinquents), and a
narcissistic group (narcissistic, confident/aggressive, personality disordered, passive
aggressive,dysthymic/negativistic).Then,thereappeartobetwomorebroadgroupingswhich
arelessclearcut:aninadequategroup(inadequate,immature,unusual/isolated,submissive,
anxious) and an overcontrolled group (overcontrolled/reserved, conforming,
dysthymic/inhibited).
TheanalysisofdifferenttypesofASOsisimportantbecauseeachofthesegroupsofASOswill
havedifferenttreatmentneedsandposedifferentchallengestothoseofferingtreatment.For
example, those who are high on antisocial characteristics may need a focus which also
addressestheirpropensityfordelinquencyandaggression,whilethosewhoarehighlyanxious
willneedstrategiestomanagetheiranxiety.Althoughallwillneedtreatmentmoduleswhich
addresstheirovertoffendingbehaviour,someoftheotherpersonalityandbehaviouralissues
willalsoneedtobeaddressedinordertoreducetheriskofreoffending.

treatment of ADHD (Department of Health, 2005).

59

TheValueoftheTreatmentProgram
One of the effects of treatment appears to be changes to family functioning. There were
significantpositivechangesinpretreatmenttoposttreatmentscoresonameasureoffamily
functioning completed by the IASOs. Although this may be a result of growing maturity as
wellasworkdoneintherapy,thisfindingwasalsosupportedbyposttreatmentinterviews
with parents. There were few other significant effects shown in the analysis of
pretreatment/posttreatment data. However, adolescents in the study group stated that
after treatment they were less impulsive and were able to articulate strategies to help in
stressful situations. They felt that the home environment was calmer and that they were
also calmer. Social skills training, a component of SafeCares treatment of ASOs, was one
area that improved during treatment, with adolescents stating that they were able to
developand maintainpeerfriendships,orasoneparticipantstatedfoundwhereIfitin.
They attributed some of these changes to the opportunity to talk to someone about their
problems.Parentsalsoexpressedtheviewthatfamilylifewaslesstenseandrelationships
betweensiblingshadimprovedtosomeextent.
Although changes were not statistically significant on most measures used, parents and
ASOs reported that they felt differently. It appears that even slight changes to the family
systemandtheindividualtranslateintoimportantchangesforthoseinvolved.Parentsand
adolescents who were interviewed after treatment expressed satisfaction at the progress
madetoimprovefamilylife.
Theimportanceofafamilyfocussedholistictreatmentmodel
The SafeCare families presented with multiple problems manifesting as the adolescents
inappropriate sexual behaviour with his/her sibling or close family member. Upon
assessment it became apparent that without addressing these additional problems within
thefamilyenvironment,progresswiththeIASOwaslikelytobelimited.Parentsengagedin
theprogramreportedthattheygainedvaluableinsightintothesexualoffendingcycleand
theroleofthefamilyinmaintaininganenvironmentwhereoffendingbehavioursoccurred.
Further, parents gained valuable skills that enabled them to parent their children more
effectively and the strength to deal with problems that might arise in the future. Greater
progress and understanding was demonstrated by adolescents and parents where at least
one parent was also engaged in therapy. However, when only one parent was involved in
therapy, it was noticed that the other parent often struggled to come to terms with what
hadhappened.
Upon completion of the treatment program, parents and adolescents described the family
environment as more harmonious, although not completely problem free. In general it
appearsthatparentsfeltmoreconfidentabouttheirskillsasaparent.Parentsspentmore
time talking to their children, conveying family rules and discussing family life, issues, and
problems.TheIASOsfelttheyhadabetterunderstandingofthepressuresofparentingand
moreconfidenceintakingresponsibilityfortheirownbehaviours.
As many of the children came from homes where one or both parents were either totally
absent or maintained only intermittent contact with their children there were particular

60


problemspresented.Therelationshipbetweentheseparatedparentswasoftenstrainedor
openlyabusive.Whenthesexualabusewasdisclosed,parentsfounditdifficulttosupport
both the victim and the IASO. Changes to the family system or functioning were noted in
somefamiliesattendingfortreatment,mostnotablywhentheparentswerealsoengagedin
therapy.
A comparison of program completers versus non completers indicated that intact
families 8 were more likely to complete the program. In addition, prior victimisation of the
adolescent was associated with non completion of the program. This suggests that non
intact families may find it more difficult to commit to, or carry through with, a lengthy
treatment process. Alternatively, it may be that some families require more intensive
support at the assessment stage to engage them in therapy. For these families it may be
importanttofocus,initially,onproblemsthatcanberesolvedexpediently.
Grouptherapy
Group therapy was the single most important treatment modality endorsed by both
adolescentsandparentsofthestudygroup.Grouptherapyprovidedaforumtodiscussboth
the offending behaviours and other issues that affected individuals and families. Group
therapy reduced the isolation felt by the IASO and his/her family surrounding sexual
offending.Grouptherapyalsoprovidedaforumtoconfrontbehaviourthatcouldpossiblybe
avoidedinindividualtherapy.
Group therapy was universally approved by the parents interviewed. The appeal of group
therapywastheopportunitytospeaktootherparentsinsimilarsituationsandtoworkon
issues that were relevant to all group members. The adolescents attending group therapy
foundtheinitialsessionsdifficultbecauseoftheshameandguiltsurroundingtheiroffending
behaviours.However,oncetheywerefamiliarwiththeothergroupmemberstheyfeltthey
benefited by gaining perspective and that hearing the stories of their peers reduced their
senseofisolation.
The only negative comments regarding the group therapy sessions related to the mix of
childreninboththeadolescentandvictimgroups.Severalparentsfeltthechildrenwerenot
matched either in age or offence type. Interestingly, this was not considered an issue by
eithertheadolescentsortherapists.
Implications
Treatment
It is clear that most IASOs will present with a variety of psychological difficulties, many of
whichareassociatedwiththeirfamilydynamics.Treatmentneedstobeholistic,varied,and
flexible to meet the needs of the individual circumstances. There is still a need for
understanding the various contributions of education, psychotherapy, and social
intervention. Based on the results of the current study, treatment programs can provide
valuable help for parents of the IASO. Parents found learning how to deal with the sexual

Intact in this context means families with one or two parents or parent figure that had existed as a
family unit for most of the adolescents childhood

61


abusewithinthefamilyandhowtodealwithotherfamilyrelatedissuessuchasconflictand
settingboundariesthemostusefulaspectsoftheprogram.
In regard to assessment there is a distinct need in this area for appropriate assessment
instruments. It was difficult, in the conduct of the present study, to source psychometric
testsappropriateforthisspecificgroupofoffenders.MostofthetestsforASOshavebeen
modified from adult tests (Shaw, 1999). The research team found the MACI and YSR were
the most useful in terms of identifying problem areas. Although as a group there were no
significantdeficits,individually,almostallparticipantsscoredaboveBR75onseveralscales
ontheMACI,indicatingasignificantclinicalissueinatleastonearea.
As discussed in the methodology section, the lack of an appropriate instrument for
measuringsexualdysfunctioninadolescentswasimportant.Researchanddevelopmentof
psychometrictestsdesignedspecificallyforchildrenandadolescentsisurgentlyrequired.At
themomenttherearenotestsdesignedspecificallyforASOs.Teststhataccuratelyevaluate
levelsofpsychopathologyandsexualdysfunctioninASOswillenableresearcherstobetter
understandthispopulation.
Thereareanumberofissuesdirectlyimpactingontreatmentthatmaybeconsideredpolicy
issuesastheydictatetovictims,offenders,andtheirfamiliesthetermsonwhichtheycan
receivetreatment.Forexample,thereshouldbeclearguidelinesontheappropriateaction
totakeupondisclosureandreferralfortreatment.Toooftengeneralpractitioners,police,
andsocialservicesstaffdidnotknowwheretoreferfamiliesfortreatment.Servicesneedto
beadvertisedbetterinthehealthcarearena.Manyofthehealthservicespersonnelwere
unaware of community based programs like SafeCare. Pamphlets with information about
intrafamilialsexoffendersandtreatmentoptionswouldbeusefulforallparties.Therealso
needs to be a greater public awareness of the issues and risks of adolescent sexual
offending.
Another policy concern directly impacting on treatment relates to the technical aspects of
access and the difficulty in finding and accessing an appropriate treatment program.
SafeCare is not well known or well resourced. For many families, attending SafeCare
representedasignificantundertakinginandofitself.Findinghelpatthetimeofdisclosure
was an issue for many of the families. Staffing levels created problems as therapists were
notalwaysavailablewhenneededandsessiontimeswerelimited.Practical issuessuchas
parking and transport to SafeCare were problematic for some families. There is no such
treatment program in the country and some families had to travel to Perth from country
areastoreceivetreatment.
ThereferralprocesstoSafeCarewastimeconsumingandoftenfirstmeetingswereseveral
months after disclosure occurred. This was due to some outside agency staff (e.g. Police,
DepartmentofChildProtection,JuvenileJustice)notknowingthatSafeCareexisted,andthe
difficultyofschedulingnewclientswhorequired3to4staffmembersfortheinitialfamily
assessment. Families felt they were not fully briefed on the treatment process. All this
information is provided at the initial session but may not be taken in by families in crisis.
Although this information is also available on the SafeCare website the lack of awareness
suggests the need for a comprehensive and far reaching campaign to ensure accessible

62


informationabouttheavailabilityofcommunitybasedandholistictreatmentreachesawide
audienceofserviceprovidersandatriskfamilies.
Policy
The sexual abuse of children is a problem that has, unfortunately, been with us for a long
time.Howeveritisaproblemthatisincreasinglycomingtopublicawareness.Theincreasing
awareness of the extent of child sexual abuse, particularly in Indigenous communities, has
alreadyledtosomeradicalpolicycommitmentstheNorthernTerritoryinterventionbeing
themostnotable.
Whilst the true extent of child sexual abuse in our communities remains hidden there are
alreadysomeestablishedfactsaboutitsnaturewhichemphasizesitsimportance.Perhaps
themostcompellingfactaboutchildsexualabuseisitstendencytobeintergenerationalin
nature.Thesexualabuseofthechildvictimizesandpotentiallydamagesthechild,butinso
doing lays down the psychological conditions for this tragedy to spread to others that the
individualwilldevelopclosepersonalrelationswiththroughouttheirlives.
The sexual abuse of children does have intergenerational components and can not be
viewedasatragedyvisiteduponanindividualandhavingnootherconsequences.Perhaps
partofthereasonthatweresistseeingtheprobleminitsentiretyisthatweareunwillingor
unabletoholdthe notion oftheindividualbeingavictimandan offendertogetherat the
sametime.Howeverthisisexactlythetaskthatisrequired.Itisthisdualrolethatisatthe
heartofthecycleofabuse.Itisnowwellunderstoodthatapropensitytodomesticviolence
is transmitted generation to generation and we readily recognize now the cycle of
violence within academic and policy communities. However, perhaps because of
understandable sensitivities we are yet to see sexual abuse in the same light, particularly
thatperpetratedbyayoungperson.ThechildrencomingforwardfortreatmentatSafeCare
are both offenders and victims. The extent and tragedy of their victimization has been
documented throughout this report as has the extent and tragedy of their offending. The
policyimplicationsthereforearetoapproachASOsasvictimswhohavebecomeoffenders.
Seeing sexual abuse as cyclical and intergenerational will also allow us to gain a more
realisticandholisticpictureoftheproblemandallowinarangeofinterventionstohelpthe
parents and other family members, the identified victim/offender, and other atrisk
children. At the heart of this intervention must be a set of principles that can guide and
supportwhatwearedoingsothatweoptimizethechancesofmakingacontribution.Itis
argued that the best position to start from is one that articulates our goals within a
meaningful holistic frame of reference, appropriate to what we know about the
psychologicalandsociologicalembeddednessofthisproblem.
Itwouldbeproductivetodeveloppolicythatseekstobalancecompetingpolicyinitiatives
so that the overall level of harm and damage is reduced to the lowest possible level. Our
responsesthusfarindealingwithadolescentsexabusehavelargelybeenguidedbyarchaic,
simplistic,andpossiblydamagingprinciplesofcrimeandpunishment.Insofaraswerefuse
toacceptthatintrafamilialsexoffendingisadamagingresponsefromadamagedindividual
we see it as a wanton response from a criminal. This kind of thinking leads to an
impoverishedconceptualizationoftheissuessurroundingthebehaviourandfeedsintothe

63


mediasensationalismofsexabuse.Thisfeedsapoliticizationofpolicypreciselyatthepoint
whereitdoesthemostdamageandwhereacompassionateapproachorsimplyadetached
andunderstandingapproachismostneeded.Whenthesexualoffenderisachildthereisa
special opportunity to change our emphasis somewhat and conceptualize the problem
primarily as a health issue rather than primarily a moral one. Adopting the principle of
reducing and preventing harm to all parties involved would allow this kind of productive
focus.
Oncewehaveestablishedthatourapproachshouldbebasedontheseprinciplesweshould
also ensure that we see adolescent sex abuse as involving more than just the offender as
part of the required treatment approach. At the very least the parents and other family
membersshouldbeengagedbecause,asdemonstratedbythecurrentstudy,itismorethan
likely that the offending is but one manifestation of problems within the family and
potentiallymuchharmcouldbereducedbytakingasystemicapproach.
Theresultsofthisstudyiftakeninitsentiretyhavemanyimplicationsforthecriminaljustice
system. First, the fact that at present we only see the tip of the iceberg in terms of the
extentofchildsexabuse.Ifwetrulywanttominimizeharminthecommunityweneedto
do more to reach out to the community and offer help to families where sex abuse is a
problem.Asillustratedinthepresentstudythesefamiliesknowthereisaproblembutfew
know what can be done about it. Only a minority will wish for the issue to be processed
through the criminal justice system. However, we have not established pathways to make
the disclosure of sexual abuse easy. We have not offered to support and assist families
where sexual abuse is a problem. Basically we have done everything we can, through our
policies,toensureitremainshiddenandwillonlybeuncoveredyearslater.Punishmentof
theASOmayhavetheadvantageofconveyingtheseriousnessoftheoffencebutdoesmean
thatyoungpeoplearelabelledassexoffendersatatimeintheirliveswhentheyaremost
vulnerable.
Given the widespread, complex, and intergenerational nature of child sex abuse and
adolescent sex offending a more holistic approach focussed on treatment needs to be the
guiding philosophy of the intervention. The preference for criminal justice interventions
means that individuals such as police officers who are illequipped to help victims are
pushedintoapositionofinvestigatingthesecrimes.Italsopushesvictimswhoareusually
related to the offender to overcome family loyalties and act in a manner far above that
expected for their age. Basically, the response punishes everyone involved and is seen by
familymembersandtheoffenderasanoptionthatwillactuallymakethingsworseandnot
better.Itisquitepossiblethattheyareaccurateinthisperception.Sotheimplicationsare
forapolicyapproachthatisguidedbyaprincipleofharmreduction,thatseekstoapproach
theproblemholistically,andonethatreachesoutintothecommunitytothosesectorsand
individuals that might need help. For those individuals that do respond to an offer for
assistance,shouldtheybereportedtothepolice?
Obviouslytodosowouldreducethelikelihoodthattheywillseektreatment.Howeverthis
is exactly what we do by passing legislation that requires mandatory reporting. Despite all
theevidencethatmandatoryreportingisafailedpolicythathasabsorbedmassiveamounts
ofresourceswhilstdeliveringverylittlehelpitcontinuestobefavouredastheproblemof

64


childsexualabuseispoliticized.Theseareissuesbeyondthescopeofthepresentresearch
project and much has already be written on these topics but the subject matter of the
current research once again raises issues about mandatory reporting and the benefits of
providingaconfidentiallifelinetofamiliesinneedinthisarea.
The final policy implication that we would like to touch on here concerns how to engage
withfamiliesandASOs.Althoughthiscouldhardlybeconsideredinisolationfromtheissues
discussedaboveitisworthwhiletoconsiderthestrategicdimensionsofanyeffortdesigned
toreducetheprevalenceofadolescentsexualoffending.Therearesomefactorsthatmake
adolescent sexual offending much more likely. Typically these areas are indicated by the
presenceofmanyofthecommonlycoexistingproblemsdiscussedinthecurrentstudy.The
available evidence suggests that many of these coexisting problems could be seen as
indicatorsofrisk.Intermsofreachingoutweshouldbecognizantofthe highriskareas
and a special effort made to reach out to families and individuals in these areas to offer
supportandassistanceandalsoperhapstodrawattentiontotheexistenceofproblemsthat
mighthavebeendeniedorinsomeotherwaydismissed.

65


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APPENDIXA
ParentInformationSheet
SafeCare, in conjunction with Curtin Universitys School of Psychology, are undertaking a
study which examines the experiences of adolescents who complete SafeCares Young
PeoplesProgramme(YPP).Thisprojectaimstoexploretheexperiencesandperceptionsof
theadolescentsandtheirfamilieswhotakepartintheprogramme,inadditiontoexamining
issuesrelatingtoriskfactorsandtreatmentoutcomes.Itisanticipatedthatthefindingsfrom
thisprojectwillfurtherourknowledgeofeffectivetreatmentoptionsforyoungpeoplewho
engage in inappropriate sexual behaviour, and the risk factors that may lead to this
behaviour.
Should you agree to take part in the study, while you and your family are involved in the
programme,yourparticipationwillconsistof:

Allowing the researchers access to information obtained from questionnaires and

interviewsthatyouwillcompleteaspartofthetreatmentprogramme.Allinformation
willbeunidentifiable,andreportedasgeneraltrends.

A closing interview upon completion of the programme (child and parent). This will
explore participants experiences of the treatment programme, views of the
programme,anditsimpactonboththechildandthefamily.

The study has been approved by the Curtin University Human Research Ethics Committee
andhasbeenfundedbytheCriminologyResearchCouncil.
Participationinthisprojectisvoluntaryandparticipantsarefreetowithdrawfromthestudy
at any time. Any information provided will be held in strict confidence in line with
SafeCares policy. Participants in the study will remain anonymous; all identifying
information will be removed from the interview transcripts. All documentation and
transcripts will be stored in a secure facility with access only to those members of the
researchteam.Resultsfromtheprojectwillbeusedforpublicationinscientificjournals.
Any questions concerning this study can be directed to Gail Boyle, Andrea Halse, and
Amanda Thompson listed below, or to the Project Coordinator Associate Professor Jan
Grant,CurtinUniversity(92667231).
Thankyouforyourtimeandconsideration.Pleasefindattachedtheconsentformforyouto
completeshouldyouagreetoparticipate.Pleaseretainthisinformationsheetforyourown
records.

75

AdolescentInformationSheet
SafeCare and Curtin University are conducting a project to look at the experiences of the
young people who take part in the Young Peoples Programme (YPP). This project aims to
findoutwhattheyoungpeopleandtheirfamiliesthinkabouttheprogrammeandhowwell
ithelpsthoseinvolveddealwiththeirproblems.Itishopedthattheresultsfromtheproject
will add to our knowledge of helping young people who engage in inappropriate sexual
behaviour.
Ifyouagreetotakepartinthisresearch,yourinvolvementwillconsistof:

Allowing the researchers access to information obtained from the questionnaires

andinterviewsthatyouwillcompleteasapartoftheprogramme.Yournamewill
notbelinkedtoanyinformation.

Aninterviewattheendoftheprogramme,tofindoutwhatyouthoughtaboutthe
programme,whatyouwouldchange,keepthesameetc.Yourparentswillalsotake
partinaseparateinterviewtoseewhattheythoughtoftheprogramme.

Yourinvolvementintheprojectisvoluntaryandyoucanstoptakingpartatanytimeduring
the project. Leaving the project will not affect your participation in the treatment
programme. AnyinformationthatyougivewillbekeptconfidentialinlinewithSafeCares
policy.Your personaldetails,suchasyourname,willnotbekeptwiththe information we
collect,soyouwontbeabletobeidentified.Theinformationwillbeusedtoimprovethe
Young Peoples Programme and for publication in research journals. However, at no time
willanyonebeabletoidentifyyoufromtheinformationused.
IfyouhaveanyquestionsabouttheprojectyoucanspeaktoGailBoyle,AndreaHalse,and
AmandaThompsonlistedbelow.
Thankyouforyourtime.Pleasefindattachedtheconsentformforyoutosignifyouwould
liketotakepartintheproject.Pleasekeepthisinformationsheet.

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APPENDIXB

ParentConsentForm

I,_____________________________confirmthat:

Ihavereadandunderstandtheinformationsheet

Iwasgiventheopportunitytoaskquestions

Allofmyquestionshavebeenansweredtomysatisfaction

NopressureisbeingputonmetoparticipateandIunderstandthatparticipationin
thisstudyiscompletelyvoluntaryandthatIcanwithdrawmyconsentatanytime.

toparticipateinthisproject
Igiveconsentformychild,

andfurtheragreetotakepartininterviewsatthebeginningandendoftheprogramme.I
understandthattheseinterviewswillbetaperecordedandthetranscriptswillbekeptina
securelocationsothatnooneotherthantheresearcherswillhaveaccesstothem.

I give consent for information derived from both myself and my childs interviews and
questionnairestobeincorporatedinpublicationsforscientificjournals.Iunderstandthatall
informationwillbepresentedingeneraltermsandthatneithermychildnormyselfwillbe
identifiableinanyresultingpublication.

Date

ResearchersSignature

Date

ParentSignature

77

AdolescentConsentForm

I,___________________________

Havereadandunderstandtheinformationsheet

Iwasgiventhechancetoaskquestions

Allofmyquestionshavebeenanswered

I understand that taking part in this project is voluntary and that I can leave the
projectatanytime.Thiswillnotaffectmyplaceintheprogramme.

Iunderstandthattheprojectincludestakingpartinatapedinterviewandthatno
oneotherthantheresearchteamwillhaveaccesstothetaperecordedinterview.

Iunderstandthatinformationfrommyinterviewandquestionnaireswillbeusedtoimprove
the SafeCare Young Peoples Programme and may be published in scientific journals. I
understand that this information will be presented in general terms and that I will not be
identifiedinanypublication.

ParticipantsSignature

Date

ResearchersSignature

Date

78