A Treatment Manual for Adolescents Displaying Harmful Sexual Behaviour: Change for Good.
A TREATMENT MANUAL FOR ADOLESCENTS
DISPLAYING HARMFUL SEXUAL BEHAVIOUR: CHANGE
McCrory, E. (2011). London: Jessica Kingsley. pp. 160 + CD Rom (pbk)
49.99[pounds sterling] ISBN 978 1 84905 146 0
This Treatment Manual, commissioned by the NSPCC, sets out to provide an intervention programme for male adolescents, who are exhibiting harmful sexual behaviour. The programme is designed to be delivered to an individual young person rather than with a group of young people. The actual programme session plans, and worksheets for client use are contained on the accompanying CD-ROM which allows for easy duplication and use. In addition, the CD-ROM contains a 'Character Library' of fictionalised characters ranging from toddler to adult with a range of facial expressions. These characters are designed for use in a variety of ways but, principally, to explore thoughts and feelings of the characters within real or fictionalised vignettes. The Library also contains drawings of ten 'background scenes' such as a living room, bedroom, bathroom, park and playground described as 'common settings for normative adolescent behaviours and they have also been chosen as the most frequent places where adolescents displaying HSB target their victim' (p. 20). The author states that the use of these materials offers an opportunity to improve engagement with the young person who is participating in treatment.
The treatment programme comprises 30 one-hour sessions divided into four modules, namely, Engagement (4 sessions); Relationships (9 sessions); Self-Regulation (8 sessions) and Road Map for the Future (5 sessions). The author has allowed 4 additional sessions to provide time for work not completed in the 26 formalised sessions and to provide scope for addressing individual issues brought by the young person in treatment. This provides some flexibility for therapists in seeking to tailor the programme to the needs of the individual rather than a 'one size fits all' approach. It also addresses what seems a highly probable outcome--that the material to be covered in the sessions is too great for the time allotted. However, many therapists would rather be faced with the problem of having a choice of material to use rather than being directed to cover every exercise whether relevant or not.
The theoretical models which have informed the treatment approach of the programme include cognitive-behavioural therapy, attachment theory, psychodynamic psychotherapy, mentalisation and systems theory. This sounds like a crowded agenda however the predominant model is CBT, delivered on a collaborative basis with much encouragement to identifying and building on strengths which can be used to achieve goals within a pro-social framework. The aims of the treatment intervention are broad and, perhaps, over-elaborate. They are cited as:
the treatment should aim to increase the likelihood that a young person will show sexual and non-sexual behaviours that are socially acceptable and refrain from harmful sexual behaviour; and secondly the treatment should aim to enhance psycho-social functioning, increasing the young person's sense of optimism about the future and their current sense of well-being. (p.47).
Not surprisingly the author suggests these aims can be reframed in language more accessible to the young person as 'to not sexually harm others and to have healthy sexual relationships as an adult; and secondly to handle problems well and feel good about myself'.
To reflect the breadth of these aims the programme is attempting to offer an intervention which 'places greater emphasis on treating underlying causes rather than simply the undesired (sexually abusive) behaviours (p. 24). The sub-title of the Manual is 'Change for Good' and the author describes the 'Change for Good' approach as one which 'aims to develop both the adolescent's positive goals for the future by enhancing their interpersonal relationship skills alongside their ability to regulate and understand their emotional experience' (p. 24). This approach reflects current good practice by seeking to replace avoidant goals by more sustainable approach goals. As a result, the programme sessions address many areas of possible difficulty for young people, whether they display harmful sexual behaviour or not. Sessions, for example, on managing conflict in relationships, developing perspective taking skills, anger management and recognising how harmful emotional states can affect decision-making are excellently designed and it is easy to imagine that they could be adapted to begin addressing these issues with a number of young people on the Youth Worker's or Therapist's casebook.
In fact, it is when viewing the session plans on the CD-ROM that the therapist will be delighted at the clarity of the format. The session plans contain the structure and aims of each session, guidance notes for the therapist, suggested areas to explore and the style in which this should be done. The worksheets provide realistic scenarios with which to engage the young person together with well-presented 'Home Project' sheets to enable the young person the opportunity to apply new learning to their own experience and situation in between formal sessions.
Unfortunately, there is no evaluation of effectiveness for this particular programme. Given the flexibility of design, and suggested implementation, such an evaluation could be difficult to structure. The Manual references some encouraging studies with positive outcomes for programmes having similar components to 'Change for Good' which gives some cause for hope. In summary, this is an excellent package. Well-informed, well-structured and designed. It provides therapists with a toolkit to address difficult and challenging behaviour and is a valuable addition to the field.
David Middleton, Visiting Professor in Community & Criminal Justice, De Montfort University