The Flight of the Phoenix

1. The Flight of the Phoenix Presented by: Teresa Winfield and Candace Reimer

2. Bird of fire who lives alone in the desert Grew old and tired and asked the sun to make it young again Sun burnt it to ash Out of that ash a new, young, fresh Phoenix arose An intensive residential program for male youth, aged 13-18 who have demonstrated sexually abusive behaviors Located in Calgary at Wood’s Homes The story of the Phoenix

3. A multi-service, non-profit organization that has been in operation since 1914 Wide range of programs to address a range of mental health and social issues Complicated, serious, often chronic mental health issues that sometimes show as dangerous and damaging behaviours Relational-Based Interventions High needs, hard-to-serve youth We never give up We never say no We never turn anyone away We believe in belonging, respect, responsibility, commitment and leadership Wood’s Homes

4. Objectives • To gain a general understanding of one treatment approach used with adolescents who demonstrate sexually abusive behavior • To become familiar with literature specific to this population • To become familiar with the theories which support this treatment approach • To become familiar with the Goal Oriented Approach to treatment • To become aware of how sexuality is affected by sexually abusive behavior • To be able to determine if a behavior is sexually concerning • Exposure to several treatment interventions • Exposure to different treatment modalities

5. PHENOMENOLOGY • Based on a psychological movement started in the mid-1890’s by Edmund Husserl which spread to Canada in the 1960’s. • The name of Gail Ryan’s approach which explains how the interaction of a child’s early life experiences combines with their own personal development to constantly shape their functioning. • Refers to one’s subjective experiences and perceptions of those experiences versus the meaning that others may bestow on it.

6. Combinations of Views of Self and OthersAinsworth (1989), Bartholomew (1990) and Bowlby (1977) as cited by Ryan (1997)

7. Combinations of Risk and AssetsGilgun as cited in Ryan & Lane, 1997

8. Development & Context(Ryan & Lane, 1997)

9. Community Family & Peers Context of Life Experience Infant growth and development The Ecological Pond

10. So… What some refer to as “distortions” can actually be considered “windows” into a youth’s internal working model.

11. Nine areas of functioning that can be supported to capitalize on overall potential (increased health) 1)      Closeness, trusting, relationship building 2)      Handling separation and independence 3)      Handling joint decisions and interpersonal conflict 4)      Dealing with frustration and unfavorable events 5)      Celebrating good things, feeling pleasure 6)      Working for delayed gratification 7)      Relaxing, playing 8)      Cognitive processing through words, symbols, images 9) An adaptive sense of direction and purpose Strayhorn (1988) as cited in Ryan & Lane, 1997

12. Factors relevant to decreased risk 1)      Consistently defines all abuse of self, others and property 2)      Acknowledges risk and uses foresight in safety planning 3)      Consistently recognizes/Interrupts the cycle of abuse 4)      Demonstrates functional coping skills when stressed 5)      Demonstrates emotional recognition and empathic responses 6)      Makes accurate attributions of responsibility 7)      Is able to manage frustration and unfavorable events 8) Rejects abusive thoughts as dissonant

13. Internal Working Model • “Mental representations of the parent-child relationship.” Two components: 1) a child’s information about, beliefs of and feelings about other people 2) a child’s own representations of themselves and their own role in these relationships (Ryan & Lane, 1997) • A child’s understanding of how others will respond to them (responsive, trustworthy, accessible, caring, unresponsive, untrustworthy, inaccessible, uncaring) and how they view their own role in relationships (worthy, capable or unworthy and incapable) factor into how they interact (Pearce & Pezzot-Pearce, 2006)

14. DEFENSE MECHANISMS • Dissociation • Identification with the aggressor • Intellectualization • Isolation • Projection • Rationalization • Regression • Repression • Sublimation • Suppression • Withdrawal

15. Balance of Risks and Assets • Decrease risk and increase assets • Assets = , “skills that support optimal human functioning” • Overarching goals – communication, empathy, personal responsibility

16. What is sexually abusive behavior? • “any sexual interaction with person(s) of any age that is perpetrated 1) against the victim’s will, 2) without consent, or 3) in an aggressive, exploitive, manipulative or threatening manner”

17. Components of Abusive Sexual Behavior • No Consent • Inequality • Coercion

18. The literature does not necessarily converge Some characteristics that are frequently seen: History of sexual abuse History of physical abuse Neglect Exposure to sexual material Exposure to adult sexual interaction Domestic violence Family instability and disorganization Inadequate support and supervision in the family Physical and/or emotional separation of the youth from one or both parents Marital stress in parent relationship Learning disability Psychiatric diagnoses Cognitive distortions Emotionally and/or physically distant parents The presence of ‘dangerous secrets’ in families Distorted attachments Significant parent-child conflict Who are sexual offenders?

19. Males Females Necking 14.0 15.0 French kissing 15.0 16.0 Breast fondling 16.0 16.5 Male/female genitals 17.0 17.5 Female/male genitals 17.0 17.5 Intercourse 17.5 18.0 Male oral/female genitals 18.0 18.5 Female oral/male genitals 18.0 18.5 What is normal?

20. SEXUALITY SEXUAL WELL-BEING, SOCIAL POLICY AND ADOLESCENTS SEXUAL ATTITUDES AND BEHAVIOR Contraceptive Use Sexual Well-Being and Developmental Transitions Social Policy and Adolescent Sexuality Heterosexual Attitudes and Beahvior Self-Stimulation Homosexual Attitudes and Behavior FORCIBLE SEXUAL BEHAVIOR AND SEXUAL HARASSMENT ADOLESCENT PREGNANCY Forcible Sexual Behavior Sexual Harassment Reducing Adolescent Pregnancy Incidence and Nature of Adolescent Pregnancy SEXUAL KNOWLEDGE AND SEX EDUCATION Adolescents as Parents SEXUALLY TRANSMITTED DISEASES Consequences of Adolescent Pregnancy Cognitive Factors in Adolescent Pregnancy Sexual Knowledge Sex Education in the Schools Types AIDS Sources of Sex Education More normal sexuality (Santrock, 1998)

21. When is sexual behaviour normal? Ryan, 1991 adapted for the Phoenix Program Normal: Sexually explicit conversations with peers Jokes within the cultural norm Sexual innuendo Flirting Courtship Interest in erotica Solitary masturbation Mutual masturbation Foreplay Monogamist intercourse Yellow Flags: Sexually preoccupied Keen interest in pornography Sexually promiscuous Sexually aggressive Violation of body space Single occurrence of peeping, exposing, frottage Mooning with known peer Red Flags: Compulsive masturbation Degrading others Attempting to expose others’ genitals Chronic use of pornography Sexual conversations with younger children Touching children in a sexual manner Sexual Threats Black Flags: • Obscene phone calls, voyeurism, exhibitionism, frottage • Forced penetration (anal, vaginal) • Use of violence and/or force • Use of a weapon • Threatening to harm the victim or something or someone the victim cares about • Engaging children to perform sexual acts on each other • Forced sexual acts • Forcing/inserting objects • Bestiality • Sadistic acts • Sexually degrading behaviours

22. ASSESSMENT CONTAINMENT Community Family Youth THERAPEUTIC CAREGIVING EDUCATION TREATMENT INTERVENTION TREATMENT MODEL

23. Remember “inner truth?” • Neurobiological functioning • Trauma symptoms • Executive functioning • Information processing • Attachment • Historical examination of personality • Family’s dynamics • Level of functioning • Understanding of the youth’s offense and implications of it • Cognitive distortions • Sexual interests • Risk

24. CONTAINMENT • Physical safety • Psychological safety • Nurturance

25. EDUCATION • Regarding their offense • Psychosexual • Psychoeducational (academic) • Psychotherapeutic • Vocational • Recreational

26. “When a person plays with someone’s feelings in order to gain control of the other person (Boundaries by Peter & Dowd) “Any willful action made by the offender to prepare the victim and/or the victim’s support network that allows for easier sex offending” (NCSU website) Insecurity Anger Intimidation Accusations Flattery Status Bribery Horseplaying Grooming

27. Case examples • Charlie moves into a program and, at bedtime on his first night, he can be heard crying. Another resident, Fred, goes to his bedroom and gives Charlie his teddy bear to use for the night. • One youth tells another that he is gay. • A youth notices another boy at school who has few friends. He asks the boy if he wants to be best friends and he sticks up for him when he is picked on at school. • Cindy makes fun of Leah’s outdated wardrobe and insists that she needs her help to get “with it.”

28. TREATMENT INTERVENTIONS • “Abuse is Abuse” • Cycle of Abuse • Decreasing deviant arousal • Safety Planning • Victim Impact and Empathy • Medical

29. Abuse is Abuse Physical---Sexual---Emotional---Verbal---Psychological Self Risk of Harm Others Individuals-Groups (Animals-Pets) Property Destruction-Loss Substance Abuse Eating Disorders Sexual promiscuity Suicide Self-Destructive Behavior Violence-Physical abuse Sexual Assault-Abuse-Exploitation Harrassment-Intimidation-Discrimination-Prejudice-Objectification Vandalism Firesetting Defacing-Destroying Theft Abusive interactions defined— Behavior Or by use of UNEQUAL Power, Control Or Authority Without CONSENT Informed Choice Or with COERCION Pressure, Force, Threat

30. Cycle of Abuse Their responses to stressful situations appeared to be “compensatory, repetitive and generally consistent for each youth.” The use of this tool is important because it assists professionals to gently convince abusive youth that their means of reducing their own anxiety is really just a temporary “fix” that actually brings on more anxiety in the future (Ryan & Lane, 1997).

31. Trigger 12 Denial Victim Stance 11 1 Promises Hopelessness 10 2 Anxiety 9 3 Isolation 8 4 Anger Abusive Behavior 7 5 Decision to Act 6 Fantasy Solution Plan High Risk Cycle

32. Adult interventions Can you think of an intervention for each stage of the cycle?

33. Decreasing “deviant” arousal • Covert sensitization • EMDR (Eye Movement Desensitization Reprogramming) • Relaxation

34. Safety Planning • What are the risks? • How can those risks be moderated? • Does the youth possess the skills to follow through and if not, what type of supervision do they require?

35. Victim Impact and Empathy • Acknowledgement • Apology • Demonstration of empathy within the milieu • Get creative!

36. Medical These can “fuel” the cycle of abuse • Tests • Medications • Genetic factors • Organic issues

37. Healthy Masturbation • When in a private place • When feeling good about self • When thinking caring thoughts (about self and others) • No abusive fantasies or memories

38. Relapse Prevention • “Risky” practices and situations • Detours • Identifying resources such as supportive individuals, soothing practices, individual strengths and positive cognitions • The culmination of concepts learned brought together into a plan

39. THERAPEUTIC CAREGIVINGCare that goes “above and beyond” • FAMILY WORK • INFORMED SUPERVISION • AND BEYOND…

40. “Bad pee pee karma” as therapeutic care BEWARE THE BAD PEE PEE KARMA IN THIS BATHROOM!

41. “Tools” of Therapeutic Care • Relationship • Nurturance • Modeling

42. Therapeutic Caregivers will be more successful if they expect: • Resistance and Opposition • Escalation • Regression

43. Informed Supervision Informed Supervision is a term used to describe a person who is knowledgeable about individual youth’s treatment needs and the concepts taught in sexual offender specific treatment. There are about eleven requirements that one must receive training on in order to be considered an Informed Supervisor (and even more concepts). There are several states in the U.S. that have added these to statutes outlining the care of young people who demonstrate sexually abusive behavior.

44. And Beyond • Providing therapeutic care is perhaps the most important aspect of the treatment model. One’s role as a therapeutic caregiver is critical to showing young people numerous examples of healthy ways of interacting and coping. Adults must always remember that they are role models to young people. Interactions are seen as opportunities to show how best to cope and mistakes can be a hidden opportunity to teach.

45. Family Involvement • The family is a rich source of developmental history; • The family may be a primary source of supervision; • The family may be able to support the juvenile’s treatment and the maintenance of change; and • The family may be capable of making alterations in the family structure and function that facilitate change and reduce risk situations for the juvenile (Ryan, 1997) The family is likely to be the one lasting connection to the youth in treatment (research supports this)!

46. Family involvement • Is woven into all processes and rituals • Introduced as a family-centered program • Availability? • Marital therapy? • Home visits • Strengthening relationships • Non-judgmental approach • Invitations to visit and join in • Frequent communication and support • Parent training • Family therapy • Patience, patience and more patience!

47. What are the benefits? • Reducing recidivism (Breer, 1987). • Children’s success in residential treatment and the child’s post-discharge adaptation increases (Modlin, 2003). • Opportunity for staff and therapists to model pro-social and benevolent behaviour to parents, thereby teaching parents new ways of interacting with their child which promotes long lasting change after treatment. (Schladale, 2002) • Understanding by families of relapse prevention techniques (Ertl & McNamara, 1997). • Allowing parents to address their feelings and the stigma associated with having a “sex offender” in the family. (Ryan, 1997b; Thomas, 1997; Lundrigan, 2001)

48. Barriers to family involvement • Many youth have no connection to their biological families at the present time. • Often parents blame their children for the problems within the family and are not willing to take responsibility for family factors contributing to the youth’s behavior. • Parents often present with their own mental health issues (including their own histories of abuse) that would prevent meaningful and helpful involvement. • The distance of the program from families makes physical involvement limited. • Connecting with families on reserves, where sexual abuse and other forms of abuse are a community issue and where in many cases these youths are ostracized for leaving the community for treatment. • Managing the privacy of kids in regard to their individual therapy. (The Phoenix Program, 2007.) • Parents sabotaging the youth’s treatment by being unsupportive, rejecting or nonexistent (Thomas, 1997) • Initially, youth may demonstrate increased problems with behaviour related to divided loyalties between the new treatment concepts they are learning within their treatment program and the values/beliefs of their families (Modlin, 2003) • Denial of youth’s sexually abusive behaviour.

49. Family factors that affect risk… • The family’s awareness of the youth’s offense and the presence of denial or minimization related to that offense and other abusive behaviors. • Youth are not allowed access to potential or past victims without monitoring and without evidence of decreased risk. • Abuse, in all of its forms, is recognized, defined and not tolerated. • Family awareness regarding the dynamic patterns associated with abusive behaviors is present and those behaviors are recognized. • The use and necessity of safety plans is understood and the family is able to assist the young person to design, implement and monitor them. • The family is aware of the definition of illegal behaviors and how to report unlawful acts. They are able to inform youth of this and support responsible and legal behavior.

50. More factors that affect risk… • Understands the rules surrounding children (such as probation orders) and is able to hold youth accountable to these rules. • The family is able to communicate openly with the child regarding accurate observations of behavior as well as other helping professionals involved. • The family provides a physically safe environment by implementing effective behavior management techniques and consistent consequences. • The family provides a psychologically safe environment by modeling consistency, respect and trustworthiness. • The family models non-aggressive and non-coercive interpersonal interactions and non-aggressive anger management. • The family supports opportunities for the juvenile to interact with positive male and female adult and peer role models. • The family supports opportunities to practice new coping skills and social skills. • The family supports activities that promote positive relaxation, recreation and play. • The family supports participation in “normalizing” experiences in the community.