“The Challenges of Family Reunification with the Juvenile Sex Offender: An Ecosystemic Approach”

1. “The Challenges of Family Reunification with the Juvenile Sex Offender: An Ecosystemic Approach” This presentation will review Ecosystemic Play Therapy Theory as it applies to the process of family reunification with juvenile sex offenders. I will review some related statistics and will present family reunification under the broad umbrella of sexual abuse prevention and breaking inter-generational patterns of sexual abuse. Finally, I will provide information on how to capitalize on a family’s strengths, work cooperatively with other treatment providers, the courts, DYFS and probation in presenting an outline of the process of family reunification and returning the juvenile offender to the home and safely maintaining him/her afterward. The presentation will include case materials and examples throughout. Robb Hinds, MA October 28,2011

2. Family reunification • Don’t do it! • or • Don’t do it alone!

3. Why do reunification, then? • The only statistics I’m going to show you… • Amongst Juvenile Sexual Offenders 31% of those twelve and under offended against family members and 73% of those happened at home. • Amongst Juvenile Sexual Offenders 24% of those twelve and older offended against family members and 68% of those happened at home. • OJJDP (2009)

4. That means…… • That about thirty percent of our Juvenile Offenders committed their offense against a family member…… • And that about thirty percent will need some form of family reunification…. Because…

5. To be SURE…… • It will happen, eventually, whether you think it’s the right thing to do or not!

6. The Jump Start Program…What I do, What I’ve done • Individual, group and family therapy • Currently, two groups per week with twenty clients • Small groups (dyad, triad and sometimes more) per week • Probation meeting with each group • Family therapy PRN • It’s all about the MILIEU!

7. My Theoretical Foundation…

8. O'Connor & Ammen, 1997, as modified by Hinds 2011 World Community Metasystems Dominant/National/Political Culture (Sex Offender Hysteria) Regional Culture Medical System Mental Health System Social Services Legal System Other Systems Probation/ Megan’s Law School/ Daycare Employment Church Peers Familial Systems Nuclear Family Extended Family Ethnocultural Context of Child & family (Ethnicity, Culture, Religion, SES, etc.) Interactional Level Child Parent Dyadic Relationships Representational Level Internal Working Model of Family of Origin Internal Working Model of Relationship Internal Working Model of Self Internal Working Model of Self Internal Working Model of Relationship Sexual Offender Monster Historical Time

9. The Ecosystemic Model and Theory • Is “a hybrid model that derives from an integration of biological science concepts, multiple models of child psychotherapy, and developmental theory.” • "It is a systems theory that addresses intrapsychic, interactional, developmental and historical processes.” • It differs from most systems theories in that it includes the idea of the actively developing individual over time and because the primary "unit” of focus “is the individual”. • It differs from ecological models (Knoff, 1986, Bronfenbrenner, 1977) in that it begins with the individual as a system that entails, at a minimum, the interaction between the mind and the body, and that allows for various other elements as needed or desired to describe intrapsyhcic functioning.

10. The Ecosystemic Model and Theory • Recognizes that the individual is "embedded within multiple interrelated systems" and that "these systems must be taken into consideration.” • The concept of nested systems, however, is not sufficiently complex to reflect the nature of any individual's real ecosystem.....The very nature of an ecosystemic model is such that it is readily inclusive of additional points of view and evolves as time passes • It begins with the individual and focuses on the functioning of the individual and, in particular, on "optimizing the functioning of that child in the context of his or her ecosystem.” • The ecosystem is potentially either a source to support or to interfere with the optimal development of the child (O'Connor & Ammen, 1997). In all likelihood, both support and interference are likely to be normal and even necessary parts of optimal development in some degree (Kohut, 1978), only affecting development severely when in extreme degrees, such that support is severely limited, or interference is excessive, or both.

11. The Ecosystemic Model and Theory • Moves from the individual level to the level of interactions that occur in dyads. • It incorporates interactions within various other systems, including the parental/spousal unit(s), siblings and family. • And beyond the immediate family lie the extended families and their respective histories. • And various additional systems, as well, including race, ethnicity, culture and religion, on an abstract level, and medical, educational, vocational, judicial, social service, police and mental health systems on a more concrete level (which of course applies to our clients). • Beyond these systems are regional culture, dominant/political/national culture, world culture and finally historical time; referred to as Metasystems. (S.O. Hysteria)

12. The Ecosystemic Model and Theory • Metasystems influence individuals indirectly through their influence on the representational understandings of the culture's expectations, beliefs, and values. But this also directly affects the child when these representational understandings determine the behaviors of people in systems in which the child is involved. The meta-systemic level refers to both the current socio-cultural context and the recognition that this context evolves over time and is affected by its history. (The current state of affairs re: S.O.’s applies here). • O'Connor (1994) emphasizes the importance of the passage of time in the model. For the individual this means that developmental change over the course of the life span must be considered, as well.

13. The Ecosystemic Model and Theory • They refer to Maturana's ideas about systems theory. that living organisms are autonomous and autopoietic (self-creating or self-defining), and that "what makes a living organism living is it's way of being in the world is always organized around maintaining its own being (p5)". • The individual is said to operate from a subject-dependent perspectiveThat we create internal meanings, and thereby our definition of reality, as we experience and interact with the world. • This subject dependent state means that "we understand the regularity of the world as a result of our history of interactions and current interactions without any point of reference independent of ourselves (O'Connor & Ammen, 1997, p5)." (which we often see as egocentric).

14. The Ecosystemic Model and Theory • As human beings we are drawn to engage in interactions with others and to use language to develop meaning systems about our experiences. • Maturana introduced the term structural coupling, which is the process whereby the organism interacts with the environment over time. This results in a coordination of behaviors that take on meaning between the involved organisms. From this develop interpersonal or social systems and "an intrapsychic symbolic system in which the individual becomes an observer of his or her experiences (including behavior, affect and thoughts) and as an observer develops internal models of self, others, relationships and the world. The development of our intrapsychic systems cannot emerge independent of interactions with others in our interpersonal systems. (Our guys are lacking here…they don’t observe their experience, they just exist in it.)

15. The Ecosystemic Model and Theory • These intrapsychic meanings affect our behavior, which affects our interactions, which affect our intrapsychic meanings, etc. in an ongoing feedback loop and, in time, become "internal representational systems" derived from the history of our interactions with others. (Our guys have trauma as part of their representational systems.)

16. Historical information is embedded on three levels according to Maturana's theory • On the biological level, this entails the maturational and constitutional abilities of the child (And we are beginning to know how trauma effects brain development (Singer, 2010)). • On the intrapsychic system level, it occurs in the internal representational systems (And now they have an internal representation as a sex offender, at least, or as a Monster, at worst). • On a broader level, it occurs in social systems and culture, whereby norms are established and passed on inter-generationally. (And now we have “sex offender hysteria” where they grew up in families that have sexual abuse in their histories, but now they are considered monsters.)

17. Philosophic Underpinnings of Ecosystemic Theory • Based on a phenomenologic philosophical perspective that is consistent with the subject-dependent perspective previously described. • From the phenomenological perspective, reality is the result of an interaction of both the observer and the observed. In contrast to the natural science perspective, it assumes that objective reality is not determined by an absolute external phenomenon, nor is it arbitrarily determined by the observer's internal processes. Rather, reality is the result of an interaction of both the observer and the observed (Giorgi, 1983, from O'Connor and Ammen, 1997, p3)."

18. Key Elements of Ecosystemic Theory • Concepts of personality and pathology, as well as the goal of therapy. • Development in all social, emotional, and behavioral areas is cognitively driven; that is to say, children cannot progress in other areas beyond the limits imposed by their cognitive development. • Once the environment inhibits progress in one or more areas, the course of the child's subsequent development is altered, sometimes irrevocably (p. 69)." Thus, the individual's interactions with significant others in his or her environment is seen as crucial to the individual's concurrent and subsequent development and to our conceptualization's of personality functioning and psychopathology (O'Connor, 1994).

19. Concepts of Personality • O’Connor describes personality theories as having several common elements • They pose some force that motivates behavior • They incorporate "developmental changes in functioning over the life span” • They explain pathological functioning in a manner consistent with the first two elements

20. The Ecosystemic Concept of Personality • Ecosystemic theory (O'Connor, 1994) postulates that human behavior is, at least to some degree, biologically driven, with the intent of individual and species survival. "At its most basic level, this drive motivates humans to seek rewards and to maximize personal gratification in a relatively egocentric way. Secondarily, this drive motivates humans to avoid punishment as a potential risk to survival.” • “If the human infant's development and socialization proceed optimally, the drive is modified to the point that the individual will seek to maximize his or her own gratification while minimally interfering with other individuals seeking to do the same. The drive is then channeled into more social behavior, and the child becomes less egocentrically focused (p. 68-69)." • Ecosystemic theory includes a secondary drive that is social or affiliative in nature motivating the individual to interact socially and to participate in and form social groups (O'Connor, 1994).

21. The Concept of Pathology • Psychopathology in this theory is diagnosed when individual's are unable to get their needs met in a manner they find satisfactory, or when getting their needs met substantially interferes with the ability of others getting their needs met. • Thus, pathological behavior is viewed as the individual's "best attempt at coping with his or her internal or external circumstance....The phenomenology of the behavior is that it has more positive than negative associations, or it would not continue” (O'Connor, 1994). • Psychopathology in this theory is diagnosed when individual's are unable to get their needs met in a manner they find satisfactory, or when getting their needs met substantially interferes with the ability of others getting their needs met.

22. The Concept of Pathology • Allows for the explanation of dysfunction as resulting from internal and/or external mechanisms (O'Connor, 1994) as the source of an individual's inability to get her or his "needs met may be individual, interactional, or systemic in origin.” (O'Connor, 1997,p241). • The theory recognizes that some pathological conditions, including genetic, biologic, neurologic, cognitive or other constitutionally based disorders, have the individual as their point of origin. • The theory also recognizes that some disorders have their point of origin in one of the systems in which the individual is embedded. In these cases pathology results when a healthy individual is involved in a pathological system or from the interaction between seemingly non-pathological individuals, in a relatively benign environment (O'Connor, 1994).

23. The Concept of Pathology • An individual who is unable to get his or her needs met adequately as a product of distress or conflict turns to socially unacceptable means to get those needs met

24. The Concept of Pathology • Thus, an individual who is unable to get his or her needs met adequately as a product of distress or conflict caused by any myriad of factors, who turns to an inappropriate object to get their needs met, whether sexual, emotional or otherwise, becomes a juvenile sexual offender. • Bottom line… they’re trying to get their needs met, but doing it in the wrong way.

25. O'Connor & Ammen, 1997, as modified by Hinds 2011 World Community Metasystems Dominant/National/Political Culture (Sex Offender Hysteria) Regional Culture Medical System Mental Health System Social Services Legal System Other Systems Probation/ Megan’s Law School/ Daycare Employment Church Peers Familial Systems Nuclear Family Extended Family Ethnocultural Context of Child & family (Ethnicity, Culture, Religion, SES, etc.) Interactional Level Child Parent Dyadic Relationships Representational Level Internal Working Model of Family of Origin Internal Working Model of Relationship Internal Working Model of Self Internal Working Model of Self Internal Working Model of Relationship Sexual Offender Monster Historical Time

26. MY BIG PICTURE……. • Treatment of the Juvenile Sexual Offender and Family Reunification • Are about preventing sexual abuse…. • And about disrupting inter-generational patterns of sexual abuse….. • So that not only do our clients not commit further offenses…. • But, that they also prevent their own offspring from becoming offenders or from becoming victims.

27. Break for experiential exercise… • What are the needs and goals of the offenders? • What are the needs and goals of the victims? • What are the needs and goals of the family?

28. Needs of the offender…. • They want to be back home with their family. • They want to not offend anymore. • They want to resume having a ‘normal’ life. • They want to have their needs met without interfering with the needs of others…and they want to learn how to do that. • They want to have a ‘normal’ sex life. • They want to get over their guilt (if they have it) and they don’t want to accept that they are to blame and are responsible for the harm they’ve done.

29. Needs of the victims….. • They want their family to be whole again. • They want to be safe. • They want to feel they can trust others. • They want to be able to enjoy normal sexual development and romantic/sexual relations. • They don’t want to feel stigmatized. • They want to feel good about themselves and to have positive self-esteem. • They want to stop feeling like it’s their fault. • They want to feel they have control and are empowered to control their own lives. • They want to not be angry anymore. • They want to sleep at night. • They want to stop having flashbacks. • They want to stop being depressed and anxious.

30. Needs of the Parental Units…. • They want their family to be whole again. • They want to love and support both of their children (which is an almost impossible task to manage). • They want their abusing child to get help so he/she doesn’t do it again. • They want their victim child to be okay. • They want to get over their own guilt for having allowed such a horrible thing to happen under their watch. • They want it all to just ‘go away.’

31. Clearly the needs of these three interdependent units are contradictory • Thus, I say… Don’t do it! • Except that, once the JSO is off of probation, all these forces will come together and reunification will happen anyway. • Thus, to safeguard the victims, we need to push to do reunification…. • We have a moral and ethical obligation to undertake this work.

32. So How do you do reunification? • Again, first, YOU CAN’T DO IT ALONE! • Second, the ideal way to do it RARELY happens • Third, and most importantly……………… THE PRIMARY FOCUS SHOULD BE ON THE NEEDS OF THE VICTIM, NOT THE OFFENDER

33. But what a challenge….. How do you place the needs of the victim over the needs of your own client????

34. Did I mention?????YOU CAN’T DO THIS ALONE! So, who are the players and what are their roles??? The Courts DYFS Probation/Parole YCM/CMO School The Family The Mental Health Clinician of the victim The Mental Health Clinician of the JSO And make sure you get consent to communicate with all of the above players. For me, it means five separate signatures for release of information at the time of intake.

35. The Courts • For the offender, usually order ‘no victim contact.’ • Which means, if you want to do family reunification, you have to petition the court to modify that order. • Or, they are otherwise involved with DYFS and approve ‘supervised contact’ before the victim is ready. • Which means, you have to advocate against your client to get the court to order ‘contact as per the recommendations of treatment providers.’

36. The Department of Youth and Family Services…. • May have been involved with the case from the onset of the report of sexual abuse. • May have had several changes in caseworkers since the origin of their involvement so the current caseworker may not be any more knowledgeable of the case than you are. • May have as their primary goal ‘to close the case’. • May be able to access other resources that you cannot. • May be nothing but an inconvenience. • May be a great aide in getting and monitoring the other services the family needs. • May be the only other resource you have. • Remember, you can’t do it alone.

37. The Care Management Organization and/or Youth Case Management • Sometimes they’re involved and sometimes they’re not. • When they are, they’re motive is to close out as soon as possible (They’ve often been involved for ninety days before you even get the case) . • In the additional ninety days they may be involved, you need to get what you can from them while the full burden of the case transfers onto your shoulders. • You need to try to get them to extend any in-home services for as long as possible. • You need to get them to terminate in a healthy, appropriate way so as not to cause further trauma (They are often the first mental health providers to intervene with the family, which often gets quite attached to their services or to them as providers. And they often don’t realize the import of their interactions with families/clients).

38. Probation/Parole • What an asset. (wink, wink, Laura) • Probation plays a primary role in the process. • They are the eyes that can check out the living situation to make sure the circumstances are safe enough to follow a basic safety plan and to prevent unsupervised contact. • They are the hammer to ensure that offenders adhere to treatment. • They are the ‘superego’ to the ‘id’ of the juvenile and the ‘ego’ of the therapist, thereby reinforcing in real life the metaphor of what they’re learning in therapy.

39. The Schools…. • Success at school for Juvenile Sex Offenders is paramount… and hard to achieve, for both the JSO and the Clinician. • Is the student classified for Special Education… • If so, is the plan appropriate and meeting the educational and emotional needs of the student? • If not, has there been a Child Study Team evaluation? Should there be? How do you get the family to request one? How do you get the school to agree to one? • How do you intervene with the school to deal more effectively with the student to get him/her to experience some success? (I still don’t have the answer to this one as it requires a case and school specific response). • The valuable role of probation in this aspect of the client’s functioning, as well. • What a huge impact on the client’s life when you can get it to work!

40. The Clinician of the victim • Perhaps the hardest of the roles…..They have to help a victim heal and gain control of their own life (See, “Evicting the Perpetrator” by Ken Singer, 2010). • They have to process the details of the sexual abuse with the victim. • They have to help the victim find resolution to feelings of animosity for the abuser and positive feelings for the abuser such that they want to have renewed contact with that person. • They have to manage their own feelings of animosity for the abuser to be okay with the victim wanting to have renewed contact with the abuser. • And they have to feel the victim will be safe, physically and emotionally, if there is renewed contact with the victim.

41. And the clinician of the sexual offender has to be the one to manage all the other players…… and their concerns.

42. The Clinician of the Juvenile Sexual Offender…. • Has to get the client to acknowledge his/her offense fully. • Has to get the client to identify and be willing to adhere to an effective safety plan. • Has to get the client to comprehend the harm that he/she has done to his victim, his victim’s family, his own family and himself. • Has to get the client to experience remorse for his offense beyond the consequences he/she has suffered (yet at the same time, be able to recover from such remorse). • Has to get the client to be able to communicate all of the above to his/her victim in reunification sessions.

43. How the Hell do you do THAT? …And manage all the other players, and keep the victim in mind as the person whose needs are primary, when the offender is your client??????? • It’s impossible! Just don’t do it alone!

44. What I do…..the five modules. • Social skills/Anger Management… • Sexual Respect… • The Sexual Assault Cycle… • Victim Empathy • Relapse Prevention

45. Victim Empathy….. • The debate about empathy and it’s role…There’s no evidence, but we all know it’s true. • How to get empathic responses from our juvenile sexual offenders. • The letters…to someone who hurt you, the apology letter and the letter to yourself from your victim…. • The letter from Sean the Survivor.

46. Relapse Prevention… • The Relapse prevention module. • The ‘Woodsman’. • Defense Mechanisms vs. attitudes/beliefs and thoughts. The Catch 22. • Healthy Living and the applicability of the model to everything in life and NOT just sexual offending.

47. Meta-Cognition Thinking about doing Thinking about thinking Internal conflict creates stress & anxiety Thoughts Cognitive distortions Self-talk Defense Mechanisms Super Ego Id Behaviors Attitudes Beliefs Ego Feelings Sex offender label Probation Megan’s Law Treatment Perceptions See, hear, smell, taste, touch External conflict from the demands of the outside world creates stress & anxiety Interaction with the outside world Meta-Cognitions Avoid Escape Healthy Living Seemingly unimportant decisions High risk situations Lapse Giving up Relapse Hinds, 2008

48. The Reunification… Foundations • The victim’s had treatment (hopefully, but not always) and is ready to meet with the abuser (as okayed by the victim’s therapist). • The offender has accepted responsibility and can communicate that. • The parents have accepted what happened, their own role for allowing it to happen, while still allowing their son/daughter to accept full responsibility for the offense.

49. The Reunification Therapy Session • The offender expresses gratitude for the victim being there and total control to leave if it’s too uncomfortable. • The offender expresses remorse/guilt and an apology for what he/she did and a willingness to talk in detail about the offense if the victim wants. (Many recommend going into detail about the offense, but I’m not so sure, especially if the victim is hesitant … I welcome feedback about this.) • The offender expresses full responsibility and absolves the victim of any responsibility for what happened (including, if possible, how he/she manipulated or coerced the victim to comply with the inappropriate sexual behavior). • The offender identifies the safety plan and what steps the victim should take if he/she should ever feel uncomfortable or unsafe in the future.

50. The Reunification Therapy Session • The offender expresses a willingness to respond to any questions the victim might have and does so (having prepared for the kinds of questions that might be asked previously with the therapist). • The offender promises to continue in treatment to get the help he/she needs, to never commit another sexual offense against anyone, ever, again. • The offender expresses that if there is anything he or she could do, now or in the future, to make up for the offense, that he/she is willing to do so if the victim requests it (and the therapists agree it’s okay). • The offender agrees to participate in future sessions if the victim wants them and an agreement to participate fully in family therapy sessions as the reunification process proceeds because now we have to address the other issues of family functioning.