Podcast: understanding denial in children displaying harmful sexual behaviour

Last updated: 28 Feb 2022 Topics: Podcast Type: Podcast
Overview

Why children may experience denial after displaying harmful sexual behaviour (HSB)

In this week's episode, Katy Tomkinson and Rowan Wolfe who deliver our HSB service, talk about:

  • what denial and shame might look like in children and young people
  • the physical signs and non-verbal cues that children might display when talking about their experiences
  • building trusting relationships and using therapeutic and trauma-informed approaches
  • exercises for practitioners to help understand children’s lived experiences and explore feelings of shame and denial
  • the impact on children of parents or carers experiencing denial
  • techniques for working with a child or young person when they are fixed in their denial.


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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.

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Related resources

> See our resources and research about harmful sexual behaviour

> Listen to our episode on direct work with children displaying HSB

> Play our episode on planning therapeutic sessions for children displaying HSB

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. The episode you're about to listen to was recorded in January 2022, and focuses on shame, denial and minimisation when working with children and young people who have displayed harmful sexual behaviour (HSB).

Katy Tomkinson and Rowan Wolfe are children's service practitioners and social workers from our Stoke Service Centre, and they work on our harmful sexual behaviour service. In this podcast, they talk about what denial looks like and the ways it can present itself. How denial is dynamic and can change over time. What practitioners can do to put themselves in the shoes of the child or young person they're working with to understand why they might deny. How to work with children and young people when shame and denial is present. How to build a trusting relationship with a child over time and how to take a more therapeutic and trauma-informed approach.

Katy and Rowan began by talking about the challenges of working with children and young people when there is denial. And how, by understanding where this comes from, we can begin to work with them safely and effectively.

Katy:
I think the first thing to think about is that, it is actually really quite normal for children to deny things isn't it? So I don't think we should be too worried when children deny things because I think it is developmentally, fairly typical anyway. But certainly as a practitioner, if you're working with a child around some concerns around the behaviour like HSB, or other behaviour concerns, or behaviours that might indicate distress, when you're faced with denial it can feel really challenging. It can feel like they're doing it on purpose, or that they're not wanting to engage, or that they're wanting to make your life difficult, or they're doing it to be awkward. And I think that's not the case and it's about understanding it to make sure that we can work with those children effectively and safely.

Rowan:
So for you, what does denial look like? What is it?

Katy:
I think it's important to think about denial in various different sort of presentations. So you might get absolute denial, which is, as we said, with the child spilling the drink on the carpet. “I didn't do it. I wasn't there. I don't know what you're talking about. It wasn't me. I don't know anything about it” and that's what absolute denial would look like. But denial can sort of move away from that. You might have, around HSB, you might have a denial of awareness really. It's really common for children to say to me, “I don't remember. If I did do it, then I don't remember”. And of course they will remember but that must feel like a safer place. Or for older children you might get “I was drunk” and so they're not in control, they're not taking responsibility. And then you might get denial of responsibility, so “they consented. They wanted to do it. They joined in”.

Rowan:
“They didn't say no”.

Katy:
Yeah, “they didn't say no”. Or we might get that denial of any impact or harm being caused. So you might get, “well, they're too young to understand. They looked like they were liking it. They were laughing. They were going along with it. They looked kind of happy about it. They didn't stop me”. And then you get some that might not want to do any work with you. It's kind of like, “I don't need to work on this. I'm absolutely fine. I won't do it again”. And that might be the case. They might not do it again. But how can you possibly know and test that out and be certain that everybody is going to be safe if you don't do any sort of meaningful assessments and work with them?

And children might move around those statements or similar things, and they might be able to deny impact one week and then the next week acknowledge impact, but then actually move away from that again and say, “oh, no, no, it didn't cause any harm”, et cetera. There's various models around the continuum of denial isn't there Rowan?

Rowan:
Yeah. And I think a lot of the models that have been used, they've been based on maybe older models that have been used with adults, such as the ‘Continuum of denial' by Taylor which was done in 1996. It's an older model but a lot of that information implies, it shows that these are not static things, that denial can be quite dynamic. It can change over time. And that people might move up and down a continuum of denial at different points in their work. And I think those models are useful. But we do always have to remember that we're working with children and young people and not adults. So we have to have a note of caution when using models that have been based upon adult work.

When we think about denial, I think we often think it's wrong that people deny, or it's bad or that must make them more risky, and we sort of feel that that's not the case. And a useful exercise for practitioners to have a go at and think about is looking at what might be your experience if you were asked to share something. So if I can do that with you for a second, Katy?

Katy:
Yeah.

Rowan:
So I want you to think about something that you have maybe experienced or done in your past. Something that you're really ashamed of and is not something that you would want people knowing about. Now I'm not going to ask you to share that and clearly, particularly because we're on a podcast, I'm not going to ask you to share, but I want you to just think about that thing. Now I want you to imagine that I'm asking you to share that information with somebody who's really important in your life.

Katy:
Okay.

Rowan:
And you don't want them to know. How do you think you might feel about having to say that information?

Katy:
Oh, I think it would be really, really difficult, actually. I think I'd worry that they'd judge me. Or that they'd think differently about me. Or that they might think that I'm the same now, even though things happened a long time ago.

Rowan:
Yeah, we all change.

Katy:
That I would do the same thing again which I know that I wouldn't. I think I feel scared, scared of rejection. And I guess for some of our young people, there are really serious implications. For some people, they might lose that job if they admit to things that they did or they might get in trouble with the police or something like that as well. But I think I feel really frightened and quite overwhelmed with really uncomfortable feelings like shame and guilt. It'd be difficult.

Rowan:
So if I said, regardless of all that, you've still got to tell them, what might you do? Do you think you would tell them everything?

Katy:
No.

Rowan:
What might you do, then?

Katy:
Confidently would minimise it and tell you a story that sat more comfortably with me.

Rowan:
So the truth's in there, but it's been softened.

Katy:
Yeah, but it is a distortion.

Rowan:
Or minimise. What would you be afraid of?

Katy:
I think just those things of people judging me. Being rejected. People thinking less of me. And it would be really scary, it would be difficult to manage.

Rowan:
What might you do to prevent the information coming out? If you were in that moment and it was like you've got to say.

Katy:
Well, I think if you were asking me in that moment, I think I might get quite angry with you and tell you to shut up. And as an adult, I have this sort of ability, I guess, to get up and walk out of the room and know that I can do that.

Rowan:
Just refuse.

Katy:
Or just refuse which I think is harder for children. If we're applying the same thing for children, I think that's much harder for them when there's such a power imbalance. I might want to discredit you altogether. I might think, “well, you don't know what you're talking about because…”.

Rowan:
Or the information you've got is inaccurate.

Katy:
Yeah, “you talk a load of rubbish. Rowan's always making stuff up”, that kind of thing. That's the sort of thing I might do, I think.

Rowan:
And we're talking on quite a cognitive level really about how you might think and feel. I want you to imagine, thinking more about your bodily sensations, so what might you think about in your body? If you were doing what we'd call 'a body check in', what sensations might you have at the point that you're being asked to share that information?

Katy:
Well, I think physiologically, my body would give me away. I would definitely go red.

Rowan:
You'd definitely go red.

Katy:
I’d definitely go red. And not just my face, but round my neck. I'd get really hot and I'd be sweating. And I'd get a really dry mouth. And I'd get the butterflies but like, not butterflies?

Rowan:
I'd get really tense. My muscles would be tense. My shoulders would be round my ears.

Katy:
And then I think to hide that from you, my non-verbal communications - I would be turning away. I'd be looking in the opposite direction. I would struggle to have any contact with you because I'd want to be hiding and I'd be leaning back, I think, away from you as well physically, if I couldn't get out of the room.

Rowan:
And I think what we need to do is really think about what we're asking of children and young people. They're often in a dynamic between them and the professional, and the professional is holding all the power. And the child can be in this position where they feel they're being forced to share something that they might be incredibly ashamed of. They might have a lot to lose by saying it. And I think we can sometimes, as professionals, forget actually just how much we're asking them to do and risk.

And sometimes that exercise is just helpful to remind you, it's not a very pleasant experience having to share something like that. I think the closest probably the majority of adults would be thinking, is if they had to go to the doctor and talk about a sexual problem that they might have, or something about an intimate part of their body, and that discomfort of having to go and share that. Well you imagine that's then something that is not a legal thing that you've done. That someone's been hurt because of that. And you feel very ashamed. And then you're saying to a child, “right, now you've got to admit to it”. I think we've just got to remember that denial serves a very important function to protect people's self-identity to keep them safe in lots of ways.

Katy:
We need to take care, don't we? And I think, like you say, it's not just particularly around harmful sexual behaviour, it's not just they've got it wrong and that they've harmed somebody, but actually just asking any young person to talk about anything to do with sex where they're still very much right in the middle of this complex stage in development and trying to work things out themselves, and they haven't landed on making peace with their sexual identity.

Rowan:
It makes you cringe.

Katy:
It's so difficult.

Rowan:
An adult they don't know as well. It's somebody that they haven't got a relationship with.

Katy:
So that's like an extra layer of real difficulty. I think it sounds like we really, really need to take care of children when they're in denial and not blame them. Rowan, what are some of the functions of denial that we might see?

Rowan:
I think that often there's little benefit for a child to admit it. But there is often a negative consequence. So you've got a situation where they may not feel like there's a benefit, and there's also a negative consequence. As a professional you need to think what do they stand to lose? It might be that they could lose their school friends, their family, other friends that aren't at school. It might be teachers see them differently. All these people that are in their life might look at them differently. And when we talk about losing them, that can be the loss of how they see them. Or it could be a genuine loss, so you will no longer live with your family. It might be rejection that a parent can't stand to be around them. And I know in other podcasts, we talk about sibling sexual harm, and then if you've got those dynamics at play as well, about how a parent may feel, to deny is actually a much safer option.

I think the criminal justice system, there might be situations where your legal advice is to give no comment or to plead not guilty. So that's a very significant consequence, that if the young person then says, “I did do it”, they may then be facing criminal prosecution as a result of it.

Katy:
Because they're going to implicate themselves, potentially.

Rowan:
Yeah and that professional might need to pass it on. It might not always be that the police decide to, or the CPS, decide to take action but that is a risk for them. And I think also that there might be child protection or safeguarding implications as well. And that might have implications on where they're allowed to live and the contact that they could have with people. I think sometimes you might have parents who are in a position of denial. So it might not just be the child and young person, it might be parents or family members. And then it doesn't really give the child permission to admit it. Because if your parent is strongly saying, “my child did not do this”, you don't feel like you've got the option then to say, “actually, I did”.

Katy:
There's no permissions there. And this huge stigma as well, isn't there around any kind of sexual offending, sexual harm. So how do you come to terms with that? Because we see it all the time in the media and the perception that people have… People are perverts, that they're paedophiles, that language is…

Rowan:
And these are not many sex offenders. These are children and young people. They don't need to be going on into adulthood to display further behaviours. And I think it's really important that we remember that and we don't use that terminology that we hear that are towards adults. But the reality is that that can in our society happen. And that's a fear for them.

I think we do need to think about, whilst we want to encourage children to be open, we would want them also to think about who they're sharing the information with and whether that's appropriate. So we wouldn't want them to tell their neighbour down the street that they've displayed a behaviour, but it may be appropriate that they tell a professional that they're working with and it might be appropriate that they tell a family member. So we would want to manage who knows that information.

Katy:
And we've certainly done child-led safety plans where we set out really clearly who's a safe person to talk to about. And also similarly, done work with children where they've been able to be really brave and talk about what's happened in a session, but then you almost need to do some work with the parents to support them in coming to terms with that. It's really difficult.

I think, just to flip it though and it is really important that yes, we get lots of children who have displayed the harmful sexual behaviour, that have to maintain a position of denial. But the flip side is, some children may not have done these things that they've been alleged to have done. And we need to hold that in our head as a possibility because it is difficult to pick apart a child who's telling the truth and the child who is in denial sometimes. But there is, of course, a possibility that they haven't done it and that I think is important.

Rowan:
How might shame present itself? What might you observe with the young person where you think they're showing signs that they're ashamed?

Katy:
I think it's common and it's really common at the beginning of our work. I think we'll often see, even before you get into the room to have a session when you first meet a child, I've had children that won't come into the room to talk to me. That they might want to run out of the house. I've had children that will swear at me and be aggressive, to get me away in that way because that's what feels safe. And then once you overcome that first initial meeting and you're able to reassure them, and that they can come into the room with you, I've had children that have come in with their hood up, and they keep their hood up and pull down…

Rowan:
That very defensive body language.

Katy:
So you can't see their face at all. And I think it's really important to allow them to keep their hood up. I think sometimes we'll see parents and carers [say], “take your hood down”, and they don't need to do that. If that's what helps them feel safe and keeps them in the room, that's absolutely fine.

Their non-verbal body language, they might be sitting and turning away, looking at the floor, not looking at me, not engaging in any kind of verbal conversation with me. They might be aggressive to keep me away that way. Or there might be lots and lots of deflection and distraction and I'm going to do everything I can to make you talk about other things that I want to talk about. And all of those are absolutely fine. We need to allow children to go at their own pace. And sometimes we can name those things and we can say, “I'm wondering if, you know, you've got your hood pulled up because that's what feels safe?”. I know during coronavirus and the pandemic, I've had children that have kept their masks on, even though they don't have to keep their masks on in the room and they'll say that...

Rowan:
Or the cameras are off...

Katy:
Yeah, all of those things and that's okay as well. Like I say, it's about sometimes naming it - “I'm wondering if you're feeling uncomfortable”.

Rowan:
And not putting too much pressure on. Sometimes we put pressure, don't we? We want eye contact. We want the hood off. But letting them do that in their own time because you've created a safe environment.

Katy:
And generally speaking, I think they do. If you don't push it. I think eventually the hoods come down and you start to see that change which is really lovely to see.

Rowan:
How do you work with children when shame and denial is present?

Katy:
I think at the beginning, you've got to be very careful to be clear about why you coming, and transparent about it, but not put them in a position that forces them into denial. So you might want to lay out very concisely what you know about the harmful sexual behaviour and why you're going to be working with them. But then quickly move that conversation on so it doesn't give them an opportunity to say, “but I didn't do it”, “but I don't know anything about it”. You might say, “we know that it's because something's happened to your cousin, you sexually harmed them, but we're not going to talk about that today. We're going to talk about that next week”... Not next week but as the work goes on. And then you move the conversation away from it, because I think the risk is that if you give them opportunities at the beginning, when they're feeling really quite overwhelmed with shame and fear to say “I didn't do it, I didn't do it”, then it's a harder place to come back from to then be honest about what happened even if they want to, because they think, “oh God, that means they know I've lied to them four or five times”.

Rowan:
But you don't want to act like it didn't happen, or that's not what you're there for. You need to be clear that that is what you're there for, and that you believe that's happened.

Katy:
And I think it's acknowledging some of the risks as well. So when you get into that place of where they're saying, if they do say, “I didn't do it” or “it wasn't an impact”. And I think the reflection back is to say okay and acknowledge that you can hear what they're saying, but actually suggest that “that's telling me that you're not quite feeling safe enough to talk to me about that, yet, and that's okay. We don't need to talk about that today. I think that's absolutely fine”.

I think fundamentally, it's about building that trusting relationship with that young person, that unconditional positive regard, so that they can trust you to talk. And they might never, for all the reasons that we've outlined, it might always remain the safer choice to never admit to what's happened. But for some young people, they can move on, and they are able to be open and honest about what has happened. But it does take time and it takes real investment in that relationship. But do you think that, working with denial, and our view of how we work with denial has changed over the years?

Rowan:
Yeah. I think there used to be a perception in this work that a person needed to admit what they've done to move on. And they needed to take responsibility or accountability for what they've done and I think that stemmed a lot from adult services, where I think there's a growing recognition that these are children and young people and we need to take a more therapeutic and trauma-focused approach to the work with children, so we can work in different ways to work around that denial without pushing them to a position of changing.

I mean, let's face it as a practitioner, if a child acknowledges what they've done, can learn to understand it and articulate it and take responsibility, it feels a lot better doesn't it? I feel more confident that I can say they've moved on. But the reality is that's not always something that they're able to do, and especially if they're in a position where they could lose family members or criminal consequences, you might be asking themselves to put themselves at risk and that there could be a risk of physical threat if they admitted to what they've done. And so yes, I think services are moving on in how they see this work.

Katy:
And I think the research base will evidence, won't it, that actually denial and increased risk don't go hand in hand. And if I think back to that exercise you did with me, just because I wouldn't want to tell you about what it is, doesn't mean for a second that I've any intention of doing it again. So I suppose it's about that personal responsibility and personal honesty about what's happened.

So Rowan, what are some of the approaches that you might use if you're working with a child and young person who is remaining fairly fixed in their denial? What might you do?

Rowan:
Sometimes I name the denial. I'm not necessarily saying to them “you're in denial”, but I might look at what denial is and what purpose denial serves for people. So I might use an exercise where I get denial statements. That might be things like, the different reasons why someone might deny. I'll pick things like my parents won't love me, people might think I'm a pervert, I may never get a job. And these statements are all things that we've heard many, many young people say over a period of time. And when I hear different experiences, I might increase the different statements that I've got. And then I'll give them to the young person and say, “what do you think some of the reasons why people might feel the need to deny or minimise?”.

Katy:
So you're not asking them why they deny?

Rowan:
No. It's a more generic thing. But what the young person is most likely to do is pick things that they can relate to because they're the reasons that it might be why they're denying it. And that might give you an insight to some of those reasons. And they may be things that you can then subtly work on and support them with. So if, for example, it's the fear of the loss of the parents, because at the same time I’d be doing parent work, I might be talking to the parent about how they feel about it. How would they feel if their child acknowledged it? And if I felt very sure that the parent could give an appropriate response, I might need to bring them together and ask that parent to name that for them and say, we believe that this happened. There's different ways of that.

I also might just do third-person work and case studies, so “this is a scenario where such and such a body has done…” and then I'll state the behaviour. And then I will ask them to unpick that scenario about who might have been thinking and feeling? What was going on in the scenario? Why did that happen? But I might have picked a behaviour that is very similar to that young person's experience. Not identical, but similar. Because again they're going to draw on their own experiences from that. I know you do ‘similar but different' family. How do you do that?

Katy:
This is a really, really simple technique that has been really effective, either where children are denying or where they're really struggling to think about and talk about the emotional impact or the emotional impacts on others. So I have a great big A3 print-off that has lots and lots of different cartoon people of all sort of shapes, sizes, age. And I'll take that into the room and I'll ask the young person to create a family using those cartoon people, ask them to give them a name and an age and think about the family dynamic. And again, what we tend to see is that children will pick families that are fairly similar, reflective, to their own. And then I will put in scenarios for that family that I know are similar, but slightly different to their own experiences. So if a child's parents are separated but they are really struggling to be able to tell me what that feels like for them, then I might talk about the parents in their made up family, that there's been a divorce and how does the little girl or the child feel about that. And often children are able to talk in that way with such insight and such thought about emotional fallout, impact, in a way that if I'd said, “how do you feel about your parents separating?” they would never have...

Rowan:
They would just shut down...

Katy:
They would just shut down. They'd never be able to do it. And then I might think about introducing a similar but different scenario of harmful sexual behaviour, or any other behaviours where if they're also displaying angry, aggressive behaviours or other behaviours that are indicating distress, put that in. And now we know that the older child has sexually harmed the younger child and how does the older child feel? And what was going through their head at the time? What do you think the younger child is thinking? But because they've been given names and identities, it externalises it I think, from their own experiences and they can talk really quite freely in a way that they wouldn't be able to do.

I think the only note of caution is that if you really believe that they're talking about themselves, which quite often they are, and then you get an inadvertent disclosure or admittance to something that either you didn't know about, you just need to think carefully about confidentiality and whether or not you need to share that information. That's a discussion to have with your supervisor, with a colleague or someone else who perhaps knows that family, to think is this a disclosure about them? Or are they talking about this fictional family? It's just a note of caution really, but otherwise it's effective, just like you said, like a case study in vignettes.

Rowan:
And I think it's not about colluding with the young person or trying to pretend it didn't happen. We are still acknowledging with them on a regular basis that this is why you're coming to do this work and what the reasons are. But it's just meaning that we take that pressure off. And like you say, when you externalise that slightly and you don't put the focus onto the child, “you're the problem, you've done the behaviour”, it can allow them to become a little bit more relaxed and open up more.

I mean denial ultimately is something that you can work with. You don't have to force an admittance of the behaviour. It can be a safety mechanism for that young person to protect themselves or to avoid negative consequences. But there are lots of different ways and different techniques that you can work with denial.

(Outro)

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