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Comparison of Cognitive Behavioral Therapy and Solution Focused Therapy for Families of Juvenile Offenders
This paper will explore families with an adolescent identified as a juvenile sexual offender. It will examine therapeutic concerns common to families in this stage of the life cycle for adolescents and those teenagers classified as juvenile sexual offenders. It will review how these concerns are connected with developmental issues and how I would approach a family struggling with the realization that one of the adolescent members is a sexual offender using Cognitive-Behavioral therapy and Solution Focused therapy approaches.
Therapeutic Concerns and Developmental Issues
Developmentally, adolescents undergo several changes. Teenagers grow at a remarkable rate biologically, the fastest since infancy. Adolescents begin to utilize abstract thinking and they become extremely egocentric, believing that everyone is watching them and no one has ever experienced what they are experiencing. These beliefs are commonly called “imaginary audience” and “personal fables” respectively. Socially, teenagers start moving toward their friends and away from their families. Sexual activity is possible and desirable. Sexuality and relationships are explored. Overall, for many teens, adolescence can be a painful time. Common problems generally seen as belonging to adolescents include: running away, truancy and school problems, suicidal threats or behaviors, threats or acts of violence, and disrespect. The majority of adolescents experiment with alcohol sometime before high school graduation, and the majority will have been drunk at least once; but relatively few teenagers will develop drinking problems or will permit alcohol to adversely affect their school or personal relationships (Hughs et al 1992, Johnston et al 1997). Similarly, although the vast majority of teenagers do something during adolescence that is against the law, very few young people develop criminal careers (Farrington 1995).
Some teenagers fall into patterns of criminal or delinquent behavior during adolescence, and for this reason we tend to associate delinquency with the adolescent years. However, most teenagers who have recurrent problems with the law had problems at home and at school from an early age; in some samples of delinquents, the problems were evident as early as preschool (Moffitt 1993). Rates of drug and alcohol use, unemployment, and delinquency are all higher within the adolescent and youth population than among adults, but most individuals who have abused drugs and alcohol, been unemployed, or committed delinquent acts as teenagers grow up to be sober, employed, law-abiding adults (Steinberg 1999).
There is a genuine increase in bickering and squabbling between parents and teenagers during the early adolescent years, although there is no clear consensus as to why this occurs when it does; psychoanalytic (Holmbeck 1996), cognitive (Smetana et al 1991), social-psychological (Laursen 1995), and evolutionary (Steinberg 1988) explanations all have been offered. Second, this increase in mild conflict is accompanied by a decline in reported closeness, and especially, in the amount of time adolescents and parents spend together (Larson & Richards 1991). Third, the transformations that take place in parent-adolescent relationships have implications for the mental health of parents as well as for the psychological development of teenagers, with a substantial number of parents reporting difficulties adjusting to the adolescent's individuation and autonomy-striving (Silverberg & Steinberg 1990). Finally, the process of disequilibration in early adolescence is typically followed by the establishment of a parent-adolescent relationship that is less contentious, more egalitarian, and less volatile (Steinberg 1990).
The common problems many adolescents deal with seem to be magnified for juvenile sexual offenders. Typically, these teenagers choose sexual acting out as a coping strategy for the difficulties in their lives. They will sexually offend in order to regulate their emotions. This over-compensation is maladaptive. Most juvenile sexual offenders lack empathy for their victims, view their offenses as justified and have extreme difficulty visualizing inappropriate patterns in their behaviors. Safety and supervision are the two critical focus areas for offenders. Protection for the victim(s), community and family are of paramount concern and interventions must be explored thoroughly so specific measures can be set in place to eliminate the risks for re-offenses.
Cognitive Behavioral Therapy
In some cases, the problem of sexually acting out is a product of operant conditioning. The messages and responses children received from others (i.e. parents, other influential adults or older children, etc.) about boundaries and acceptable actions reinforced and shaped their behaviors. In other cases, children may have had maladaptive coping responses to emotional distress and chose to act out in a way that felt pleasurable. They may have been motivated to sexually offend for a variety of reasons including, the perceived need to obtain power and control, to escape the problems of their lives, as a way to get a “high” (an intoxicating feeling one may receive while planning and getting away with a sexual offense) or for sexual gratification.
In assessing this problem, I would need to examine the ranges of sexualized behaviors the adolescent engages in. These behaviors may include sexualized talk, viewing of sexual materials (pornographic magazines, videos, etc.), voyeuristic activities, exhibitionist tendencies, fetishes, bestiality, frottage (purposely brushing up against someone for sexual pleasure, but making it appear accidental), fondling, and oral, anal, and vaginal intercourse. It would be imperative to pinpoint the specific motivations for each of the sexual behaviors the child used to offend. I would work with the family to identify all triggers for all ranges of offending behaviors and use event recording to count specific instances in which the pinpointed behavior occurs. The antecedent to the problematic behavior must be determined in order to employ effective relapse prevention and intervention strategies for both the child and the family. This will enable the entire family to be proactive in identifying high risk factors for the child and work to reduce or eliminate those factors. For example, if the adolescent feels out of control or powerless during frustrating situations and it has been determined that during these times, he copes by sexually gratifying himself with small children in order to regain some semblance of power and control over his life, then it would behoove the family to closely supervise juvenile offender around small children or attempt to eliminate the offender’s ability to come into contact with small children.
Families must learn that it is difficult to ascertain the emotional distress a person is under unless that person verbalizes his critical emotional level or the family has mastered the skill of identifying non-verbal cues that indicate risk for sexually acting out from the offender. Therefore, one critical intervention is to control the level of freedom and individuality an offender has with the identified population that poses a risk for him to relapse.
The consequence for the targeted behavior is the willingness of the family to allow fearless communication from each other so that the thoughts and feelings from the offender are encouraged to be openly discussed. The plan developed involves shaping the adolescent’s behavior. Since this may be an unfamiliar situation to place the family in, it is important to begin with “baby steps” in order to increase the comfort level when verbalizing vulnerable feelings and discuss sexual thoughts and fantasies. The family will likely need much support from the therapist during the initial phase of this process. Specifically, it would be important to have the juvenile offender practice disclosing his thoughts and feelings and the family listening to and accepting him without judgment or criticism so they may work together to formulate a safe haven in which he has the ability to share openly and they can validate his feelings. Validating feelings are vital as this may be the first interruption of the offender’s sexual assault cycle. If he can increase his tolerance for stressors, he may be able to learn more adaptive coping mechanism.
The family should implement reinforcements and response cost for the adolescent related to his success in labeling and disclosing his feelings as well as his ability to identify high risk factors or seemingly unimportant decisions he makes related to increasing or decreasing his risk for sexually offending. Both the reinforcements and response cost need to be specific to that teenager and must be developed with him and approved by the family. The family and the individual adolescent should work on systematic desensitization. The entire family will work on desensitizing themselves with regard to anxiety surrounding the inevitable discussion of deviant thoughts and behaviors, particularly deviant thoughts and behaviors that may mortify them. This learned skill is necessary in order to encourage and maintain open lines of communication so parents can help their sons interrupt their sexual assault cycle.
In order for families to be more forthcoming and solution focused when a problem occurs for the juvenile sexual offender requires the offender to think about honestly disclosing what he thinks and feels. A therapeutic assignment may be the use of an Automatic Thought Record to track his thoughts. In the therapy session, patterns of thoughts, feelings and the intensity of each will be explored. Therapy will focus on more rational responses for thoughts, putting things into perspective, regulating emotions and working on changing beliefs systems may occur. Acknowledging and reviewing cognitive distortions of the individual adolescent and the collective family will likely become a focal point in working to achieve therapeutic goals. Becoming aware of these distortions may allow the teenager or family to identify rational conclusions more quickly.
Solution Focused Therapy
Solution Focused Therapy believes that clients have the resources and strengths to resolve complaints and that change is constant. For a family with a member identified as a juvenile sexual offender, resources and strengths must be identified as they relate to working toward attaining the goals of safety, relapse prevention and fearless communication. It is the therapist’s job to identify and amplify change. It is not necessary to know a great deal about the complaint or the cause or function of the complaint in order to resolve it. Solution Focused therapy assumes that change in one part of the system can effect change in another part of the system, therefore, only a small change is necessary. It is important to focus on what is possible and changeable, from a present tense perspective, rather than what is impossible and unchangeable. Rapid resolution of problems is possible.
Channeling is a vital approach for Solution Focused therapy. The therapist would put problems in a past tense and describe them as a transition. Problems will be reflected as a thought. For example, when talking about an issue with the family the therapist may say, “sometimes it seems…” The therapist would comment on “old you” and “new you” when discussing the issues that brought the clients into therapy and what they would like to achieve related to their goals. Solution Focused therapists would “normalize” experiences for the family and focus on depathologizing the language used by the family. For example, using moody or discouraged, rather than depressed. This would be particularly important for families with adolescents because typically many families have similar experiences with adolescent behaviors and it can be very easy for people to pathologize common feelings and behaviors.
The use of presuppostional questioning is a key area of Solution Focused therapy. Typically, the therapist would ask questions that presuppose exceptions to the problems the family identifies for therapy. For example, the therapist may ask the family what is different about times when (the exception happens)? How do you get that to happen? Have you ever had this difficulty in the past? (If yes) How did you resolve it then? What would you need to do to get that to happen again? The therapist would work with the family to find the “clues” that the exception reveals about the solution to the problem. For example, the therapist would ask questions such as “what does it teach you?” or “what skills, strengths, and resources does it reveal about you?”
Scaling questions may also be used to assist the family. During each session with the family, the therapist should have the family rate how successful they are doing at achieving each of their goals on a Likert scale of 1 -10, with 1 signifying being unsuccessful and 10 as successful. The therapist would focus on all measures of success identified by the family members. When families were seemingly “stuck” the therapist should ask about exceptions to the problems they describe and help orient the family to putting time and energy into moments like those.
As the family demonstrates investment into Solution Focused Therapy approach, the therapist should work with them to a future oriented focus, constantly asking what will be different when the goals are met. Helping them create a picture in their heads about the changes they want in their lives is an important piece of therapy. It maintains focus and fosters hope.
As each type of therapy being used is applied to the goals worked on in therapy, it is clear that both approaches, Cognitive Behavioral Therapy and Solution Focused Therapy may work well in helping to achieve the goals.
As I dissected each therapy and used the techniques and interventions in working on my goal I came to the conclusion that overall Cognitive Therapy seemed to be the most suitable therapy for a family dealing with juvenile sexual offender issues. It may be valuable for the family, including the offender to examine their automatic thoughts, underlying assumptions and beliefs, and emotions as they relate to family behavioral patterns. As the family continues to probe each piece of the puzzle to their therapeutic issues, hopefully it becomes clear that they need to become active in resolving their issues. Ideally, once they choose to engage in the process, they may find that their goals are measurable, attainable, and easily met. The bottom line is that they need to understand and interrupt their cycle of behaviors, get down to business and become active in communicating with one another. On a side note, in my work at a residential treatment center for adolescent male sexual offenders, I use both Cognitive Behavioral therapy and Solution Focused therapy and find the boys respond most readily to the Cognitive Behavioral therapy approach on a daily basis, with an emphasis on Solution Focused therapy during crisis situations. Overall, these therapeutic models worked well for me personally and professionally, are a critical part of treatment for the youth at my facility.
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