Breaking the Cycle: Challenge and Opportunities

BREAKING THE CYCLE: CHALLENGE AND OPPORTUNITIES

Tapping into such a rich database the paper by Glasser et al raises important but complex issues challenging the direct causal link between involvement in sexual activity with an older person and subsequently becoming an adult who perpetrates child sexual abuse.

Definitions of incest and paedophilia have and will in practice continue to be shaped and influenced by changing legal frameworks and social policy. The authors remind us that about half of fathers and stepfathers referred for treatment to clinics for having abused children outside the home had at the same time been abusing their own children.

All the disadvantages of a retrospective case note study on an unusual clinical population can be set against the advantage of knowledge to be gained from possible full disclosure of both degree and nature of ‘offence’ behaviour in a specialist ‘confidential’ psychotherapy clinic of the 1980s.

Little reference is made to either the impact of the social and psychological constitution of gendered power relations — whether economic, social, political, domestic or sexual, operating at the level of individual, interpersonal, institutional or societal beliefs — or to the current good practice and policy guidance in this field (Cabinet Office, 1999).

It was in 1978 that Louise Armstrong's early and now classic feminist text on incest, Kiss Daddy Goodnight, was first published. In utilising material from a specialist forensic psychotherapy clinic the psychotherapeutic encounter is applied in the service of those who have traditionally been silenced — children sexually abused. At the same time it addresses core concerns expressed by Finkelhor (1986) that the implication of inevitability in ‘cycle of violence’ theory might “strike terror into the hearts of boys who have been abused” or become a “ self-fulfilling prophecy”. The concept of ‘developmental pathways’ is a more accurate and helpful utilisation of ‘cycle of violence’ as a theory for explaining and understanding the contributing factors and causal relationships that connect childhood abuse with adolescent and adult male perpetration. For each individual, dispositions conditioned by childhood abuse are subject to many different kinds of combinations of motivating and mediating factors that ultimately determine whether or not and in what circumstances being abused can lead on to abusing.

Adolescents

It is surprising that the current debate about diagnostic categories for those abusers aged under 16 — possible “sexual arousal disorder of childhood/adolescence” (Vizardet al, 1996) — is not explored by Glasser et al. Further, given the growing literature on young abusers, it is questionable whether the 19% of this sample aged 19-21 can be labelled as “ mature adults with fixed personalities” and whether or not more could be learnt from teasing out the data on older adolescents still hopefully in a phase of transition.

“Adolescent limited” and “life course persistent” (Moffitt, 1993) antisocial behaviour is now clearly recognised. While research informs our prediction of sexual and non-sexual recidivism in adult offenders, and while factors are known to increase risk that delinquents will become adult criminals, the information to guide prediction of sexual recidivism in adolescent abusers is limited. The majority of factors found to predict sexual recidivism are historical and stable (history of abuse and conduct disorder) and have been seen as fixed and difficult to change through treatment.

Dynamic risk factors, which are the target of cognitive—behavioural treatment in general adult criminality, have not emerged from large reviews as predictors of sexual recidivism (Hanson & Bussière, 1996). Measures to assess dynamic variables that are the core targets of sexual offender treatment — victim empathy, cognitive distortions, relapse prevention — have only relatively recently been developed.

Findings

The significant association of sexually deviant practices with use of pornography has heightened relevance in an era of sexually abusive images of young children on the internet. The link made between male abusers abused by their mothers has resonance with the findings of Briggs & Hawkins (1996). Incarcerated child molesters were more likely to have been abused by females. Compound loss as described is a broad category and its specificity in relation to sexual abuse needs further exploration. Boswell (1996) has described the marked impact of loss and abuse on incarcerated adolescent males serving long sentences for acts of violence.

Delineating the developmental pathway of a possible minority subgroup of the victim-to-violence cycle is a significant contribution to the field but should be seen as only part of a much wider picture.

Glasser et al bring with their findings a psychodynamic understanding based on identification with the aggressor as a means of turning traumatic passive experiences into active ones as the perpetrator returns to the theme of rage and aggression seen in a range of sadistic and violent acts (Bailey, 2000). It is to be hoped this is not seen as a resurrection of the at times destructive cognitive—behavioural v. psychodynamic treatment debate but that each can inform the other in addressing the needs and risk of the individual.

Implications

From this high-risk cohort the most pathogenic experience is to have been a victim of both incest and paedophilia, then a victim of paedophilia alone and then a victim of incest alone, supporting in general the literature on victim-to-victimiser cycles.

The findings of Glasser et al can inform both adult forensic services treating adult perpetrators (in particular that group of fixated paedophiles) and child and adult mental health practitioners involved in treatment of victims of sexual abuse. To enable effective child protection all mental health practitioners need a full understanding of factors that contribute to cycles of abuse.

Wyre (2000) argues that the controls exercised by the abuser on the relationship appear to have more bearing than the type of abuse itself on the likelihood of abused child victims going on to become abusers in adolescence or adulthood. For the future, measures need to be developed to systematically evaluate family context variables such as parental attitudes to sexual abuse, as well as measures to evaluate prepubescent children who abuse, together with further investigation of female juvenile offenders. Having described a high-risk subgroup of victims who have experienced both paedophilia and incest, the challenge remains to develop treatment programmes that accurately target criminogenic need, and then to evaluate the impact of treatment programmes through long-term follow-up.