Sibling Sexual Abuse Unique Issues Emerging Research

1. 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.

2. 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

3. All that we don’t Know About Sexual Behaviour Among Siblings

4. 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.

5. Why we want to know… • Prevention!!! • Helps to shape assessment • Helps to shape treatment • Helps to create good reunification plans

6. 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).

7. Sibling Sexual Abuse A Double Edged Sword • In families where they have experienced multi-problems, sibling attachment is greater than theattachment 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)

8. 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

9. 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

10. 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)

11. 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

12. 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

13. 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 son’s offences 17% 60%

14. O’Brien, 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

15. 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

16. 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

17. Did the Siblings Reunify?

18. 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

19. 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

20. 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

21. Type of Offense Committed(the most intrusive noted)

22. Rate of Reunification for 56 Families

23. Number of Sexual Offenses/Incidents

24. Number of Sexual Offenses For Siblings Who Reunified

25. Duration of Sexual Offenses For Siblings Who Reunified

26. 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

27. 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 victim’s 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

28. Next Steps? Treatment

29. Applying a Collaborative and Staged Approach to work with Siblings and their Families • Decision Points • Placement • Contact and Communication

30. Decision Points

31. Placement Decision-Makers

32. Placement Options

33. There is No Checklist! 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 When to allow siblings to remain together…

34. Contact and Communication Decisions • Criteria for communication • Criteria for contact • Decisions

35. 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

36. 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?

37. 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?

38. 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 doesn’t cause sexual abuse? What do you think? • Do you think of touching me if I’m 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.

39. 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?

40. 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?

41. 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

42. 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

43. Prior to 1st Contact • Acknowledgement of abuse occurring • A commitment that the abuse will stop • Will of both siblings • Competent supervisor

44. 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

45. First Draft Dear Joe Sorry about making you play with my penis. I will never do it again. I was stressed and that’s 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.

46. 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 mom’s 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.

47. Potential Reunification Outcomes Habitational Static Relational No Therapeutic Reunification

48. Unique Treatment Issues • Safety • Sex and Sexuality • Parenting

49. Safety = Hope • Knowledge of one’s 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/transformation of the future.

50. 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