Sibling Sexual Abuse Unique Issues Emerging Research

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Sibling Sexual Abuse Unique Issues Emerging
Research

• Ontario Network of Sexual Assault / Domestic
  Violence Treatment Centres
• March 25, 2009
• Toronto, ON
• Bente Skau, MSW, Ph.D.
• Heather Barbour, B.Sc., R.S.W.
• Nancy Falls, Ed.D.

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Presentation Outline

• Contextualizing sibling sexual abuse
• Why should we care?
• What are our values?
• Redefining success as it relates to reunification
• Research
• Examine the factors that enhance and detract from
  successful reunification
• Findings from ongoing research examining families
  where sibling sexual abuse has occurred
• Treatment
• Setting the stage decision points
• Highlight unique treatment issues

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• All that we
• dont
• Know About
• Sexual Behaviour Among
• Siblings

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Prevalence

• Finkelhor (1979) found that 15 of girls and 10
  of boys had sexual contact with a sibling
• Adler and Schutz, 1995 Smith and Israel, 1987
  Wiehe,1990 suggest that prevalence rates for
  sibling sexual abuse are greater than
  parent/child sexual abuse.

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Why we want to know

• Prevention!!!
• Helps to shape assessment
• Helps to shape treatment
• Helps to create good reunification plans

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Value of Sibling RelationshipsBased on the work
by Groza, Maschmeier, Jamison, Piccola,
2003Siblings and Out-of-Home Placement Best
Practices

• Most children grow up with siblings. The time
  they spend together in their early years is often
  greater than the time they spend with their
  parents. This relationship often lasts for a
  lifetime, longer than most marriages and
  parent-child relationships(Dunn, 1985).

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Sibling Sexual Abuse A Double Edged Sword

• In families where they have experienced
  multi-problems, sibling attachment is greater
  than the attachment shown by siblings who have
  not experienced such difficulties. (Lamb
  Sutton-Smith, 1982)
• In multi-problem families siblings learn to
  depend upon and cooperate with each other as a
  mechanism of coping. (Hochman,
  Feathers-Acuna, Huston, 1992)
• By the end of preschool years older children
  serve as subsidiary attachment figures for their
  younger siblings. (Stewart and Marvin,1984)
• Older siblings assist younger siblings in school
  transition by acting as a role model and by
  giving information about the experience.
  (Stewart and Marvin, 1984)
• Provides emotional support to adults in later
  life.
• (Cicirelli,1982 Hegar, 1988)
• (Groza, Maschmeier, Jamison, Piccola,
  2003)

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EARLY FRUSTRATIONS

• NO CLEAR ROAD MAP
• OPPOSING NEEDS OF VICTIM, OFFENDER AND FAMILY
• PROFFESIONALS NEED TO RECONCILE THEIR
  OPINIONS/FEELINGS ABOUT WORKING WITH VICTIMS AND
  OFFENDERS
• HIERARCHY WITHIN MULTIDISIPINARY TEAM
• GIVING VOICE TO THE OPPRESSED IS EASIER SAID THAN
  DONE

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BELIEFS

• REUNIFICATION IS A PROCESS
• VICTIM NEEDS DICTATE THE PROCESS
• ACCOUNTABILITY AND RESPONSIBILITY ARE NECESSARY
  TO MOVE BEYOND SAFETY
• ADULT VICTIMS HAVE INFORMED OUR THINKING
• RESOLUTION IS PART OF A REUNIFICATION PROCESS
• RESOLUTION IS THE PROCESS OF RESTORATION, MAKING
  AMENDS, MAKING PEACE
• FAMILY RELATIONSHIPS ARE CHANGED THROUGH A
  RESOLUTION PROCESS

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UNIQUE FEATURES OF SIBLING INCEST

• MAGNIFICATION OF SAFETY ISSUES
• CONFUSING RESPONSIBILITY
• HEIGHTENED BAD PARENT SYNDROME
• DIVIDED LOYALTIES
• COGNNITIVE DISTORTIONS,BELIEFS, ATTITUDES,AND
  COMMUNICATION PATTERNS THAT ARE SHARED AND
  ENDORSED IN THE FORM OF FAMILY MYTHOLOGY (SCHEMA)

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REUNIFICATION

• RELATIONAL REUNIFICATION
• A therapeutic reunification is completed - the
  siblings do not reside together but relational
  contact is maintained
• HABITATIONAL REUNIFICATION
• A therapeutic reunification is completed
  contact is a progressive process which result in
  the siblings living together
• STATIC REUNIFICATION
• A therapeutic reunification is completed - the
  siblings were not ever separated and the
  reunification work was completed in therapy while
  the siblings were residing in the same household
• NO THERAPEUTIC REUNIFICATION
• The treatment and reunification work was not
  completed in a therapeutic setting

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A 5-step family therapy protocol to treat sibling
on sibling sexual abuse. Hodges, C.E. (2002)

• Step One Report the abuse and separate the
  sibling victim and victimizer
• Step Two Complete evaluations of family members
• Step Three Begin family therapy
• Step Four Bring sibling victim (s) and sibling
  victimizer together in family work
• Step Five Family therapy termination

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Kaplan, Becker, Martinez (1990) Journal of
Family Violence, 5, 209-214 Mothers of adolescent
males who sexually abused a sibling (n
48) vs. Mothers of adolescent males who sexually
abused a nonfamilial person (n 82)
Sibling Nonsibling Sexual
abuse 34 14 Physical abuse 44 25 Prior
individual treatment 38 15 Denial of sons
offences 17 60
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OBrien, 1991 adolescents with sibling victims
(n 75) vs. adolescents
with extrafamilial victims (n 95)

• On average, adolescents with sibling victims
• Offended for longer time periods
• Were more likely to engage in sexual penetration
• Were more likely to have multiple victims
• Were more likely to experience physical abuse

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Worling, 1995 adolescent males who abused younger
siblings (n 32) vs. adolescent males who abused
younger extrafamilial children (n 28)

• Adolescents who abused siblings reported more
• marital discord
• parental rejection
• negative family atmosphere
• dissatisfaction with family relationships
• physical punishment
• childhood sexual abuse

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Determining Factors Related to (Un)Successful
Reunification

• Clinical experience
• Clinicians survey
• Develop Hypothesis of 12 critical factors
• We then examined factors and variables of over 60
  families
• Identified top 12 factors
• (6 Enhancers / 6 Detractors)
• Presenting early Findings data collection is
  ongoing

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Did the Siblings Reunify?
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Descriptors of Youth/Child who was Sexually
Harming a Sibling

• 88 Male
• 50 in Special Education
• 26 have intrafamilial and extrafamilial victims
• 24 victimized more than 1 sibling
• 30 used force or violence during the offense
• 10.1 years average age of 1st Incident

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SampleMothers

• 59 have a current mental health difficulty
• 68 victim of woman assault
• 78 victim of sexual abuse
• 79 victim of physical abuse
• 25 victim of sibling incest

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SampleFathers

• 25 have current mental health issue
• 60 perpetrator of woman assault
• 6 victim of sexual abuse
• 64 victim of physical abuse
• 0 victim of sibling incest

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Type of Offense Committed(the most intrusive
noted)
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Rate of Reunification for 56 Families
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Number of Sexual Offenses/Incidents
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Number of Sexual Offenses For Siblings Who
Reunified
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Duration of Sexual Offenses For Siblings Who
Reunified
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Factors that Enhance Reunification

• Hope/Belief that reunification is possible
• (significant at the .01 level)
• Treated within the same agency
• (significant at the .01 level)
• All family members supportive and involved
• (significant at the .01 level)
• Supervisory system and unified approach
• (significant at the .01 level)
• No significant relationship found
• Parental acknowledgement /hold the child/youth
  who has sexually harmed responsible
• Clinicians familiar with the unique issues

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Factors that Detract from Reunification

• No significant relationship found
• Blended families with divided loyalties
• Ongoing victim blaming by the parents
• Lack of support/cooperation by child protection
  services
• When the victims voice is not heard or does not
  direct the process
• The lack of separation of the victim and the
  child/youth who has sexually harmed
• Mental health issues in at least one parental
  figure

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Next Steps? Treatment
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Applying a Collaborative and Staged Approach to
work with Siblings and their Families

• Decision Points
• Placement
• Contact and Communication

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Decision Points
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Placement Decision-Makers
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Placement Options
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When to allow siblings to remain together

• Decided on a case by case basis
• Often seen in historical abuse
• Seen more in younger children
• Collaboratively decided
• Risk level
• Safety must be established
• Supervision
• Voice of the victim
• When the benefits outweigh the potential harm

• There is
• No
• Checklist!

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Contact and Communication Decisions

• Criteria for communication
• Criteria for contact
• Decisions

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Criteria for Communication between Siblings

• No communication during the assessment
• Extent and timing of communication is victim
  driven
• Communication is different than contact
• Start with parameters of communication
• The discussion of the sexual offending behaviour
  is a graduated process which begins with letter
  writing and works towards an apology session

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Early Questions

• From Victim to Offending Youth
• Are you angry I told?
• Do you want to see me or are you mad that I told?
  
• Do you want to see me again
• Are you working hard to get the sexual abuse out
  of the brother relationship with me because I
  miss all of the good parts of our relationship?
• Are you talking to your counsellor about the
  abuse?
• How are you doing?

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Questions for Offending Youths Counsellor

• Is my brother working hard in his counselling
  because he did not work hard at school. How do
  you know if he is listening to you?
• How is my sister doing - does she miss me?
• Does Tony talk about missing me?
• Do you know my brother Trevor?
• Are my parents getting treatment because they
  need to?

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Middle Treatment Related Questions

• If I said no or stop would you listen to me now?
• Do you know that bothering your older brother is
  regular and that doesnt cause sexual abuse?
  What do you think?
• Do you think of touching me if Im bothering you?
• Do you think my bothering you is a test?
• Could sexual abuse happen again?
• Do you have new safety rules?
• Is being mean now the same as a long time ago
  when he was mean and sucked penis.

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Questions for Parents

• What would help you trust me again?
• Will you ever stop being angry for what I did?
• Are we still a family?

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Future Focused Questions

• How are we going to talk about this in the
  future?
• Are you going to tell your wife/husband about
  what happened?
• What about being with my kids?

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Criteria for Contact

• No contact during the assessment
• The nature, extent, and timing of the contact is
  victim driven
• Parental supervision and support is considered
• Supervised externally structured social contact
  is different than therapeutic contact that is
  co-created by clients
• A graduated approach to contact is recommended
  (from supervised community visits to overnight
  home visits)
• Negotiating family events and holidays

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General issues to work through before first
Therapeutic Contact

• Safety
• Meeting Context
• Meeting Content
• Acknowledgement of abuse occurring
• A commitment that the abuse will stop
• Will of both siblings
• Competent supervisor
• Communication
• Home Environment

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Prior to 1st Contact

• Acknowledgement of abuse occurring
• A commitment that the abuse will stop
• Will of both siblings
• Competent supervisor

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The Apology Letter

• It is a process to write
• The apology letter is an offender treatment
  exercise that addresses
• Victim empathy
• Taking the perspective of the other
• Taking responsibility
• Summary of change and a narrative of their new
  identity
• Prevention plan
• Example

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First Draft

• Dear Joe
• Sorry about making you play with my penis. I will
  never do it again. I was stressed and thats why
  I did that. I have learned from my past and will
  never do it in the future. I learned that what I
  did was wrong and I am a new guy and I need more
  chances to prove it to you.

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Final Copy

• I am writing this letter to say I am sorry
  for what was done in the past and I hope you
  accept this letter of apology. I hope you choose
  to read this letter but it is your choice. I am
  glad that you told about the sexual abuse. I
  believe that it took a lot of courage to talk to
  the CAS about this and I am not angry with you at
  all for telling. You are not responsible for the
  abuse. I alone am responsible for what happened.
  Because you told I was able to get the help that
  I needed not to ever do that ever again.
• I am sorry I made you touch my penis. It
  was wrong and I am so sorry for the harm that it
  may have caused you. It was wrong to betray the
  trust you had in me as your older brother. I was
  very confused and stressed before because of all
  that was happening. I was being teased at school
  every day and I had no friends. Our parents
  divorce was very difficult and moms new
  boyfriend did not want me around. I took that
  stress out on you and that is not fare and I know
  that is no reason for what I have done and I have
  realized that now. I have learned from my past. I
  am trying hard to talk about my feelings and not
  get so stressed. I have completed the diversions
  program and am continuing my counseling. I have
  learned to control my anger and have been doing
  better in school and got a job. I am truly sorry
  about what I did and I know it caused you harm
  and mental trauma and it will never ever happen
  again. I follow my new rules and have five ways
  to deal with stress so that I would never commit
  another offense. My plan includes biking and
  swimming and walking the dog because that helps
  me stay calm. I talk to mom and dad now and I
  have some friends that also keep me busy. I no
  longer look at pornography and know sexual safety
  rules.
• If you want me to answer any questions
  that you have I can do that. I hope we can have a
  future together as brothers but I will understand
  if you do not want that. If you need help I will
  be here. I plan to do everything I can to
  maintain a non- offending future.

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Potential Reunification Outcomes
Static
Habitational
Relational
No Therapeutic Reunification
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Unique Treatment Issues

• Safety
• Sex and Sexuality
• Parenting

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Safety Hope

• Knowledge of ones safety allows for the
  possibility of hope.
• Sexual abuse is the loss of personal power. The
  creation of safety allows for the restoration of
  power.
• When you are empowered, then you are in a
  position to define your future.
• The recognition of the victims voice is the
  vehicle that allows for the redefinition/transform
  ation of the future.

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SAFETY PLANNING

• Creation of safety rules is victim driven
• All family members must agree to abide by the
  rules
• Safety planning is a process beginning with
  rigid, well defined rules and moving toward more
  flexible, co-created rules
• Rules need to encompass home, community, and
  extended family visits
• Rules need to describe supervision requirements,
  touch, privacy, access to sexual materials, and
  sexual conversations in the home

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SAFETY RULES ON HOME VISIT

• Example 1
• No violence
• Mom must be present to supervise always
• Supervision on computer always
• No alcohol
• No smoking in apartment while Im visiting
• Brothers friends cannot be at apartment during
  visit

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Safety Rules

• Example 2
• No talking about the abuse when Im at home
• Mom has to see us if we are in the same room
• No going upstairs together
• Have to ask for a hug
• No wrestling

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Special Issues in Treatment

• Sex
• and
• Sexuality

• Brought to the forefront in the family
• Must be addressed in family treatment

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Issues to Examine in Assessment

• History of sexual abuse in family
• History of sexual offending in family
• Pairing of sex and violence in family
• Sexual Environment in the home
• The family approach to sex education
• Sexually explicit material in the home

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The Language of Sex Identity and Sexuality

• The stigma attached to sex offender
• The meaning attached to sexual abuse victim
• What about sibling incest?

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It doesnt have to be black or white

• Sex in context is good
• Normal part of development for everyone!

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Working with families where sibling incest has
occurred - Final comments

• The work is complex requiring specialized
  clinical knowledge, skills, and experience
• Need to use a collaborative and staged approach
• View reunification differently
• Where there is hope, there are possibilities

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References for working with families where
sibling incest has occurred Alexander, P. C.,
Schaeffer, C. M. (1994). A typology of
incestuous families based on cluster analysis.
Journal of Family Psychology, 8,
458-470. Bischof, G. P., Stith, S. M. Whitney,
M. L. (1995). Family environments of adolescent
sex offenders and other juvenile delinquents.
Adolescence, 30, 157-170. Bass, Linda B., Taylor,
Brent, A., Knudson-Martin, Carmen, Huenergardt,
Douglas. (2006). Making sense of abuse Case
studies in sibling incest. Contemporary Family
Therapy, 28 (1), 87-109. Caffaro, John, V.,
Conn-Caffaro, Allison. (2005). Treating sibling
abuse families. Aggression and Violent Behavior,
10, 604-623. Canavan, Margaret, Meyer, Walter, J.
Higgs, Deborah, C. (1992). The female
experience of sibling incest. Journal of Marital
and Family Therapy, 18,(2), 129-142. Cyr,
Mireille, Wright, John, McDuff, Pierre, Perron,
Alain. (2002). Intrafamilial sexual abuse
brother-sister incest does not differ from
father-daughter and stepfather-step- daughter
incest. Child Abuse Neglect, 26, 957-973. De
Jong, Allan, R. (1989). Sexual interactions among
siblings and cousins Experimentation or
exploitation? Child Abuse Neglect, 13,
271-279 Groza, V., Machmeier, C., Jamison, C.,
Piccola, T. (2003). Siblings and out-of-home
placement. Families in Society The Journal of
Contemporary Human Services, 82 (4),
480-492. Haskins, C. (2003). Treating sibling
incest using a family systems approach. Journal
of Mental Health Counselling , 25 (4), 337-350.
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References for working with families where
sibling incest has occurred Falls, N.A. (2001).
An empirically derived typology of families of
adolescents who commit sexual offenses.
Unpublished doctoral dissertation, O.I.S.E. /
University of Toronto, Toronto. Hodges, C.E.
(2002). A 5-step family therapy protocol to treat
sibling on sibling sexual abuse. In M.C. Calder
(Ed.), Young people who sexually abuse Building
the evidence base for your practice (pp.
376-385). Lyme Regis, England Russell House
Publishing. O'Brien, M. J. (1991). Taking sibling
incest seriously. In Familiy Sexual Abuse
Frontline Research and Evaluation, Michael Quinn
ED. Sage Publications California. Phillips-Green,
Mary, J., (2002). Sibling Incest. The Family
Journal Counselling and Therapy for Couples and
Families, 10 (2), 195-202. Rayment-McHugh, Sue,
Nisbet, Ian. (2003). Sibling incest offenders as
a subset of adolescent sexual offenders. Paper
presented at the Child Sexual Abuse Justice
Response or Alternative Resolution Conference,
Adelaide, Australia, May 1-2. Rayment, Susan,
Owen, Nicole. (1999). Working with Individuals
and families where sibling incest has occurred
The dynamics, dilemmas and practice implications.
Paper presented at the Children and Crime
Victims and Offenders Conference, Brisbane,
Australia, June 17-18. Rudd, Jane, M.,
Herzberger, Sharon, D. (1999). Brother-sister
incest father-daughter incest A comparison of
characteristics and consequences. Child Abuse
Neglect, 23 (9), 915-928. Smith, H., Israel, E.
(1987). Sibling incest A study of the dynamics
of 25 cases. Child Abuse Neglect, 11,
101-108. Wiehe, Vernon, R. (1997). Sibling abuse
Hidden physical, emotional, and sexual trauma
(second edition). Sage Pulications California.
Worling, J. R. (1995a). Adolescent
sibling-incest offenders Differences in family
and individual functioning when compared to
adolescent non-sibling sex offenders. Child Abuse
Neglect, 19, 633-613.