Sex Education for Emotional Disturbed and Sexually Abused Children

Andy Lole.

THERAPEUTIC CARE AND EDUCATION Vol 2: No 2. WINTER 1993

The following work took place at the Cotswold Community which is a residential therapeutic community, situated near Cirencester. It provides care, education and individually-tailored treatment programmes that are designed to identify and repair some of the damage done to the development of the children in their early lives. A focus of the work is to try to enable the children to make connections for themselves between how they feel now and some of the possible root causes of these feelings, whilst being provided with clear, firm management and consistent, concerned, non-delinquent and caring adult role models. The staff have regular individual and group supervision with a consultant child psychotherapist, an educational psychologist and a psychiatrist. The client group, who are all male and aged between 9 and 17, are referred from all over the UK, and all have social histories that include abuse, neglect, deprivation, family breakdowns and anti-social behaviour. A large number of the boys have been or are suspected to have been sexually abused, and a percentage are known to have engaged in inappropriate sexual behaviour with other children. Many of the boys display frequent explicit sexualised behaviour, both in their language and their interactions with people.

When contemplating sex education for these children the usual anxieties of embarrassment and awkwardness are aroused that would be by the prospect of talking about such matters to any child. There are also the worries about directly raising memories related to the abuse, wondering what needs to be said bearing in mind that many of these children have had inappropriate sexual experiences, and are therefore not inexperienced sexually. It is important to realise that whilst being abused children may have no understanding of what is happening to them, so it is sensible to assume that they need as much information as any other child. There is also the fear of how your interest and advances may be perceived and used by these unusually sexualised children, and the concern that you could indirectly be promoting sexual activity between the children by raising their awareness and knowledge of the subject.

These worries need to be weighed against the responsibility we have as the only adults these children have at present to be alongside supporting and informing them as they enter into the uncertain and unsettling period of adolescence. The other significant adults in their lives have often been the ones either who have abused or neglected them, or in some way allowed this to go on at the hands of others. They also have the added disadvantage of living with a peer group that has a similarly distorted experience of sex and growing up, which restricts an area that many children can use to learn and verbally test out their observations and theories.

Struggling with these different perspectives one could opt for the safer option of just answering children’s questions when they arise, as one would do with a very young child, without offering the lead.

Recently, during a discussion involving all of the older boys at the community, one boy asked if it would be possible to study sex education as part of the school curriculum. Through asking the group direct questions we established that, with the exception of one child who had probably been more grossly abused than all of the others, all of this older more mature group wanted to be involved in a sex education course where they could stay together as one large group, and that would be run by a man and a woman together. The one boy who opted out explained that he felt that people should learn about sex though reading books, and through their own experience. Our feeling was that he wasn’t yet ready to be able to face the feelings that may be evoked by talking and listening to others talk about sex in a group, so his keyworker would look for opportunities to talk individually with him about how he felt. We decided that what would be of most help to him would be to communicate our expectation that we would help to enable him to participate in a future sex education course by initially talking with him individually. We hoped that this would challenge his assumption or view of himself of being different and not being able to be contained or catered for in the group. Unfortunately he was very resistant to even allowing individual work to go on, expressing the point of view that he had talked sufficiently about his abuse in the past and he was not prepared to re-open the subject.

At this point the combined adult team of teachers and residential care workers decided to spend a series of team meetings with our consultant child psychotherapist, with the particular focus of preparing ourselves for the types of questions and likely areas of anxiety that might be raised in the boys. It seemed a useful opportunity to anticipate how we would respond, and to express our own feelings about being asked questions on this delicate subject. It also highlighted our own experiences of sex education, or lack of it in most cases, and what probably is the more common experience of just learning within your relationships with sexual partners.

We ran a sex education course for one term. It seemed important that the course had a clear fixed end to it which the boys were aware of. The course was made up of fourteen 50-minute sessions. It was available to all of the children who we felt were emotionally mature enough to be receptive and ready to join the group. In the first session we introduced the “Ground Rules” of the group:

1. No one, child or adult, was allowed to ask anyone else about their own sexual experience, ie, this was not the forum for disclosures or an opportunity for anyone to pry into other people’s private lives;
2. Things said in the group should not be used negatively against anyone, eg, if someone asks a question they shouldn’t be ridiculed or humiliated for this later on;
3. That the last 10 minutes of each session would be an open question and answer time;
4. Nobody had to say anything if they didn’t want to;
5. It was perfectly all right to be and feel embarrassed.

The sessions were run by a man and woman together, with the man leading the discussions on aspects of male sexuality and the woman leading on discussion about female sexuality. They aimed at creating a healthy interchange of ideas and comments between themselves in order to present an image of men and women being able to talk about sex together amicably, and in an open and frank manner.

The content of the sessions included the following topics:

• the feelings connected to growing up – from babyhood through to and including adolescence
• male and female anatomy and the changes that take place in adolescence;
• masturbation, sexual intercourse, wet dreams;
• contraception – birth control and safe sex;
• sexually transmitted diseases;
• pregnancy and child birth;
• heterosexuality and homosexuality.

We used several videos, including excerpts from the BBC series, “Not in front of the Children”, and a short Canadian animated film called, “Sex – A Guide for the Young”. When we talked about contraception we took in some condoms, opened them in the group and then demonstrated how to put one on (using fingers in substitution of a penis). When we looked at anatomy we decided it was more appropriate to use good quality line drawings rather than photographs.

Throughout the course we stressed the positive benefits of having sexual relationships with partners who one has very strong positive feelings for, where the sexual aspect can be just one form of expression between people who care a lot for each other. We also repeatedly emphasised the importance of being able to say no when things don’t feel right, and acknowledged that what feels right for one person may not for another.

In our last session we introduced a letter box into which we encouraged the boys to anonymously place questions that they wanted answering. The main themes that emerged as areas of anxieties were to do with aids, homosexuality and prostitution.

It was very interesting to observe how sensibly and maturely this group involved themselves, listened, asked questions and generally participated. Out of all of the subjects they were involved in at the time this was the one lesson in the week where they would be waiting quietly and patiently some minutes before the group was due to begin. The smooth and relaxed way the group ran seemed to relate to the fact that we were addressing the adult needs of the boys – ourselves as adults talking to the adult part in them – which appeared to be quietly and maturely acknowledged by the boys. The size of the group and the involvement of a man and a woman also appeared significant, providing an element of personal safety and a reduced chance of seduction.

We deliberately designed and ran the course making assumptions about the normal needs of the children in the group, despite and bearing in mind the very abnormal experiences many of them have had. We decided that what these children needed more than anything else was to be treated as any other child of their age in relation to their wanting to know some factual information about their bodies, and about how they may decide to relate themselves to others sexually. One of the most important messages that we wanted to communicate to the children was that sex is something that we can talk to each other about. Avoiding talking about it may unconsciously communicate or reinforce all kinds of negative messages to them.

One of the most valuable changes we have noticed in the group of both adults and boys since the course has been completed is an easing of being able to broach the subject of sex, and then being able to develop a discussion. As a staff group we have begun to be more active in looking for clues from which we can open up areas of interest, anxiety or concern. This could be when watching the television, hearing a line from a song, or in connection with a newspaper article. More importantly it is often in questions or opinions expressed by the children, and these are regularly phrased in such a way to disguise what it is they really want to communicate or find out. Our experience has been that because most of the children living in one household had shared sex education lessons, and that the adults who care for them had prepared themselves in readiness to get alongside them on their return to the house, it had the positive effect of helping to open up the culture in the household, enabling the work to continue beyond the classroom.