Child Sexual Abusers

A Community Treatment Approach

Jackie Craissati

• Publisher: Psychology Press
• Year: 2021
• Print ISBN: 9780863777349
• eBook ISBN: 9781317715603
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Uniquely, this book aims to provide students and practitioners with a knowledge base in relation to child sexual abusers which is focused on practice - assessment, treatment and evaluation - but rooted in psychological theory. Its strength lies in the simplification and outlining of a coherent approach to this group of offenders that is afforded by the single-author treatment, particularly so given that this author has developed and managed a sex offender project in South East London which is now one of the largest, longest running, and most thoroughly evaluated in the country.

Chapter One Introduction

DOI: 10.4324/9781315784809-1

... "By this time I was in a state of excitement bordering on insanity; but I also had the cunning of the insane. Sitting there, on the sofa, I managed to attune, by a series of stealthy movements, my masked lust to her guileless limbs. It was no easy matter to divert the little maiden's attention while I performed the obscure adjustments necessary for the success of the trick. Talking fast, lagging behind my own breath, catching up with it, mimicking a sudden toothache to explain the breaks in my patter—and all the while keeping a maniac's inner eye on my distant golden goal, I cautiously increased the magic friction that was doing away, in an illusional, if not factual, sense, with the physically irremovable, but psychologically very friable texture of the material divide (pajamas and robe) between the weight of two sunburnt legs, resting athwart my lap, and the hidden tumor of an unspeakable passion ..." (from Lolita, Nabokov, 1955).

It may appear frivolous to begin a discussion of perpetrators of child sexual abuse with a quote from Lolita, and yet little has been written which so eloquently describes the mind of a man sexually fixated on a pubescent girl: his infatuation with what she represents rather than who she is; his distorted interpretation of her responses to him; his focused, persistent and ruthless cunning in achieving his desired goal; and the erotic lyricism which almost—but not entirely—masks his sordid lust. Unfortunately, few child sexual offenders are able to articulate their thoughts and feelings with such insight, and the behavioural focus of the victim interviews for legal purposes (searching to establish whether fondling, masturbation or penetration took place) only reduces the offences to a series of sexual acts. Those practitioners who are involved in the assessment and management of perpetrators of child sexual abuse have to set feelings of abhorrance and mystification to one side in order to try to understand the motivations and internal worlds of such offenders, so as to try and develop a strategy to reduce the risk of further offending.

Current Concerns

In setting the scene for a discussion of perpetrators of child sexual abuse, this chapter aims to place these offenders within the current context in Britain. Sex offenders form a very high profile group of offenders; they provoke strong feelings in the general public and pose a considerable challenge to the professionals who are involved in their assessment and management. In recent years, there has been a burgeoning of treatment programmes targeting sex offenders—an emphasis which has not been matched with other groups of offenders (Barker & Beech, 1993). Furthermore, the Criminal Justice Act (1991) specifically addressed the issue with the following points:

1. Sex offenders can now be required to attend a probation programme or to take part in required activities for the full duration of the probation order.
2. When considering offences of a violent or sexual nature, a longer sentence than might otherwise be justified by the seriousness of the offence can be passed, when this is necessary to protect the public from serious harm by the offender.
3. Sex offenders sentenced to 12 months or more can be required to be supervised up to the end of their sentence (rather than the 3/4 point).

As this book was being written, the requirement for convicted sex offenders in the community to register with their local police was established (Sex Offenders Act, 1997): this attempt to monitor the whereabouts of perpetrators offers reassurance—perhaps falsely—to the public and but certainly might lay the foundation for a coordinated and responsive multi-agency approach to the management of some high risk offenders. Further proposals are under discussion and may soon become legislation: that sex offenders can be banned from entering public places which places the community at risk (such as parks or swimming pools); and that courts should have the power to require an extended supervision period in the community following release from a determinate sentence imposed for a sexual offence.

Media interest has reflected—and perhaps fuelled—public concern, particularly with regard to child sexual abuse. Following the implementation of registration, a national Sunday paper published an article titled "In Your Back Yard. The man on the left (silhouetted profile); is a known paedophile. Despite a new register of sex offenders, you are still not allowed to know if somebody like him is living in your area, watching your child. But if you did, it might make him even more dangerous" (Sunday Times). As never before, professionals in the field are under scrutiny, criticised at times for the emphasis on treatment rather than punishment, at other times for failing to engage high risk offenders in treatment. At a time when the public and the government are predominantly emphasising external controls, the question should be raised as to whether a treatment approach—relying as it does on self-controls—is justified at all. There is a growing body of evidence, laid out in this book, to suggest that not all perpetrators reoffend, and some not for long periods of time; that some treatment programmes for some perpetrators have reduced reoffending rates; and that treatment, alongside other child protection measures, has allowed some fathers and children to re-establish a warm and close relationship. Furthermore, there are concerns that excessive emphasis on external and potentially punitive controls may in fact increase an offender's social and emotional instability, paradoxically raising the risk of reoffending. However practitioners, in apparently embracing the principles of a treatment approach to sex offenders alongside other measures, must be prepared to justify the approach with a clear and objective rationale for assessment, treatment and evaluation.

The Extent of the Problem: Assumptions and Myths

The current state of knowledge on sex offenders is problematic, predominantly for two reasons: methodological and mythological reasons. In the former case, attempts to evaluate recidivism and treatment outcome have been dogged by inertia, poor sampling techniques, geographical bias and a lack of effective comparative data (see Chapter seven for a detailed outline of the difficulties). The result is that few generalisations can be made from the available data, particularly as much of it originates from America and Canada; in this country, until recently, the sparse research has been institutionally (often prison) based.

Clinical definitions of sexual abuse of children have tended to utilise three dimensions: an age difference of five years or more between child and offender; specific sexual behaviours, such as kissing, fondling genitalia, oral sex, penetration of the vagina/anus with objects or penis, exhibitionism and photography; and sexual intent, an area which can be difficult to determine. There is little consistent agreement on the way in which familial and cultural norms can influence the decision to define behaviour as abuse.

Criminal statistics show that in 1995 in England and Wales, 4600 men and 100 women were sentenced by the courts for indictable sexual offences and a further 2250 were cautioned (Home Office, 1995). When the figures are broken down further to those offenders where the victim was known to be aged under 16, there were 1350 cautions, 3284 prosecutions and 2554 convictions (of which 34, 30 and 19 respectively were female offenders). The criminal justice response to child sexual abusers is highlighted by the following data for the most common offence types in 1995 (Home Office, 1995):

1. Indecent assault on a female aged <16 resulted in 1440 convictions (1787 prosecutions); 31% received a community sentence and 57% immediate custody.
2. Indecent assault on a male aged <16 resulted in 331 convictions (392 prosecutions); 29% received a community sentence and 61% immediate custody.
3. Unlawful sexual intercourse with a girl aged <16 resulted in 203 convictions (195 prosecutions); 33% received a community sentence and 42% immediate custody.
4. Rape of a female aged <16 resulted in 111 convictions (330 prosecutions); 4% received a community sentence and 84% immediate custody.

Between 1990 and 1994, an average of 22% of victims of rape were aged between 10 and 15 and a further 4% were aged less than nine; the risk of attacks by strangers remained very low. In terms of indecent assaults, overall female victims tended to be older than male victims: approximately half of female victims were aged under 16 (and 17% aged less than 10) whilst over two-thirds of male victims were aged under 16 (27% being aged less than 10). One in five of victims aged between 0 and 9 were assaulted by someone aged between 10 and 15.

There is little doubt that under-reporting is problematic with regard to sexual offenders. The British Crime Survey (Home Office, 1988) estimated the report rate for rape and indecent assault as 17%, similar to rates for other crimes against the person, and whilst official Home Office statistics for 1989 showed that reported sex offences increased by 40% between 1979 and 1989, they still only accounted for less than 1% of recorded crime. More recent figures in the Home Office statistics (Home Office, 1995), state that there were 30,000 notifiable sexual offences recorded by the police, up 4% on previous years in line with other offences, and they suggest that the British Crime Survey, 1995, indicates that there is a fourfold underestimate for most offences. The law in relation to child sexual abuse offers very little in the way of a true picture: offenders may only be convicted of "specimen" charges when abuse has occurred over a lengthy period or with a number of victims; charges are likely to be dropped, particularly when victims are young, or reduced to a lesser charge in order to avoid a trial. A recent study of convicted perpetrators of child sexual abuse in southeast London (Craissati, 1994) showed that charges were more than twice as likely to be dropped when victims were under the age of ten, and that 47% of initial rape and buggery charges were dropped/reduced to indecent assault before trial. Clearly indecent assault encompasses behaviour ranging from touching the genital area outside clothing to profoundly invasive acts such as oral sex and penetration with objects.

Social services child protection teams manage families where children have been identified as being at serious risk of sexual abuse, although the majority of alleged perpetrators have not been prosecuted. Craissati and McClurg (internal document, 1995) found that between 0 and 8% of these alleged perpetrators in two London boroughs were convicted as a result of the allegations. British estimates of the prevalence of sexual abuse in the general population, based on randomised retrospective studies of adults (Baker & Duncan, 1985) reported that 12% of females and 8% of males had been sexually abused before the age of 16.

Attempts to explore the potential offending rate in the general population have alarmed practitioners who tend to quote the finding that about one-fifth of college males reported having some sexual attraction to children (Briere & Runtz, 1989). Yet there is little to substantiate the validity of these self-report studies in terms of sexual interests and, more importantly, propensity to act out those interests, particularly against prepubertal children. We know that many 'normal' people have deviant sexual fantasies and that deviant sexual arousal profiles can be obtained from non-sexual offenders under certain conditions (Quinsey, Chaplin, & Varney, 1981). Nevertheless, it is probable—but as yet unproven—that there is a considerable barrier between fantasy and action in the general population.

In terms of mythology, practitioner attitudes towards sex offenders are usually derived from a handful of research findings which have led to illogical and inaccurate rhetoric. Some of these falacious assertions are discussed by Mair (1996) and outlined below. For example, Abel, Becker, Mittetman, Cunningham-Rathner, Rouleau, and Murphy (1987) wrote an extraordinarily frequently cited paper regarding the multiple sexually deviant activities of non incarcerated sex offenders who were offered treatment in return for confidential confessions regarding their sexual misbehaviour to date. Clearly such offenders who voluntarily seek treatment outside a prosecution are both highly unusual, and likely to represent the most disturbed and deviant of the population; furthermore the average offending rate is often quoted as being in the 100s, whilst few pause to note that the majority of individuals in the study offended against a few victims on a few occasions, the minority accounting for the distortion in the mean because of their prolific sexual activity. Clearly this highlights a need to be cautious in interpreting studies that extrapolate estimates of the number of abusers from prevalence studies of adult survivors of abuse, or that rely on accumulated individual acts of abuse (an incest abuser can account for 36 'paraphilic' acts by indecently assaulting his daughter once a month over a three year period).

Retrospective studies are particularly prone to distortion because of sampling problems: for example, many serious adult sexual offenders are known as having commenced their deviant sexual interests and activities in adolescence, yet few researchers have attempted to establish a baseline rate for sexually aggressive behaviour in adolescence—although Scully (1990) found that minor sexual offences were admitted to just as frequently by prisoners who had never been convicted of a sexual offence as by convicted rapists. We know that men with previous sexual convictions are more likely to get further sexual convictions, but there is a tendency to assume that undiscovered sexual offending has the same predictive power; this assumption must be based on the premise that conviction and punishment has no impact on any man in terms of his sexual habits or his motivation and capacity to refrain from further offending.

Emotive responses to biased assumptions can only increase the daunting task of assessing and managing the sexual offenders known within our system, and identifying those individuals who do indeed pose an enormous risk to children. The message that "there is no cure" is both disheartening and probably untrue: it would seem that—despite under-reporting—a number of convicted sex offenders do not sexually reoffend. If, therefore, some of them have abstained from acting out their impulses or desires, it raises the question why they are treated differently from any abstaining offender (or indeed client presenting with disturbed mental health symptoms) who inevitably carries with them a risk—under certain circumstances—of reverting to former behaviour.

Treatment Resources in Britain

There are innumerable community-based treatment programmes, mostly on a small scale, and managed by probation, sometimes in cooperation with forensic mental health services. The only residential service exclusively targeting sex offenders is run by the Faithful Foundation in southeast England, a charitable organisation which offers an intensive treatment programme to men funded mainly by social services and probation. Within the prison system, the Sex Offender Treatment Programme (SOTP) was launched in 1991, and aims to assess and treat all sex offenders (prepared to cooperate) serving a sentence of four or more years. Thornton and Hogue (1993) reported that by 1994, over 700 incarcerated sex offenders will have been treated on the SOTP, an enormous improvement on the previously patchy service available, although still falling far short of the 3283 male sex offenders within the prison system in 1992. More recent estimates from David Thornton (personal correspondence, 1998) indicate that approximately 1400 males are sentenced to at least two years imprisonment for a sexual offence each year, and it is expected that 600 sex offenders complete the SOTP each year, the vast majority of whom are child sexual abusers. Far fewer sex offenders are managed by the National Health Service: clearly severely mentally ill sex offenders can be sectioned under the Mental Health Act (1983) and potentially treated in medium and high security hospitals. However, the use of the category of Psychopathic Disorder in the Mental Health Act (1983) in relation to personality disordered offenders, is rather more controversial, and it is probably true to say that greater attention is paid these days to the treatability criteria, resulting in a more cautious approach to hospital transfer.

Nearly all the treatment approaches to the non-mentally ill sex offenders are currently based on a cognitive—behavioural model of psychological functioning, much of which is derived from American and Canadian practitioners. The only specialist centre for the provision of psychoanalytic psychotherapy to offenders is the Portman Clinic in northwest London. Whilst the probation service has been at the forefront of running treatment projects, Barker and Beech (1993) pointed out that of the 63 programmes run by 43 probation services, only 3 had been running for more than five years, and that there has been a dearth of evaluative work in the area. In southeast London over the past five years, the author has been part of a multi-agency project to provide a comprehensive assessment and treatment programme to perpetrators of child sexual abuse living (or returning) to the community: the Challenge Project has many features in common with the majority of treatment programmes in Britain, although senior management commitment from the various agencies involved has ensured that it could evolve without undue reliance on the enthusiasm of one or two committed practitioner/therapists. Unusually, the treatment programme has been carefully evaluated, including follow-up of both treated and untreated child sexual abusers, and this research is detailed in Chapter seven (Craissati & McClurg, 1996, 1997). As the Project is fairly representative of the work currently being pursued, it will be repeatedly referred to throughout the book.

The Aim of the Book

The aim of this book is to provide a practice-based model for informing the assessment, treatment and evaluation of perpetrators of child sexual abuse in the community. However it must be stated at the outset that no text can provide a substitute for training, supervision, experience,...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents Page
• Acknowledgements Page
• 1. Introduction
• 2. Theoretical principles
• 3. Assessment
• 4. Managing denial
• 5. Parameters of treatment
• 6. Treatment content
• 7. The evaluation of treatment programmes
• Appendix I. Summary of case studies
• Appendix II. Rating scales
• References
• Author index
• Subject index