'Helping the Abuser'

By Richard Curen, Community Living, Vol. 17, 4 (2004)

Coping with an incident of abuse requires prompt action and help for both abuser and abused. Richard Curen of Respond describes the risk assessment process they used for Daniel and how the subsequent recommendations for his care is helping him come to terms with his feelings.

Daniel was referred to Respond after he sexually assaulted another man with learning disabilities, in the care home where they both lived. Respond were asked to carry out a risk assessment. A risk assessment is a piece of work that provides an independent opinion on the likelihood of someone hurting either themselves or others in the future.

Respond has been providing risk assessments for the last 8 years. The growing recognition that people are not neatly packaged into good or bad, victim or perpetrator, but are sometimes a mixture of both, led us on to develop treatment models that could cater for people who have been abused, people who have become abusers and those who are both.

Daniel lived in a small residential care home with four other male residents. The other residents were all older than Daniel and were all less able than him. Daniel's Social Worker was contacted by the manager of the care home after one of the residents, whose name was John, made a complaint about Daniel. John was scared about letting the manager of the home know about what had happened to him but did not want it to happen again. He said that Daniel had come into the bathroom one evening and had locked the door and tried to touch and kiss him. John had tried pushing Daniel away but he was much stronger than him. Daniel then touched John's penis and tried to make him touch his.

When John shouted 'Stop', Daniel stopped what he was doing and left the bathroom. It was about 2 weeks later that John finally told the manger of the home. The manager then spoke with Daniel who said that it had happened but that John had asked him to do it. The manager called the police and they then interviewed Daniel. A time and place were arranged and an appropriate adult was present while the interview took place. During the interview Daniel admitted that he had locked the door and that he had scared John and that he knew that John had not wanted Daniel to touch him.

It was decided that Daniel should be referred to Respond in order to explore the reasons for his behaviour. A risk assessment is undertaken in order to take a good look at a persons internal world, to focus on his or her history and to explore the reasons why hurting someone in a sexual way has become part of someone's behaviour. It is also important to look at the world outside that person too. Respond's risk assessment process also looks at the environment in which the person is housed, where they receive day care or where they work.

In Daniel's case Respond was asked to comment on the suitability of his placement and the needs of the other residents in terms of their protection. The assessment also looked at the events leading up to the incident and tried to find out from Daniel what his thoughts and feelings were.

After meeting with the team to discuss the referral process, Daniel attended Respond for 12 fifty-minute sessions, spread out over 12 weeks. The therapist who saw Daniel needed to build a relationship of trust. Although Daniel was initially resistant to talking about his feeling and the events that had brought him to Respond, he eventually opened up and was able to talk about things that he had never felt able to talk about before.

Early on in the assessment Daniel disclosed that he too had been abused when he was a child. It was a very difficult experience for him to describe but after some weeks he was able to do so. While we often find that people who abuse others have been abused themselves, it is very important to note that being abused does not make you more likely to abuse someone else.

What also came to light during the assessment was that Daniel had previously assaulted a young woman of 18 who had severe learning disabilities. Daniel lived with her in another residential home and had been made to leave soon after the attack. On that occasion the police had not been called. Respond recommends that at the first mention of an assault the police should be notified. Police are trained to work with people with learning disabilities whether they have been assaulted or have assaulted someone else.

The experience of hurting others through sexual aggression is rarely a behaviour in itself. Most often it has its roots in some earlier experience. Sometimes assessment involves exploring feelings about people's own disabilities, the way they were brought up and by whom, their childhood and their early sexual experiences. The more Respond considers these issues, the less restricted and the more useful recommendations are in terms of long-term risk management.

After the risk assessment was over the therapist who assessed Daniel wrote a detailed report covering all of the issues they had discussed. The therapist also wrote a list of detailed recommendations. These included:

1. Daniel should not be allowed to have unsupervised access to vulnerable people.
2. He should receive regular support and monitoring from an allocated key worker who is experienced in working with clients who are vulnerable and may act out sexually.
3. Daniel should be moved to a more suitable environment, where staff are better able to manage the risk that Daniel poses to others.
4. Daniel should begin weekly psychotherapy for a period of at least two years. A psychotherapist should be identified who has clinical experience in working with people with learning disabilities, sexual abuse and sexual offending.
5. The professional team supporting Daniel should meet regularly to review his progress.

While the assessment has a therapeutic element to it, it is not therapy and it is always important to make sure that the client is not left in a vulnerable state at the end of the assessment. However, sometimes, if appropriate, it is possible to start in therapy soon after the assessment ends. This was the case with Daniel. His referrers were able to find the necessary funding so that Daniel could start weekly psychotherapy at Respond.

As in Daniel's case, when the recommendations of the risk assessment have been followed, it appears that services have been able to achieve a higher degree of safety for all of their clients.

Daniel now lives in a home where he is closely supervised and where he receives a more appropriate level of care. He is now able to talk about and explore some of his feelings about his own sexual abuse and is able to think about the feelings of others that he sexually abused. It may take a long time for Daniel to feel free of his experiences but in the right home and with increased levels of support Daniel will continue to make progress.