by Eileen Finnegan
Many times I have considered writing an article for the Inside Out Journal on some aspect of my therapeutic journey and trusted that when the time was right the topic I would write about would become evident to me. When I was asked to write an article, I never imagined I would be writing about my work with perpetrators of sexual violence and the impact of this work on me from both a positive and negative aspect. It has been such a challenging journey for me to have reached a stage where I am working with a group of individuals I had thought I would never work with. There were many reasons I had for not wanting to work with perpetrators and one of the reasons that surprised me was how my peers, family and friends would view me. I felt my peers may not have wanted me to work with this group of individuals, and frankly I did not want to be on the outside of my peers. Yet I soon realised that being outside the group was often familiar for me and I imagine is also a familiar space for perpetrators.
I have decided to write a series of three articles, this being the first, which will look at the psychological impact on therapists working with perpetrators both from some of the current research and from my own personal experience of the work. I have tried to be as honest as I can about the impact as this is what has supported me in the work. I am grateful to my peers who have been working with perpetrators for sharing their experience of the impact of the work on them in an honest and transparent way as it has been a huge support for me. The second piece I will write about is some of the models used in the specific work with perpetrators, and finally a concluding piece about the efficacy of treatment based on my current working experience and the research carried out on the efficacy of treatment. To begin this piece I will first look at what some of the research informs us of the impact on therapists and then will give my own personal experience.
While there were large amounts of literature available that explored the impact on therapists working with the victims of sexual violence researchers such as Ennis and Horne (2003) found that fewer studies had been carried out on the impact of the therapist’s psychological distress while working with sex offenders. The studies that were carried out had noted some significant impact. Ellerby (1998) suggests burnout and compassion fatigue as possible factors. Farrenkopf (1992) suggests sympatology and burnout as factors that could impact on the well-being of therapists working with sex offenders.
Ennis and Horne (2003) carried out their own research by postal survey, which was named ‘Predicting Psychological Distress in Sex Offender Therapists’. The questions they asked were:
1) Do self-reported symptoms of post-traumatic stress increase with the amount of time clinicians devote to practice with sex offenders?
2) Does perceived support from family and peers, and participation in professional supervision diminish the risk of psychological distress?
The findings of the survey did not fit the initial hypothesis of the researchers. The results of the survey did not find any positive relationship between the hours that therapists worked with sex offenders and therapist distress. However, there was evidence of some therapists experiencing some post-traumatic symptoms ranging from moderate to extreme. The support of one’s professional peers may provide a form of coping that increases the therapist’s resilience to the risk of psychological distress. Kearns (1995) suggests that lack of support from colleagues could act as a discouragement to seeking support. Another finding was that there was no difference between the level of impact on male and female participants and that the majority of the participants seemed to be coping well. Where there was peer support there was less risk of psychological distress. According to Ellerby (1998), ‘collegial support is the single most important predictor of personal accomplishment’. Abel (1983) states that the future of effective sex offender treatment is contingent on the psychological well-being of the treatment providers.
Another really useful finding is that the significance of validation and reinforcement by peers can contribute to effective self care (Ennis & Horne 2003). The research paper also recognised the limited support structures that may be in place for those therapists working in private practice and the importance of them finding support from peers who are interested in, and familiar with their work. Ellerby (1993) also noted the lack of supervision for mental health workers, who being poorly prepared to work with sex offenders either individually or in organisations can be a factor that impacts on the psychological well being of the therapist.
‘Hate the sin and love the sinner’ (Mohandes karamchard Ghandi 1869-1948)
I began my own personal journey in therapy over twenty years ago and I can still remember the feeling of another individual being prepared to accompany me as I journeyed deep inside myself. There were many times I ran away yet always came back until I eventually realised I had arrived back home and no longer wanted to run away.
I began to internalise what I had learned through my own journey of therapy; unconditional positive regard, non-judgements, congruence, empathy and the world was not such a difficult space to be in. Yet there were and still are many times on this journey that are very challenging for me, and beginning to work with perpetrators has certainly been one of those challenging experiences. I have always encouraged others to take the courageous steps they need to embark on their own journey. I have always felt like an invited guest in some one else’s world and feel privileged to be part of their therapeutic journey. Yet did I feel the same as I worked with perpetrators?
I began my own professional training in 1997. I remember one of the lecturers asking the question, ‘do you have any prejudices against any individuals you would be asked to work with?’ Having thought for all of two seconds I replied ‘Well, perpetrators are a definite no, but I need a lot longer to see if any other prejudices come to mind.’I was glad I had said no to working with perpetrators because so did most of my fellow students so I felt part of the group and I wanted to be part of the group.
Many years have past and thankfully so have some but not all of my prejudices. In 2004 I joined an organisation which was originally set up to work with individuals who had experienced sexual violence. Peers, colleagues and family members supported me in this work. I am not sure where that landed with me but it felt good inside. When I began working for the organisation it was just before the launch of their annual report and we were asked to do some proof reading of this. I took on board all of the stories and information but nothing was to impact on me like the story written by one of the clients, who had been attending the organisation to seek support for the sexual violence perpetrated by her father. She had sought further support from the organisation in meeting with her father to facilitate a space to ask some questions she needed answers to. One of the issues she spoke of was the loss of her father and the devastation of this for her. I found this very hard to understand yet really understood her need to meet with her father. I will never forget how I felt when I read this. I had never truly taken into consideration that an individual who had experienced sexual violence would want to meet the offender and more challenging that they could move beyond the behaviour of the individual and see what lay beneath. This was the beginning of my thoughts changing in relation to working with offenders but I did not want to admit it. I did not want to give any time or energy to the curiosity that was beginning to emerge inside me about working with offenders.
Around the same time I had been working with a children’s group and it began to emerge that some of the children were experiencing sexual violence in the home. This was a shock to me and I wanted to rescue them. I imagined they wanted to be saved from the individuals they must now detest, yet to my shock all they wanted was for the individuals to say sorry and live a happy life all back together again. As my work finished with these children and I was trying to say my good byes, one of the children asked me, ‘are you going away to find out why big people hurt little people?’ This voice stays with me most days and has been an invaluable support to me as I sit in the room with an individual who has sexually offended. I feel I am there to get an understanding of their motivation to sexually offend and information that could protect children from the offending behaviour.
When I began working it was with individuals who had been victims of sexual violence supporting the victims and members of their families who had been impacted by the sexual abuse. I was aware there was some work being done with perpetrators, yet consciously or unconsciously, I tried to put that to the back of my mind, yet in reality it was never far from me. It became evident to me through my work that some of the clients did want to understand why individuals had perpetrated against them, especially if the abuse occurred within the family or with individuals that were known to them. They wanted to understand for their own healing, and to know how we can protect children in the future from similar experiences. I did not have the answers for them and indeed found it a difficult topic to bring up with my peers as to how we might begin to work with perpetrators. I realised if I was to do this work I would need a lot of my own internal and external support. I had worked for many years in the addiction field and this learning is invaluable to me as I work with the cycle of offending behaviour.
To begin with the inner journey for myself I had to really look deep inside to see if I could find a way to work with individuals who had perpetrated without my own prejudices getting in the way, and there were a lot of prejudices. I thought individuals who were motivated to sexually offend should be locked up and the key thrown away and that their lives should be made as difficult as possible. How was I going to sit in a room and listen to an individual inform me of how they perpetrated sexual abuse on a child or vulnerable adult. How would I get support from my colleagues as I worked with a group that others found too difficult to work with or indeed felt these people did not deserve the opportunity to sit in the therapeutic space. I began to recall my motivation to begin therapy which was as a result of growing up in an environment where someone else’s behaviour impacted on me in a negative way. I realised that my healing occurred when the individual concerned took responsibility for their behaviour as they too needed support also. It was at this point it became clearer to me that all individuals impacted by sexual violence needed support to stop the cycle of offending behaviour.
I decided if I was going to do this work I would need some academic support so I began a course in the Assessment and Treatment of Sex Offenders which has informed me greatly as I work with perpetrators. It is recommended that the Assessment of Dynamic Adaptation (ADA) developed by Clarke and Rogers (2007) is a tool to measure the personal and professional effects of working with sex offenders and would be useful to use in this regard. Identifying individual and organisational profiles, a specialised instrument such as the ADA could directly inform the identification and training of skills and procedures which would enhance the effectiveness of treatment interventions.
Marshall (2000) has set out a detailed list of the characteristics that are needed by the therapist to facilitate the effectiveness for treatment goals with sexual offenders. These characteristics take into account the various aspects of the treatment such as the various attitudes and behaviors that are identified by the offence chain and inform the relapse prevention. This is considered an important aspect of the work as therapists are informed by the offender of their offending behaviour. This may influence the impact on the therapist and their need to be constantly aware of the emerging counter transference. The behaviors that are identified as facilitating treatment goals are: being respectful, empathetic, warm, sincere, directive, confident, non-collusive, encouraging active participation, and being firmly but supportively challenging. It is also recommended that in facilitating treatment groups that this is carried out by a male and female therapist.
If I was to begin this work I wanted to be as honest with myself about the impact of the work on me so I began to record some of this, and was very surprised with what emerged. I realised I have become over vigilant with all the children I am related to, asking questions about who they are with and why. I am much more sensitive to TV programmes and recently was at the cinema and had to leave due to the content of the film. I find it difficult at times to allow myself have fun and laughter as I feel weighed down by the content of the offending behaviour.
Thankfully I have a wonderful Clinical Director who has supported me all the way in the work. I am also grateful to my other colleagues both working with perpetrators and those who are not working directly with them but who offer invaluable support to me. I have been extremely fortunate with my supervisors who allow me the space and offer great support to keep me grounded in the work. I have always felt the way forward is to break the cycle of offending behaviour and this can only be achieved when all individuals impacted by sexual violence are included in the healing process. The attitude of my peers has certainly changed over the last few years and while they themselves may not want to work directly with perpetrators they do support me in their understanding that in order to break the cycle, we must first gain an understanding of the motivation to offending behaviour.
Eileen Finnegan IAHIP, IACP, BACP, IAAAC is the Deputy Clinical Director at One in Four. She works with families and individuals who have experienced sexual abuse, she also works on the Perpetrator Assessment and Treatment Programme (PATP).
Ennis, L., and Horne S., (2003) Predicting psychological distress in sex offender therapists sexual abuse: A Journal of Research and Treatments, 15,149-156‘.School of Psychology (2007). Module 3: Practice Assessment & Clinical Skills, Leicester: School of Psychology – Forensic Section, University of Leicester
School of Psychology (2007). Module 5 Research Methods Module, Leicester: School of Psychology – Forensic Section, University of Leicester
Marshall, W.L., Anderson D. and Fernandez, Y.(2005)Cognitive Behavioural Treatment of Sexual offenders. Sussex: Wiley Press.