The Flight of the Phoenix

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The Flight of the Phoenix

• Presented by
• Teresa Winfield and
• Candace Reimer

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The story of the Phoenix

• 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 Woods Homes

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Woods Homes

• 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

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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

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PHENOMENOLOGY

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

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Combinations of Views of Self and
OthersAinsworth (1989), Bartholomew (1990) and
Bowlby (1977) as cited by Ryan (1997)
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Combinations of Risk and AssetsGilgun as cited
in Ryan Lane, 1997
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Development Context(Ryan Lane, 1997)
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The Ecological Pond
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So
What some refer to as distortions can actually
be considered windows into a youths internal
working model.
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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
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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

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Internal Working Model

• Mental representations of the parent-child
  relationship.
• Two components
• 1) a childs information about, beliefs of and
  feelings about other people
• 2) a childs own representations of themselves
  and their own role in these relationships (Ryan
  Lane, 1997)
• A childs 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)

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DEFENSE MECHANISMS

• Dissociation
• Identification with the aggressor
• Intellectualization
• Isolation
• Projection

• Rationalization
• Regression
• Repression
• Sublimation
• Suppression
• Withdrawal

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Balance of Risks and Assets

• Decrease risk and increase assets
• Assets , skills that support optimal human
  functioning
• Overarching goals communication, empathy,
  personal responsibility

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What is sexually abusive behavior?

• any sexual interaction with person(s) of any age
  that is perpetrated 1) against the victims will,
  2) without consent, or 3) in an aggressive,
  exploitive, manipulative or threatening manner

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Components of Abusive Sexual Behavior

• No Consent
• Inequality
• Coercion

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Who are sexual offenders?

• 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

• The literature does not necessarily converge

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What is normal?

• 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

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More normal sexuality (Santrock, 1998)
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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

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TREATMENT MODEL
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Remember inner truth?

• Neurobiological functioning
• Trauma symptoms
• Executive functioning
• Information processing
• Attachment
• Historical examination of personality
• Familys dynamics
• Level of functioning
• Understanding of the youths offense and
  implications of it
• Cognitive distortions
• Sexual interests
• Risk

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CONTAINMENT

• Physical safety
• Psychological safety
• Nurturance

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EDUCATION

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

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Grooming

• Insecurity
• Anger
• Intimidation
• Accusations
• Flattery
• Status
• Bribery
• Horseplaying

• When a person plays with someones 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 victims support
  network that allows for easier sex offending
  (NCSU website)

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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 Leahs outdated wardrobe and
  insists that she needs her help to get with it.

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TREATMENT INTERVENTIONS

• Abuse is Abuse
• Cycle of Abuse
• Decreasing deviant arousal
• Safety Planning
• Victim Impact and Empathy
• Medical

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(No Transcript)
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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).
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High Risk Cycle
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Adult interventions
Can you think of an intervention for each stage
of the cycle?
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Decreasing deviant arousal

• Covert sensitization
• EMDR (Eye Movement Desensitization Reprogramming)
• Relaxation

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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?

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Victim Impact and Empathy

• Acknowledgement
• Apology
• Demonstration of empathy within the milieu
• Get creative!

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Medical

• These can fuel the cycle of abuse
• Tests
• Medications
• Genetic factors
• Organic issues

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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

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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

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THERAPEUTIC CAREGIVINGCare that goes above and
beyond

• FAMILY WORK
• INFORMED SUPERVISION
• AND BEYOND

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Bad pee pee karma as therapeutic care
BEWARE THE BAD PEE PEE KARMA IN THIS BATHROOM!
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Tools of Therapeutic Care

• Relationship
• Nurturance
• Modeling

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Therapeutic Caregivers will be more successful if
they expect

• Resistance and Opposition
• Escalation
• Regression

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Informed Supervision
Informed Supervision is a term used to describe a
person who is knowledgeable about individual
youths 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.
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And Beyond

• Providing therapeutic care is perhaps the most
  important aspect of the treatment model. Ones
  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.

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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 juveniles
  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)!

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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!

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What are the benefits?

• Reducing recidivism (Breer, 1987).
• Childrens success in residential treatment and
  the childs 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)

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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 youths 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 youths 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 youths sexually abusive behaviour.

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Family factors that affect risk

• The familys awareness of the youths 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.

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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.

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Modes of Treatment

• Groups
• Individual Therapy
• Milieu

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Activity

• Group exercise
• We need 8 volunteers, please

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Questions?