The Management of Sexuality in Residential Treatment

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2 The Management of Sexuality in Residential Treatment

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4 The Management of Sexuality in Residential Treatment Gordon Northrup, MD Editor Routledge Taylor & Francis Group New York London Routledge is an imprint of the Taylor & Francis Group, an informa business

5 The Management of Sexuality in Residential Treatment has also been published as Residential Treatment for Children <&Youth, Volume 11, Number by The Haworth Press, Inc. All rights reserved. No part of this work may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, microfilm and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Printed in the United States of America. Reprint The development, preparation, and publication of this work has been undertaken with great care. However, the publisher, employees, editors, and agents of The Haworth Press and all imprints of The Haworth Press, Inc., including The Haworth Medical Press and Pharmaceutical Products Press, are not responsible for any errors contained herein or for consequences that may ensue from use of materials or information contained in this work. Opinions expressed by the authors) are not necessarily those of The Haworth Press, Inc. Reprinted 2009 by Routledge Library of Congress Cataloging-in-Publication Data The Management of sexuality in residential treatment / Gordon Northrop, editor, p. cm. Includes bibliographical references and index. ISBN (acid-free-paper) 1. Child psychotherapy-residential treatment. 2. Adolescent psychotherapy-residential treatment 3. Sexually abused children-rehabilitation. 4. Sexually abused teenagers-rehabilitation. 5. Teenage sex offenders-rehabilitation. 6. Children-Sexual behavior. 7. Teenagers-Sexual behavior. I. Noithnip, Gordon. RJ504.5.M ' 8914-dc

6 The Management of Sexuality in Residential TVeatment CONTENTS About the Contributors xiii Foreword Gordon Northrup, MD xvii Children and Love 1 Alan Keith-Lucas, PhD Staff Reactions to Young People Who Have Been Sexually Abused Grant Charles, MSW Heather Coleman, MSW Jane Matheson, MSW 9 Some Medical Implications of Sexuality in Residential Centers 23 Douglas Powers, MD The Impact of Sexually-Stimulating Materials and Group Care Residents: A Question of Harm 37 Raymond Schimmer, MA Discovery and Treatment of Adolescent Sexual Offenders in a Residential Treatment Center 57 Richard Burnett, MSSW, ACSW Cheryl Rathbun, MSW The Survivors Project: A Multimodal Therapy Program for Adolescents in Residential Treatment Who Have Survived Child Sexual Abuse 65 Bruce S. Zahn, MA Seran E. Schug, MCAT, ADTR

7 When Staff Members Sexually Abuse Children in Residential Care 89 Robert B. Bloom, PhD Erotic Countertransference Issues in a Residential Treatment Center 107 Danilo E. Ponce, MD Index 125

8 ABOUT THE EDITOR Gordon Northrup, MD, is a child psychiatrist in the private practice of consultation to residential treatment schools for emotionally disturbed children and youth. A Clinical Associate at the Austin Riggs Center, he is also on the staff of the Berkshire Mental Health Center and was for many years Director of a former AAPSC child guidance clinic. Dr. Noithrup has published a variety of professional papers and was Editor of Milieu Therapy for several years. Currently, he is Editor of the journal Residential Treatment for Children & Youth.

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10 ABOUT THE CONTRIBUTORS Robert B. Bloom, PhD, is Executive Director of the Jewish Children s Bureau in Chicago. Richard Burnett, MSSW, ACSW, LSCSW, is Vice President for Clinical Service at The Saint Francis Academy, Incorporated, Post Office Box 1340, Salina, KS 67402, a system of nonprofit psychiatric treatment programs in Kansas, New York, and Mississippi serving youth ages ten to eighteen. Grant Charles, MSW, RSW, is an instnictor in the Child and Youth Care Programme at Lethbridge College in Lethbridge, Alberta, Canada. Heather Coleman, MSW, is Assistant Professor in the Faculty of Social Work at the University of Calgary (Lethbridge Division) in Lethbridge, Alberta, Canada. Alan Keith-Lucas, PhD, first received an MA in English at Cambridge, and then went on to receive an MS in Social Administration at Western Reserve and a PhD in Political Science from Duke. He is the author of 16 books, among them Giving and Taking Help and Group Child Care as a Family Service, 150 articles, chapters, and the like. He is now Alumni Distinguished Professor Emeritus at the University of North Carolina and is the Book Department Editor fox Residential Treatment for Children & Youth. Jane Matheson, MSW, RSW, is Director of Residential Treatment at Woods Homes in Calgary, Alberta, Canada. Danilo E. Ponce, MD, is Professor of Child and Adolescent Psychiatry in the Department of Psychiatry at the University of Hawaii, xiii

11 xiv John A. Bums School of Medicine. He is particularly interested in the clinical applications of developmental theory; Eastern wisdom traditions (e.g., Buddhism, Taoism, Sufism, and Vedanta), and western psychotherapy; and counter-transference issues in the youth services field. Douglas Powers, MD, is Child-Adolescent Psychiatrist and Distinguished Professor in the College of Education and Allied Professions, The University of North Carolina at Charlotte. He was formerly the Book Review Editor of Residential Treatment for Children & Youth. Cheryl Rathbun, MSW, LSCSW, is Social Work Supervisor at Saint Francis at Ellsworth, Post Office Box 127, Ellsworth KS 67439, one of Saint Francis Academy s related corporations. Raymond Schimmer, MA, is currently Assistant Executive Director for Residence and Education at the Parsons Child and Family Center in Albany, NY. He worked previously at the Tufts-New England Medical Center s psychiatric day hospital for children in Boston, MA, and at the Walker School, in Needham, MA. Mr. Schimmer received a BA from Hunter College, and an MAT from the Harvard Graduate School of Education. Seran E. Schug, MC AT, is a Movement Psychotherapist at Mathom House in Bucks County, PA, a residential treatment facility for adolescent sex offenders, where she provides individual and group therapy to residents utilizing and integrating psychodynamic, cognitive-behavioral, and creative arts approaches to treatment. Prior to this appointment, Ms. Schug was Movement Therapist at The Devereux Foundation, Devon, PA. She has presented her work at national conferences and currently serves as adjunct faculty member in the Creative Arts in Therapy Department of Hahneman University. Seran also works as a consultant to organizations interested in the psychotherapeutic use of the arts and is currently engaged in a project at the Doylestown Center for Psychological Services.

12 Bruce S. Zahn, MA, is Director of Psychological Services and Cognitive Therapy Programs at Presbyterian Medical Center of Philadelphia, PA. Mr. Zahn has extensive experience in residential treatment and has recently collaborated with David D. Bums, MD, author of The Feeling Good Handbook, to adapt cognitive therapy to inpatient and residential psychiatric programs. Prior to his appointment at Presbyterian, Mr. Zahn was Senior Psychologist at The Devereux Foundation in Devon, PA. Mr. Zahn is a doctoral candidate in psychology at Temple University, and maintains an active private practice in clinical psychology. X V

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14 Foreword The word love is discordant, even shocking, when coupled with articles on the practical management of sexuality. Nevertheless, I have placed Children and Love first because the personal relationship between staff and the youngster being treated is where the trouble-and the good-starts. The residential treatment of youngsters includes socialization and parenting as well as psychotherapy; it therefore must include elements of loving, and especially for a direct care worker, direct body contact, as well as candid appreciation of the youngster s gender social role (masculinity and femininity). Responding to these needs does not include physical sexuality, of course, but carries a grave risk of being misunderstood as that by other staff, parents, and program inspectors. The risk extends to other children viewing the interaction and even to the child concerned, especially if he or she has been sexually abused. Staff Reactions to Young People Who Have Been Sexually Abused carries on this theme: it is a careful survey of personal relationship problems of direct care staff with these youngsters, such as attack, avoidance, arousal, rescue efforts, and the like. Though the emphasis is on direct care staff, no staff is exempt, and even the whole residential treatment center may at times replicate the dynamics of isolation and strong adherence to authority that exist in abusive homes... Children in residential programs may be especially vulnerable to abuse from staff due to a combination of learned victim behavior, intense attachment needs and increased reliance and dependency on adults. The authors emphasize the staff s need for support and training in dealing with their reactions, and remedial administrative measures are presented. [Haworth co> indexing entry note]: Foreword. Northrop, Gordon. Co-published simultaneously in Residential JYeatmentfor Children <ft Youth (The Haworth Press, Inc.) Vol. 11, No. 2,1993, pp.xxi-xxiii; and: The Management of Sexuality in Residential Treatment (ed: Gordon Northrup) The Haworth Press, Inc., 1993, pp. xvii-xix. Multiple copies of this article/chapter may be purchased from The Haworth Document Delivery Center (1-80G-3-HAWORTH; 9:00 ajn. - 5:00 p.m. <EST)J by The Haworth Press, Inc. All rights reserved. xvii

15 xviii The Management of Sexuality in Residential Treatment After this general survey, two articles offer practical advice on managing everyday sexuality. Some Medical Implications of Sexuality... is not about physiology, but is in fact a humane survey of minor sex problems in the milieu: masturbation, sex play, sex talk, and the like, and how to respond to them, all introduced by a gently humorous poem in blank verse. A single such problem, The Impact of Sexually-Stimulating Materials... (such as Playboy magazine) is considered thoroughly in the following article. It includes a review of the pertinent studies, a characteristic summary being that simple exposure to non-violent, non-degrading sexual depictions, irrespective of their explicitness, does not appear to cause increased viewer aggression or attitudinal changes in laboratory situations. Thus, the studies suggest that violence and coercion, not sexuality, are the problems; that viewing violent or degrading sexual material offers a potential for harm. This article presents notes on policy development that are developed fully in the author s article... The Governance of Sexual Behavior... in Volume 11, Number 1 of Residential Treatment for Children & Youth. The first of two treatment programs is... Treatment of Adolescent Sexual Offenders.... The staff of an open center for 28 conduct-disordered boys aged 12 to 17 found that 10 of them had committed sexual offenses. The article discusses the development and course of a program including group therapy, individual counselling, sex education, journal writing, and family therapy. It documents some indications of modestly successful outcomes. Many practical points are made, for example, teaching the offender how to discuss the offense with the victim, and in family counselling the patient should not be present with the victim until he owns the sexual offense. The Survivors Project... describes an eight week program for five adolescent girls in an open residential setting, including structured process, stress skills training, and movement therapy groups, in addition to the customary psychotherapy. Treatment centers considering such a program will welcome the ample details, such as the note about the therapist s liability to strong countertransference feelings of anger, disregard, and hurt. As co-therapists, we found it beneficial to work through these feelings outside the group sessions, because they could then more easily accept the members