Podcast: direct work with children displaying harmful sexual behaviour

Last updated: 15 Nov 2021 Topics: Podcast Type: Podcast
Overview

Using trauma-informed and therapeutic practices with children and young people

In January 2020, we published a series of podcast episodes on assessing and preventing harmful sexual behaviour (HSB).

Our newly published three-part series focuses on direct work with children and young people displaying HSB and using trauma-informed and therapeutic practices.

The first episode in the series features Katy Tomkinson and Rowan Wolfe who are social workers and children's practitioners at our Stoke Service Centre. You'll hear us discuss:

  • creating safe spaces in therapeutic session and using different techniques and strategies
  • providing clarity around confidentiality and safeguarding when working with children and young people
  • managing expectations of assessments
  • their own experiences of working with children and young people.
This episode touches on our practitioners' experiences of working directly with children and young people. Although all experiences are generalised, they could be upsetting for some, and may cause distress. Listen to the second episode and third episode.


Listen on YouTube

 


About the speakers

Katy Tomkinson is a qualified social worker who has worked at the NSPCC for over five years. She has undertaken assessments of therapeutic need and provided therapeutic interventions for young people who have been sexually harmed.

Rowan Wolfe has worked at the NSPCC for fifteen and a half years as a qualified social worker. She has worked with children and young people who have displayed harmful sexual behaviour by undertaking assessments and providing therapeutic interventions.

NSPCC Learning Podcast

Our podcast explores a variety of different child protection issues and invites contributors from the NSPCC and external organisations to talk about what they are doing to keep children and young people safe. Use our episode directory to browse through all our episodes to date.

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Related resources

> See our resources for understanding, preventing and managing incidents of harmful sexual behaviour

> Listen to the second episode in the series on planning therapeutic sessions

> Listen to the third episode in the series on technology-assisted harmful sexual behaviour

> Listen to our episode about harmful sexual behaviour in schools

Transcript

Podcast transcription

Introduction:
Welcome to the NSPCC Learning podcast, where we share learning and expertise in child protection from inside and outside of the organisation. We aim to create debate, encourage reflection and share good practice on how we can all work together to keep babies, children and young people safe.

Ali:
Hi and welcome to the latest NSPCC Learning podcast. Back in January 2020, we published a series of podcasts on harmful sexual behaviour, also referred to as HSB. To date, these have been amongst our most well-received episodes, and so we've recorded three new podcasts on HSB.

The first in the series focuses on the underlying principles of direct work with children and young people who've displayed HSB. Katy Tomkinson and Rowan Wolfe are social workers and children's practitioners at our Stoke Service Centre, who both have years of experience working on HSB services and with children and young people, which they discuss in this episode.

This episode was recorded in March 2021, and Katy and Rowan have pitched the conversation for those that are maybe newer to HSB work, but offer really good tips, advice and information which we hope you find interesting and helpful regardless of experience.

Katy:
Rowan, when you meet a child for the first time and you're going to be completing a piece of work with them around harmful sexual behaviour, what do you think is really important? 

Rowan:
I think the first thing is that the children who come and see us often are feeling really scared and really worried. They don't know what it's going to be like. They don't know if it's going to be like a police interview. A few have said they expected us to almost put a spotlight on them and interrogate them, and I think that's quite scary, where actually we take a much more trauma-informed and therapeutic approach to our work. That doesn't mean that we don't challenge. It doesn't mean that we don't say the difficult things, but we always come from a nurturing perspective when we do that.

Katy:
Yeah. I always say to children, when I first meet them, you're not in any trouble with me and you will never be in any trouble with me. My job is to keep you safe and keep everybody else safe. It's that kind of thing.

Rowan:
Yeah. And I think with that, we're always transparent that there are caveats to what stays private between us and then what actually would have to get passed on. So, you know, if a child is on an order, there might be a situation where there is a consequence if they share information with you, or they don't comply with an order. And that doesn't mean that you can't do that in a sensitive way.

It’s just trying to always keep that nurturing approach to it, even though there might be sort of quite serious consequences or if they told you that they'd done further behaviour and that had to be passed on for safeguarding concern.

Katy:
I suppose it's really helpful to think about explaining to them safeguarding, and confidentiality and its limitations, right from the get go.

Rowan:
And I think we've always said like, you need to be really clear on what the behaviour is, why they're coming to see you; because sometimes they've seen lots of different professionals in their lives, especially they've had experience of abuse or neglect in different sorts of trauma.

And you need to be clear that you're there to work around the harmful sexual behaviour and name it. Because often just saying it in the first place is the thing that makes them more relaxed because they're worried about what it will be like. If you get that out of the way at the beginning, you've laid it on the table: you've said why you're there, and then you can move on.

Katy:
Yeah. And I sometimes — exactly that — tell them why we're there and the piece of work that were going to be doing and what that might look like, but also gives them that reassurance: "but we're not going to talk about that more today". It's that kind of containment around that message as well, so that initially they're not thinking [it is], exactly like you said, a police interview.

Rowan:
Yeah. And sometimes I'll take — I've got 'areas of work' cards — so things like harmful sexual behaviour, worries, fears, feelings, school, you know, the sort of usual topics that we cover. And then I might lay them out and say: “these are the sorts of things we're going to talk about, because it's that fear of the unknown that's quite scary”. But then I'll say, “just on the first sort of session, would you like to choose which topic we do first?” So they've got a bit of control and ownership over it. I don't let them do that forever because obviously sometimes you never move on in your works because they'll stay with things that they feel most comfortable with.

Katy:
Yeah, I tend to give them a bit of a warning as we're moving through the assessment that we're going to start to think more about the specific harmful sexual behaviour that bought them to the service. And I might say, "are we going to talk about that next week or the week after?" And give them that very limited choice, so there's some sense of empowerment, but like you say, not complete control over the sessions because often children won't want to bring it at all.

Rowan:
Yeah. And I think the probably the most important thing is that therapeutic relationship we have with them and developing trust and allowing them to feel safe so that they feel that you're somebody they can open up to. Because they're ultimately going to be asked to talk about some of their darkest feelings, and if any one of us was asked to share our sexual experiences with another person, we'd be mortified and we would just be cringing, wouldn't we?

And then not only are we asking them to talk about their sexual experiences, they're still only children. Also that sexual experience has been one that's been harmful and they've got in trouble with someone for it. And potentially they may no longer be allowed to live with their family. There could be all sorts of implications for them. So you need to make them feel really safe so that they do feel that they can open up and talk about those things.

Katy:
And I guess also that unconditional positive regard that we would have; it's really, really bigging them up. Probably more so than you think feels natural sometimes because you can't say enough positives, can you, to really build that relationship and let them know that their identity is not the harmful sexual behaviour. That's one part of one thing that they did, and it's certainly not all of them, but remind them of all the strengths and skills and lovely qualities that they have.

Rowan:
And one of the biggest things when you're doing any AIM [what does this stand for] assessment or anything like that is you looking for those strengths. You're looking at how you can build on them and you need to be demonstrating in your work all along that you value them, that you can see all the things that they're good at, so that they're getting that constant reinforcement that you're trying to build on their strengths. Because you're also going to be identifying lots of things that they've done that have been harmful. So if you haven't got that contrast, it can just feel sort of quite punitive and shaming of them.

Katy:
And I guess then when children feel overwhelmed by shame, they'll quite often revert to a position of absolute denial. They can't go anywhere near the behaviour to think about it in a way. I think overcome those feelings of shame and have those very gentle conversations with them; naming it [the harmful sexual behaviour] from the beginning, perhaps naming it in a way of, "Oh, we know that this happened and that some people are worried about it", rather than asking them about it. But it's doing it in a very sort of gentle way and reinforcing that in most sessions. How many sessions would you have with a child or young person before you directly address the harmful sexual behaviour in order to build up that therapeutic relationship?

Rowan:
It really varies. I mean, I've occasionally had a child that would choose harmful sexual behaviour as their first topic because they're so terrified they just want it out of the way. But that's few and far between. Generally, it's the last thing they want to talk about. But also, we'd thread it through. So every session there'll be a small mention of it, even though we're not going into any depth. Five or six sessions in, maybe, where I've started to talk about it.

It depends if I feel that I have built that rapport with them where they're ready to get to that point. And it might depend as well on how open parents are, because some parents will talk from the outset quite openly in front of the child. And then that allows— a lot of those words have been said before with them, so it's not as sort of scary. Can you remember back to the first session you ever did on harmful sexual behaviour and how you felt?

Katy:
Yeah. I remember meeting the first young person I worked with. I came to the NSPCC as a student — I was doing a home visit with my practice educators, so I was being assessed as well which obviously massively I added to my nerves — and the young person that we'd gone to meet wouldn't come downstairs and was absolutely terrified. You know, fundamentally, that was what was going on for him. He was really scared that he was in trouble, going to get shouted at, all sorts of things. And he had been interviewed by the police. So it will have felt like a very scary experience.

And what I did in that instance, and it's not the last time that I've ever done it, is I sat at the bottom of the stairs and said, "I'm not going to come up, I'm just going to sit here." And the young person was in their bedroom and I just started off really gradually, "Do you think you could just open your bedroom door and we could say, hi? Do you think you could talk to the landing so that I can see you?" And then had like a bit more of a chat.

And then bit-by-bit, you know, he was able to come downstairs and felt reassured that he wasn't in trouble. It was really about us building a relationship and working together. But I think it's allowing that time. If you think "I'm just going to do a quick home visit to meet this young person for the first time and I've got 20 minutes at the end of the day", it's just potentially not going to be enough, is it, for that child? Can you remember any experiences like that, of children that have been really frightened?

Rowan:
Yeah, I mean, you get ones where they run off. You're then thinking about whether they're safe. I think the ones I find the most difficult is where the hood's up, it's down. They don't want to talk to you. They might have turned their chair. And although they're physically in the room, especially if they're on an order and they've been told they've got to come, but they've got no intention of engaging with you and you're trying to slowly break down those barriers to get them to talk whilst also being aware that there's a time scale for you, getting your assessment done and getting the information.

Although we need information from young people, there's also lots of other sources for that information. You can go and do file reads, you can talk to the professionals, talk to the family, so it doesn't mean that you can't do anything. But I think it's quite scary when you're sitting there, especially when you're new to it, and then you just can't even get them to engage at all.

You have to just use your personality. It might be that you just try and find out things about what they enjoy and you're trying to find any way in, where you can just get that hood to come away from their faces slightly and you think, "right, OK, I'm in. I've got a little bit". And you have to take it slowly. The majority of the kids we work with get there eventually. Occasionally not, but the majority do.

Katy:
I would say so, and I would say quite quickly; a home visit and a couple of sessions. But I think it's really interesting, talking about the hood up, because what I've seen, you know, when I've met children at home, is parents saying, "take your hood down, you need to look at them", and actually, it's the opposite of what I would do because I think children have their hood up and covering their face because they're scared and that feels safe.

And what we don't want to do is to expose them when they're not ready to be exposed. It's about letting them do that in their own time and not challenging that. Eye contact is a really interesting one because I think there's so much research about kind of it's really positive that people are making eye contact with you, et cetera, et cetera. But, actually, we know if you try to talk about really difficult things it's so hard [to keep] eye contact.

A social worker said to me that children told them everything when they were driving in a car. And I really believe that's because they're not looking at them directly and I will sometimes use that as a tip. I'll even name it really clearly with the young person. I'll go, "I'm going to ask you something really tricky but actually, I know it's really hard for you to look at me. So I'm just going to turn away." And it's done in a really sort of light-hearted way, in a kind of fun way, but it's really naming that "I know this is difficult and I know I can make it a little bit easier".

So you don't need to have that sense of the child needs to be sat, and they need to be sat still, and they need to have their hood down, and they need to be respectful, and they need to be making eye contact, because I think none of those things are very conducive to that therapeutic relationship, which, like you say, is the key.

Rowan:
And sometimes doodling, or playing with a stress ball, or fiddling, or letting them walk around the room, that can be seen as, you know, they should be sitting there and behaving because they've done something wrong and then actually, that's just the wrong approach because they're then not comfortable and they're not opening up.

You're better off taking a much more therapeutic approach and allowing them to feel safe because you going to get a lot more out of them and it will be less likely they'll display further behaviours. We've talked a little about some of the behaviours that can be challenging to you as a practitioner when you're working with and a child who's withdrawn or scared or refusing — it could be angry, it could be that they're denying — what sort of boundaries do you put around sessions to make that a safe space?

Katy:
I think you've got to think about the practical issues. You've got to make sure that you've got a consistent room, where you're not being interrupted. I once did a piece of work in a school and for whatever reason, we were put in the room with the photocopier. And even though they knew why we were there, about three or four times a member of staff kept coming in...

Rowan:
...and they say, "sorry, sorry. Sorry, carry on. Sorry."

Katy:
And you're thinking: I'm not going to be able to do any meaningful [work], and how is a child ever going to feel like they're going to explore something? And I don't know if you've experienced this, but sometimes when a child starts to talk, it almost feels like a bit of a spell. And I almost daren't breathe because I just want to let it flow without breaking the spell. What you absolutely need is that really contained safe space and trying to secure rooms, I know is tricky, but I think it is really important.

Rowan:
Especially at the moment where we're working virtually a lot. That's even more challenging because it's hard when you're working with children you've known for quite a long time and then you're working virtually, but when it's a child you've never met before, and you're doing a lot of that work virtually, it becomes even more of a barrier. But again, you can still make it work.

Katy:
You can. And it's setting your stall out at the beginning and explaining to the child, the young person, their family, whoever they're living with, why that safe space is important and why it's not helpful to have interruptions or noises outside that are distracting. And we all live in the real world, so it's about doing our best with what you've got, I guess, but remembering why it's important.

Rowan:
Some young people we work with might have a lot going on in their life, so every week there might be a crisis or they come in in a certain mood. How do you deal with that? Do you go with whatever crisis it is or do you try and get your session done?

Katy:
Predominantly you want the work to be child-led. There's no point trying to metaphorically drag a child through a session because that's what you've planned, that's the work that you've planned to do. And because you've got timescales that you need to meet to complete whatever piece of work you're doing, because it's not going to be meaningful to them, so it is pointless.

We know that a lot of the children that we work with have got a lot of other stuff going on for them, and they might be bringing that that day. Sometimes what they need is just to be able to explore what's meaningful and real to them today, and you need to put your session plan to one side altogether and go with it. But you've also got to balance that. Sometimes, in an avoidance strategy about why they're there, they'll be bringing something every week. And so I've used strategies like 'Car Park'; we'll have an A4 piece of paper and this is your car park, and then we talk about the issues and we put them on our car park and we're like, "we're just going to park them for today" but I give that space to begin with, to name them.

Rowan:
Do you sometimes say we'll discuss it again at the end, so you make sure that you've acknowledged it again before they leave, or how you are going to resolve that, if it's appropriate?

Katy:
Or just allow them a little bit of space to talk every session or say, "we can talk about that next time." It really does depend what it is because sometimes children are bouncing from crisis to crisis. And then I think the question you've got to ask yourself for those children is: what else do we need to do to secure their safety?

You might be able to do an assessment of that young person, but whether or not you're going to be able to do any meaningful intervention work is questionable, I would say, because they need that safe and stable base to engage in any work. So if you were an adult and you wanted to do some therapeutic work about your experiences of your parents divorcing when you were a child that was really difficult for you, and you were going through a divorce yourself, it’s probably not the best time to do it.

And we expect that and understand that for adults, but actually, we put expectations on children that — despite everything that's going on for you — we're still going to ask you to come and talk about some of the most difficult experiences or communicate, not necessarily talk, about some of the most difficult experiences you've ever had.

I think as professionals, we need to be better at advocating for children where they're not in a position to do that work through no fault of their own. I think that's also really important that we lead on that as professionals. And I think it's helpful to have some strategies around emotional regulation; some grounding techniques. So it might be about asking them to think about the senses, you know, just name something you can see, name something that you can smell, something that you can hear, just to kind of bring them back into the room if they're becoming really emotionally uncontained.

Rowan:
Making sure they've got both feet on the floor, [concentrate on] what can they feel through those feet so that it physically grounds them.

Katy:
There's good ones about — especially for younger children, or older children actually, I think whoever it works for, it doesn't matter — around using breathing but in a more fun way, so it doesn't feel like you're saying, "just breathe", which might sound a little bit patronising, so you could talk about kind of a bowl of their favourite hot food that they hold up to their face and they take a deep breath in through their nose to smell that beautiful food, but then it's too hot to eat, so you need to blow on it to cool it down. Those are quite useful techniques just to have in your toolkit to bring if you can see that child's becoming a little bit uncontained.

Rowan:
I had one where — it was from a children's yoga thing I saw — where you get them to pretend to blow up a hot air balloon and then they have to imagine that they're holding that hot air balloon, so they have their arms out really, really wide, and then they're rocking to try and keep hold of that balloon. But actually, what you're doing is mimicking those very early soothing techniques of rocking the body from side to side, which helps to regulate them. It's more for younger children, but also it can make them giggle because they're trying to keep hold of it, and then you can make that kind of more visual with them.

Katy:
And you might have to think of some different ones because, like you say, that might work great with one child, but if you've got a fairly grumpy 16-year-old, they might think, "I'm not going to be holding any kind of hot air balloon, thanks very much." So it's about having skills and strategies that are going to work best with them and who they are.

Rowan:
I think some crises as well can almost be like sort of learning points, either for you, for your assessment or for them. We'll often get young people, particularly with online behaviours, where they'll come to a session and the parent or carer might say, "you'll never guess what they've done", and then they'll give you sort of an example of something they've done online; they've chatted to someone they shouldn't.

And although it's not great that they've done that, and that's worrying, actually it's a really tangible way of having a conversation with them about something that's happened where you can explain to them why. And it's in the moment; it's real for them. Because often when we get them for harmful sexual behaviour, they've been through a whole court process or safeguarding child protection process, and then that means you might be getting them quite a few months after that behaviours occurred. And then we get lots of "I don't remember", because, who would want to remember? But it's easier sometimes. So actually, they can be invaluable when these so crises do happen.

Katy:
Yeah, I think some of the best sessions I've had have been ones that were completely unplanned because it's about what the child brought. And they're so in the moment that what they're able to communicate and articulate is more in-depth than they would be able to bring about things that happened ages ago. In terms of top tips and strategies and things, do you have anything else that you think is really helpful?

Rowan:
Because it's harmful sexual behaviour, I think the reality is it is shocking, it is upsetting. So we, as practitioners, need to think about how are we going to respond when they start to tell us some of that detail.

If you look at a child like you're disgusted by what they've done or disgusted by them, then they're not going to want to open up to you. So even when what they're talking about is really upsetting, especially if it's, say, sibling abuse, when I've met the sibling and I might have a face that I'm putting to that behaviour, that can be really emotional as a practitioner to think about that child being hurt. But I still have to think about: how is my face or my body language letting that child see that I still value them, that I see that behaviour as something separate to them. It's something that they've done. They can't take it away.

But actually, there's still lots of really, really good things that there are about them. So it's that, even if you're shocked, you've got to try and have your game face on. You've got to be thinking, "right, I'm at work now. I need to be there for that child in that room to allow them to feel supported."

Katy:
So I guess on the back of that, it's about having really good quality informal and formal supervision where if you do have some sort of complex feelings about a child or young person...

Rowan:
Explore them.

Katy:
Explore them in a safe environment away from that child.

Rowan:
The other thing is, it's almost like getting your patter down. Because talking about sex is difficult, and then talking about harmful sexual behaviour is even more difficult. And then when you're sitting with someone who doesn't want to talk about it and you're also worried because it's a child and you don't want to get it wrong and you don't want to damage them emotionally.

Having had a bit of practice — and we've probably been doing it long enough now that we do have some of those phrases and ways of saying it — but [when] I first started, I remember almost practising and saying to my colleague on my first few visits, "well, how do you just say it to them?" And thinking about how those initial conversations would go. How would I approach it? And because I practised it and I thought about it, it was still awkward those first few times I did it, but it got easier.

Katy:
But there's nothing worse, is there, than a child's going to pick up on your own discomfort and embarrassment? It's so much better if you can come across that you're confident. And also, I think sometimes even when we're talking about difficult things it's much better to talk about it in a really natural and light way, rather than go all whispery and quiet because you're like, "oh, this is so awkward."

Or you're very formal and matter of fact. Because I think actually it's about [saying] “we know that this happens”, then explaining it, but in the same sort of tone of voice in the way that you would speak ordinarily. 

What about things like how you ask those questions? We both use that kind of "I'm wondering if..." to reflect back to children, which is quite helpful if you think you can see something in their responses.

Rowan:
You need to be interested in children, don't you, to do this job. If you're not interested in them and interested in their lives and you're not curious, that's going to come across to them. So be curious. Ask questions. Show that you want to know them and you want to know about them. And that's whether it's about the harmful sexual behaviour or it's about their life in general.

I think... sometimes it's quite hard if there's been denial and we sort of think, "well they've denied it, therefore, we can't do any work" but actually there's lots you can still do because denial isn't a precursor to risk. It doesn't mean that they have to go on to display further behaviours and we can use case studies or third person scenarios. Ultimately, that child or young person is going to be drawing on what they think and feel to answer those questions.

But by making it third person, it stops it being about, "You did this. What did you do? How did you feel?" It might be, "How do you think James felt when James did this?" because you've given them a case scenario that's very similar to what they might have done. And then you can draw on that and and you can think about, well, if actually James was feeling quite angry, there's quite a chance your young person might have been feeling angry as well. And then you can explore why they think James might have been angry (or whoever the person).

Katy:
And for some young people, that is as far as I can go. But I think denial is their safe space, isn't it, so they're not doing it to be difficult or badly behaved or not engage with you—

Rowan:
They might have a lot to lose.

Katy:
Exactly. And this is how they feel safe. So I would quite often name it. If I met with kind of denial, my reflection back would be, "I can see that you just don't quite feel safe enough to explore that with me just yet. And that's fine", and I would just leave it at that. But I'd name it for what I believe that it is.

Rowan:
And you can try different ways of then going back in, can't you? You can think I'm going to go back to that topic again, but I'm going to take time to think about it and how I'm going to approach that. Some of the other techniques you might want to use are things like scaling questions.

And what I'd say is, just because this is harmful sexual behaviour, don't forget all of the other skills that you've got from working with young people in different settings. If you're working with a child who has issues around anger or theft or something else, that doesn't mean that those skills and strategies won't work.

If you use scaling questions — say from a scale of one to ten, how does a child feel about a certain topic with ten being the worst they've ever felt in their entire life and one being the best — and then get them to plop themselves on it, it's a starting point. But it's also a really good measure because you can then ask in the next week or at the end of a session, "how are you feeling about it now?" Especially when it's a topic that maybe you can see that they've become quite emotional during the session, you need to regulate them back for the end of the session. Scaling questions are a really good way of measuring that.

Katy:
I do something similar. As well as scaling questions, for kids that don't get on so well with numbers and ordering sometimes I'll draw a circle and say, "if this is your head..." — and we'll always name how bad I am at drawing to try to redress the balance of power a little bit — but anyway, draw a head and go "can you colour in how big that feeling was in your head or how much of your head was telling you to do this? And how much of it was telling you to do something else?" So it gives them that kind of visual tool as well, and you can see that sort of scale.

Ali:
We hope you've enjoyed this podcast. The second episode, which will be released next week, will look at specific sessions of direct work that you can do with children and young people. And this includes more general work and doing work around sexual behaviour and harmful sexual behaviour.

(Outro)

Thanks for listening to this NSPCC Learning podcast. At the time of recording, this episode’s content was up to date but the world of safeguarding and child protection is ever changing – so, if you're looking for the most current safeguarding and child protection training, information or resources, please visit our website for professionals at nspcc.org.uk/learning.