Honoring Our Colleague, Diane Langelier

By David S. Prescott, LICSW

Organizing conferences and other trainings is tough work that requires just the right people–just ask anyone who has worked for ATSA and its chapters. Having had the privilege of participating in conferences on five continents, one recognizes a kind of archetype of the person who makes it all happen. Not an event planner in the traditional sense, this person always seems to be working quietly behind the scenes. They avoid the limelight, calling no attention to themselves, and make complicated things seem simple to the attendees. When such organizers do their work effectively, they tend to pass only barely noticed in the conference experience.

Above all, these people believe in, and quietly embody the mission of preventing abuse. Diane Langelier is the ultimate example.

I first met Diane Langelier in the final days of September 1999–25 years ago! She was managing the registration and operations for a ten-day training event on adolescents who had sexually abused. The training, coordinated by New England Adolescent Research Institute (NEARI), gradually morphed into several different conferences, including the annual conference of MASOC and MATSA (the Massachusetts chapter of ATSA). She has been involved at every turn in every one of these conferences, and related trainings.

The people who benefit most from the diligence of people like Diane never know to say thank you because they won’t have been abused. Through her efforts, it is impossible to know how many people owe a debt of gratitude to Diane for her work in furthering the education that prevents abuse.

To round out this blog post, I turned to some of her closest colleagues. What do they say?

First, MASOC Executive Director Emerita, Joan Tabachnick, noted:

“I could tell so many stories about Diane.  How she sits at the front desk from the beginning of each conference until the end.  She knows each name and remembers stories about each person, and she treats every single one of us with incredible kindness and respect. THAT is exactly what our field is or at least should be about, and she models it for everyone as they walk in the door.  

“Everyone always saw Steve Bengis (Founder of MASOC, NEARI Press, and the NEARI School) as the face of MASOC and this conference, and he was out in front.  But it was Diane who did ALL of the detail work to make sure that the conference ran smoothly.  From reaching out to sponsors, to registering individuals and whole groups from state agencies, making packets of information (in the old days), editing our brochure for typos and then our website, to making sure that there were signs for each room and putting the right workshops in each room, and I could go on and on.  And in the old days?  This was all done by hand, and we had 15 workshops for each session!  

“And in addition to this, if you sit with Diane during any of the sessions or in the down time, she has a wicked sense of humor that she also used when she got a particularly challenging phone call (e.g., a question that was answered at least five times on the website and in the brochure)–but always after she hung up the phone.  

“I can't say enough about Diane!”

Meg Bossong, the Executive Director of MASOC (along with that organization’s board of directors), had this to say:

“As NEARI’s fiscal manager, Diane Langelier has shepherded MASOC from its roots as a tiny, all-volunteer organization existing on in-kind contributions, work trades, and the donations of time and treasure by its founding members to its current form. Diane has done the often unsung but deeply essential work that makes organizations run: opening the mail, managing the books, and being the voice on the other end of the phone whether someone needed an invoice for a conference or was a parent or a clinician looking for help. She has welcomed thousands of people to MASOC’s conferences and helped people with problems big and small for decades. We are profoundly grateful for her work and her deep knowledge and care.”

Finally, Past MASOC Board Chair Kevin Creeden added his own thoughts in his own inimitable style:

“Diane:  patient, kind, incredibly competent, funny, does not suffer fools.  At MASOC we have been incredibly fortunate to have leaders like Steve Bengis and Joan, but Diane is the cornerstone that they both have leaned on.  I would say she is the “Conference Queen”, but I don’t think queens tend to work as hard as Diane does.  I propose that we rename the conference center at the Best Western (where the MASOC and MATSA conferences have traditionally taken place) after Diane (or at the minimum the Princess room: Princess Di ?)”

In my own final analysis, most important of all is that Diane Langelier has helped thousands of professionals and assisted in improving the lives of countless thousands more. That is a fantastic track record for someone who is only rarely acknowledged. I trust I speak for all attendees and readers when I say a heartfelt “thank you!” to Diane.

Million Mile Reflections

By David S. Prescott, LICSW, and Kieran McCartan, PhD

ATSA’s Sexual Abuse blog reached a milestone in the past few weeks: It has now been read well over a million times. This is the blog’s 546th post, and it was recently rated as the world’s 5th most-read blog in the area of sexual abuse. We regard this last statistic as particularly welcome; ATSA’s blog focuses in different areas from those of organizations such as RAINN, NCMEC, The Centre for Expertise on Child Sexual Abuse, which often work more on raising awareness of common issues and challenges among those who have been victimized. They are less likely to focus on areas like risk assessment, treatment innovations, or the use of the polygraph.

The blog itself started as a venue for discussing studies published in the journal, Sexual Abuse. Robin Wilson was the original “blogger.” Kieran remembers getting the email to take over from Robin in the summer of 2014, he was on a train from Leeds to Bristol after having attended a Circles of Support and Accountability conference. David was already contributing at that point and then participated more regularly when Kieran came on as chief blogger. The blog became more regular moving to three or four times a month, and its content expanded into other directions: taking note of innovations in assessment and treatment, sometimes mentioning trainings or reviewing conferences, and occasionally providing reviews of multiple studies. Since 2014, Jon Brandt, Alissa Ackerman, and Kasia Uzieblo have all served as Assistant Bloggers. Others have often stepped in to provide guest posts, including Joan Tabachnick, Cordelia Anderson, members of ATSA’s Prevention Committee, Don Grubin, Norbert Ralph, and many others. We have been grateful to them all.

The aim of the blog has always been two-fold, communication and upskilling. It’s important to emphasise the importance of talking about sexual abuse and making it a true lived reality, so that people and communities and understand and own it. Because both Kieran and David write academically and professionally as part of their day jobs, they understand the importance of research and the evidence base, but academic writing is not always the best way to communicate issues to different populations. We must talk to people where they are at and in a way that appeals to them. Writing the blog has help communicate our understandings of sexual abuse and hopefully upskilled a range of populations, encouraging further debate and insight. The most important thing that the blog can do is make people stop and think; hopefully we have done this over the years.

If there has been anything we’ve learned by watching which posts garner the most attention and feedback, it has been the importance of how we all frame our messages. Guitarist and composer Frank Zappa once observed that, “The most important thing in art is the frame.” Otherwise, he observed, it’s all just a bunch of stuff on the wall. So, it is with the work of responding to and preventing sexual abuse. Several ATSA conference plenary speakers in the early and mid-2000s, along with our most recent ATSA lifetime achievement award winner Joan Tabachnick and Gail Burns Smith winner Alissa Ackerman (both past and present bloggers) have challenged us to consider how we construct our messages and arrange them in a way that meshes with the public’s highest aspirations. For example, we don’t simply work in prisons or civil commitment centers; our work really is about preventing sexual abuse from occurring and recurring. From there, we’ve learned the importance of writing tight prose for a general audience. If anything, the proof this approach lies in the fact that ATSA’s blog posts are rarely misunderstood.

Using safety tech to help stop people from watching child sexual abuse images and videos

By Larissa van Puyvelde, Minne De Boeck and Catherine McShane

Editors note: the PROTECH tool and the consortium that produced it were funded by the EU Horizon 2020

The growth of technology, ease of access to the internet and the ability to be anonymous online has fuelled the supply and demand for child sexual abuse images and videos online. Millions of child sexual abuse images and videos are distributed on the internet every year and these are only the ones that we know are reported by organisations like the Internet Watch Foundation in the UK or the National Centre for Missing and Exploited Children in the US.

The impact on survivors of child sexual abuse is horrific, as imagery of their abuse can continue to circulate online long after they may have been rescued and safeguarded. Survivors suffer repeated victimisation whenever the record of their ordeal is shared and viewed. Traditional law enforcement approaches struggle to cope with the volume and scale of the global problem.

New ways to tackle the complex issue urgently need to be explored and, as part of the EU’s strategy for a more effective fight against child sexual abuse, the EU has been funding several studies aimed at early intervention.

One such project, Protech, regards the development, implementation and evaluation of a safety tech tool to stop the viewing and distribution of child sexual abuse material (CSAM). The intention is for it to be used as part of a prevention programme by people who are at risk of viewing CSAM. The project is mid-way, and what follows are early insights into the project’s progress so far.

To develop the tool, the Protech project has brought together experts from the European Union (Belgium, the Netherlands, Germany and Ireland[i]) and the United Kingdom, from diverse backgrounds including criminology, public health, clinical and forensic psychology, technology, child protection and internet safety.

The aim is to create on-device technology in the form of an app that aims to identify and prevent sexual abuse images of children from reaching the screen of the user’s device and that displays blocking messages warning of harmful content.

The design of the safety tech started with the 'for and by' principle, which implies that the intended users would help inform how the tech should be shaped, to ensure that the app could effectively support them to stop their risky behaviour, and significantly reduce the viewing and demand for sexual imagery of children on internet-connected devices.

To do this, the project team invited two cohorts of participants to give input on how the technology should work and what was needed to ensure that it would be used. The first group included 30 individuals at self-reported risk of CSAM offending – those likely to want to view images and videos of child sexual abuse. The second group consisted of service providers, mainly therapists of CSAM users, who participated in focus groups.

All participants were asked to share their opinions and concerns regarding four domains for the app’s development: privacy issues (1), blocking functionality (2), potential interactivity (3) and possible deployment methods (4).

The results show that privacy (domain 1) was a challenging point, as most respondents indicated that they are concerned about the storing of personal data, data security and the potential legal consequences. Hence, sensitivity around privacy needed to be taken as a core point around which the app was developed.

For domains 2 and 3, Protech researchers could not find consensus among all responses. Overall, the results showed that every respondent would like to personalize features of the app. This highlighted the need to make the app customizable, for example, in terms of blocking messages or implementing a pornography filter, because some respondents felt that access to adult pornography would either help them control their impulses or perhaps make them worse. Some felt that adding certain features such as a diary would be helpful. Participants also advocated for access to FAQs relating to use of the app, and an option to provide feedback to the developers.

Among the participants, there was no unanimity on how best to download the app (domain 4). Some thought it would be easier to download it through an official channel. Then again, others found anonymity important. Through discussion with the app’s developers, it was decided to offer the download link through an external portal, the most secure method for deploying the app.

These findings created the first version of the app, called Salus. Salus is now ready to be tested in a pilot stage. During this stage it will be assessed whether the app or similar technology and its implementation, has the potential to be part of an effective prevention programme. The app uses machine learning and conventional techniques (such as keyword or URL matching for detecting known imagery of child sexual abuse) to block CSAM from appearing on the screen of the user’s device.

The Protech project relies on voluntary participation and participants will be able to make informed decisions during the entire pilot to ensure transparency about functioning, onboarding and how to withdraw from the app. There are, and always will be, methods by which users could circumvent technology such as this but the important characteristic of the Protech target group is that these will be individuals who want to take part, who want to get help and who have volunteered to do so.

The three month pilot will be rolled out for up to 30-50 participants in a treatment programme and will consist of an intervention group, which will effectively test the app. All participants will be sent a survey at two different time points with questions regarding their wellbeing, their (online viewing) behaviour and their opinions on the safety tech.

The final step of the project will draw on survey findings and evaluate the effectiveness and outcomes of the pilot. Furthermore, project partners will evaluate what has been achieved and learned as well as address any questions regarding the technology, implementation and the pilot that emerge because of the project.

If effective, the novel use of technology to help at-risk individuals to control their viewing of CSAM could hopefully be used as a blueprint for using safety tech for perpetrator prevention across the EU, but it is by no means a silver bullet. Ideally any technology would need to be implemented as part of a wide, holistic package of measures intended to help prevent child sexual abuse and exploitation, further protecting victims and alleviating the workload of law enforcement.

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[i] The Protech project members are Charité – Universitätsmedizin Berlin; Tilburg University; The Lucy Faithfull Foundation; Offlimits/Stop it Now Netherlands; the University Forensic Center/ Stop it Now! Flanders at University Hospital Antwerp/University of Antwerp; SafeToNet; the International Policing and Public Protection Research Institute (IPPPRI) at Anglia Ruskin University and the Internet Watch Foundation.

 

The Changing Face of Men Behind the Scenes

By David S. Prescott, LICSW

An “Opinion – Data Points” piece in the Financial Times by John Burn-Murdoch dated September 20, 2024, illustrates a growing trend in research involving men’s experiences. Titled “Young Women Are Starting to Leave Men Behind,” it reviews the current state of education, employment, and outcomes and concludes, in essence, that much has changed in the past 30 years.

Reporting on these findings is never easy. Before even reading this kind of article, it is easy to object on the grounds that the “glass ceiling” is still firmly in place, that the majority of violence is perpetrated by men against women, etc. It is also noteworthy that the role of gender in this research is seemingly limited to cisgender men and women and does not examine race. Just the same, in line with Richard Reeves’ 2022 book, “Of Boys and Men,”  Burn-Murdoch points to data that professionals seeking to end abuse will want to know. From the article:

- Where slightly more men than women used to go to university; now far more women go than men. This finding is similar in the UK, US, Canada, Korea, Norway, and Spain.

-  Young women's employment rates are overtaking men's in several developed countries including the UK, US, Australia, Canada, France, and Norway.

-  The share of young men who are neither in education, in work, or looking for a job is climbing, including in the UK, US, Canada, and France.

-  Young women's incomes have overtaken men's in the UK. It is a similar story in the US, where young non-college women and college-educated people of both sexes have all seen incomes either hold up or increase, but non-college men have plummeted down the income distribution.

-  Young men continue to out-earn women in the US, though non-college men's economic status has fallen steeply.

As Burn-Murdoch notes, “while discourse and policy remain focused on other things, the repercussions of these tectonic shifts are quietly playing out everywhere you look.” He further comments that, “With socio-economic trajectories heading in different directions, a growing minority of young men and women do not see eye to eye. Young male support for populist rightwing parties is on the rise, particularly among those without jobs and degrees.” He further postulates that “Violent unrest is more likely with a growing pool of young men with little stake in society or their future. And relationship formation itself is being affected, as growing numbers of female graduates discover a shortage of male socio-economic counterparts, and simultaneously have less need than ever to pair up with a man for financial support.” Like Reeves, he emphasizes that situations should never be a zero-sum game. To this, this writer would add that the original aims of social unrest beginning in the 1960s was to increase equality, not to leave people behind.

Why mention these findings in a blog centered on sexual abuse prevention? After all, individuals are responsible for their own behavior and these kinds of findings should not be considered exculpatory with reference to violence. And all adults have a responsibility to prevent child abuse. Nevertheless, there is much going on behind the scenes of these data. One need only look at the life expectancy gap due to increases in “deaths of despair” among men.

Some considerations for practitioners include:

-  Taking note of the circumstances and contexts in which dynamic risk factors may become aggravated (e.g., collapse of social supports, escalating negative emotions, emotional loneliness, etc.).

-  Being able to discuss these findings with clients and understanding that societal inequities can be more complicated than they seem.

-  Doubling down on expressing empathy and compassion, and forming meaningful working alliances with clients.

Some implications for broader efforts at sexual abuse treatment and policy include:

-   The need to be aware of and discuss these issues with our colleagues and policymakers; while concepts like patriarchy and hegemonic masculinity continue to require our focus, we should also be aware that there are other changes taking place. We can’t focus in one area at the expense of another.

-  Understanding that if we really want to end violence, we may need to take a long, hard look at our education systems, including in the earliest grades.

-  There is an urgent need for more research to understand the roots of these trends and disparities.

The good news in all of this is that we finally have data to help us find our way. Whatever the pet theories that might emerge in some areas, we are several steps ahead in terms of finding data-driven ways forward.

 

 

 

 

 

 

 

All you need to know about preventing the perpetration of child sexual abuse

By Joan Tabachnick and David Prescott

What is the current state of prevention?  Stop It Now! hosted an engaging hour-long conversation with many leaders in our field about preventing the perpetration of sexual abuse.  This is particularly useful for you, as ATSA members, because you have such deep knowledge of the adults, adolescents and children who have sexually abused.  What you will hear is how YOUR knowledge is something the rest of the world needs to know.   

The discussion was part of an award ceremony, but what it offered was a rare insight from colleagues who have been doing this work for as many as 30-40 years. 

Karen Baker (former executive director of PCAR and the NSVRC), Cordelia Anderson (Preventionist extraordinaire), and David Prescott (ATSA co-blogger and past president of ATSA) spoke about what was known about sexual abuse 30 to 40 years ago.  Cordelia spoke about the profound silence around child sexual abuse.  There was nothing in the news, TV shows, or the movies that addressed this issue.   Nothing existed for treatment and the only prevention strategy was focused on stranger danger.  David talked about the lack of any general training for anyone working with children or adolescents or even adults engaging in problematic sexual behavior.  Karen echoed the comments from Cordelia and David and added that our only avenue for survivors was through crime reporting and yet these courageous individuals often faced victim blaming, shame, and the complete lack of resources for survivors.  Furthermore, the messaging was both incomplete and misleading in many ways.  Rather than convey hopelessness, these perspectives from the past decades showed us just how far we have come and the progress we have made.  There is no longer silence about this issue.  Information, training, programs, related to prevention and the focus on trauma-informed care has become the norm.  We now offer prevention strategies that reflect the reality of sexual abuse in families and communities. 

The other speakers focused their remarks on the future and what can be accomplished in the next three years.  Although Stop It Now! and ATSA have focused on the importance of preventing the perpetration of sexual abuse, the following four panel members spoke about how this perspective, especially in the last 10 years, has finally been embraced by the larger prevention community.  Ryan Shields (Assistant Professor of Criminology and Co-Chair of MASOC), Tyffani Dent (clinician, educator and Immediate Past President of ATSA), Elizabeth Letourneau (Director of the Moore Center and a past president of ATSA), and Jane Silvosky (Director of the National Center on the Sexual Behavior of Youth) each shared their insights on where the field needs to go. 

Ryan started us off, blending his background in public health and criminal justice.  Given that “we humans are story-telling creatures” he said, “part of our challenge is to describe what prevention looks like”.  It is easy to visualize how the criminal justice system works with arrests, court, judges and jails.  We need concrete stories of prevention as well.  Tyffani continued the thread that Ryan began and challenged us to tell “our” prevention stories in a way that can meet the diverse needs of diverse communities.  We need to create an overlay of these stories , our policies, and our funding to reach beyond the one solution of punishment.  She also emphasized the need to build our community efforts in collaboration with survivors.  It is so much more powerful if we tell our stories together and it can also break the isolation so many of us feel.   

Elizabeth spoke about the explosion of science and research on preventing the perpetration of sexual violence.  This means that we not only have developed perpetration prevention programs, but we are in the process of evaluating what is working.  She noted the concentration of prevention programs in the global north, not something that we had connected with before.  Even though it may not be a short term initiative, she spoke about the necessity of having government funding of these prevention programs.  Jane spoke eloquently and passionately about the need to align our work on the ground – families are not in silos like our professional communities.  They need our resources regarding sexual violence prevention but also suicide, child abuse, mental heath issues and so much more.  And we as adults need to align all of our resources around the children and around the trusted adults.  If we do want to address the complexity of these issues, families need to be able to talk about sex and relationships and the complexity of our human interactions, including pornography.  This is a multilayered conversation that needs to address spaces, both physical and electronic, that interweave the protective factors of each family and each program.  She ended with a message from youth – “This is serious and we need hope to get through.” 

The Q&A was equally engaging and multi-layered.  If you care about prevention, this is an easy hour to spend listening and learning from some of the best in our field.  Here is the LINK and you can watch the discussion starting at 20:07.

 

Blogger’s note: Joan is being modest. Although the discussion happened as described, it all took place in the context of celebrating Joan’s career as she received Stop It Now’s Founder’s Award. Congratulations, Joan!

 

Preventing Our Systems from Causing Further Harm

By David S. Prescott, LCSW, LICSW

There have been several news items recently that should cause anyone concern. Fortunately, they illuminate activities that can be improved under the right conditions. Just as sexual abuse is preventable, so we can also ensure that our interventions do not cause further harm to clients who have sexually abused and/or been abused. In this author’s opinion, it is crucial that we recognize what we’re up against, where our failures are, and talk about them.

On August 1, 2024, the US Justice Department issued a report finding unconstitutional conditions at five Texas juvenile justice facilities. The report can be heartbreaking to read (including failure to protect children from sexual abuse and exposing them to excessive force). However, it is not the only report of its kind. Lawsuits involving numerous other facilities around the country are ongoing.

On September 4, 2024, the US Justice Department announced a civil rights investigation into sexual abuse by correctional staff at two California prisons for women. From the press release: “Concern about the physical safety of people inside California women’s prisons is not new,” said U.S. Attorney Phillip A. Talbert for the Eastern District of California. “Media coverage, state audits, advocates’ efforts and private litigation have sought to draw attention to an issue often unseen by many in the community. This investigation responds to those concerns and will aim to ensure that California is meeting its constitutional duty to incarcerated individuals.” Whatever the crimes that led to their incarceration, it is difficult to imagine a more vulnerable group of individuals in the absence of the proper policies and supervisory practices.

On September 9, 2024, the New York Times ran a piece titled, To the World, He Is an Anti-Trafficking Hero. Women Tell a Different Story. It involves Tim Ballard, who, as the article describes, is a former Homeland Security agent. The article points out that Mr. Ballard built his nonprofit, Operation Underground Railroad, at a time when awareness of child sex trafficking was gaining greater currency: “High-profile cases — some of them appallingly real, some of them inventions of conspiracy theorists — drove outrage about minors being forced into sexual servitude.” At the same time, the Times reports, he was grooming, manipulating, harassing, and sexually assaulting women. The Mormon Church described his activities as “morally unacceptable.”

Perhaps of interest to professionals skilled in identifying client excuse-making, Mr. Ballard is quoted as responding to these allegations, saying “I just find it so sad that everybody who has come out with negative smears, lies, lawfare — they are accomplices to child trafficking,” he said in an online video. “Their actions are causing children to suffer, to be raped, to be tortured.” It is as though he is the hero of his own story, and it is his detractors who are the abusers.

A striking aspect of these news items of recent weeks is how they have occurred in diverse locations. These abuses appear not to be bound to one location or political jurisdiction. Meanwhile, other shocking situations have come to light that should concern therapists seeking to serve virtually any client.

On August 25, 2024, ProPublica published an investigation into the activities of insurance companies, titled “Why I left the network.” It outlines the numerous difficulties that psychotherapists have had trying to be reimbursed for their services. The article describes payment delays and “claw backs” (in which the insurers determine that they are unhappy with the therapist’s documentation and take their payment back, sometimes long after the service was provided), among other activities that to an outsider would appear to be a nearly hostile work environment. As many have observed, it may be that there is not a shortage of therapists so much as a shortage of therapists willing to work in accordance with insurers’ demands.

In a similar vein, a September 10, 2024, media account describes how therapy patients are stopping treatment after insurance companies have required “pre-payment reviews.” To paraphrase from the article: The interruption in treatment comes after one insurance company began subjecting thousands of payments to a “pre-payment audit” in the last several months. After the session takes place, the out-of-network psychiatrist or therapist is paid by the patient (usually) and the patient submits the bill for reimbursement, to the insurance company. But the subsidiary managing health services for the insurer, sends a letter to clinician and patient saying it wants detailed records for a “pre-payment review” before sending money. No reason is given.

Meanwhile, a September 9, 2024 data breach has resulted in notification of nearly one million Medicare recipients that their medical information was compromised. Perhaps the most frightening recent news item, however, was a September 1, 2024, exposé in the New York Times, titled How a Leading Chain of Psychiatric Hospitals Traps Patients. It describes how these hospitals conspire to keep patients in their care for considerable sums of money, often using legal actions to extend stays.

Why blog about these things? All these events point to opportunities for us to improve practice as well as the ease with which clients and clinicians alike can suffer. In an era when so many professionals are seeking out evidence-based approaches for ending abuse, we also need to acknowledge how our clients’ environments are sometimes traumagenic and our funding sources less reliable. As one ATSA progenitor once observed, “I’d like to retire from this field someday because I want to and not because I’m forced out by circumstances.”

Every reader cares about preventing sexual abuse, and across the recent decades, we’ve seen just how possible this is. Many forms of prevention exist, including by focusing on society at large, on people who are at-risk to abuse or be abused, and on preventing further abuse through empirically sound supervision and treatment. Now it’s time to aid prevention efforts by focusing on preventing our whole field from becoming abusive to clients and ensuring that professionals have the opportunity to actually do the work without excessive and unnecessary obstruction.

It has been over 50 years since the Stanford Prison Experiment illustrated what can happen under the wrong circumstances. My hope is that we can take what we’ve learned and better advocate for safe spaces for clients and professionals alike.

Treating Abuse Before It Happens: Getting the Balance Right

By David S. Prescott, LICSW

Past posts to this blog have shown how providing the right treatment to people who have a sexual interest in children can help prevent abuse. There is a small but growing number of people reaching out for help, often saying, in essence, “Help! I have this interest and I never want to act on it. Can you help me to live a better life?” Often, this interest is accompanied by any number of other conditions, such as anxiety, depression, backgrounds of trauma, substance use disorders, and others.

Treating people who ask for help and are not known to have abused need not be a controversial topic, but it is in many quarters where people have not studied the issues involved. Our field understands the treatment needs of people convicted of sex crimes and has shown that the right interventions have the potential to prevent abuse and other harms. Our track record demonstrates better outcomes than simply punishing people. Likewise, psychotherapy has a long history of efficacy with the other conditions above. We have every reason to believe that the right treatment with the right client can help them to prevent acting on their interests. The evidence for optimism is there, even as much more research and treatment innovation are needed.

Where providing therapy to these individuals becomes controversial, of course, is in the actual context of treatment. Proper balancing of individual rights and mandatory reporting laws, for example, can be complicated. Much has been written in this area, including misconceptions around language. For example, Allyn Walker, Robert P. Butters, and Erin Nichols surveyed 200 students preparing for entry into social service professions at a public university. From the abstract of their paper:

Survey results show that more than half of the students believe clients who identify themselves as pedophiles must be automatically reported to the police, which has implications for providers’ understandings about the term “pedophile,” as well as their knowledge of guidelines for when clinicians may break client confidentiality. This belief was not significantly affected by taking ethics courses, nor courses that discussed mandated reporting guidelines. Despite this finding, 91% of students did not believe that they would need to report a client who had attractions to children, but who had never committed a sexual offense against a child. The majority of students indicated a willingness to work with minor-attracted clients, and commonly indicated in comments that they wanted more information about MAPs and when to break client confidentiality in their programs of study. Study results indicate a need for education among social service students about these issues.

To be clear, “person with a sexual interest in children but who has never committed a sexual offense” and “pedophile” can be the same thing. This study illustrates that words matter. The paper’s title further illustrates the problems that clients and clinicians alike can have: “‘I would report it even if they have not committed anything’: Social service students’ attitudes toward minor-attracted people.” One can rightly wonder if the status quo could possibly make it more difficult to get help.

More recently, a study by Agatha Chronos, Sara Jahnke, and Nicholas Blagden explored the treatment needs and experiences of people with pedohebephilic interests. According to their paper, the authors examined “findings from 22 qualitative, 15 quantitative, and 3 mixed-method studies on the treatment needs and experiences of pedohebephiles.”  From the abstract:

Research suggests that this population experiences significant levels of distress, depression, and anxiety related to their sexual interest. Many individuals belonging to this population would seek (median = 42.3%), or have sought (median = 46.5%), treatment to cope with their sexual interest or with potential related mental health repercussions. Their experiences in treatment have been mixed, with some reporting positive experiences with empathic therapists and others reporting rejection. Most frequently, pedohebephiles report fear of exposure and rejection as barriers to seeking treatment, in addition to fear of the legal repercussions. The current study is the first to summarize and discuss previous findings on the treatment needs and experiences of pedohebephiles. The findings indicate that the treatment needs of pedohebephiles often remain unaddressed. Suggestions to increase the fit between treatment services and the needs of pedohebephiles are put forward.

It is not surprising that so many people would not want to enter treatment under these conditions. Nonetheless, one finding in particular offers implications for the way forward: some clients reported having positive experiences with empathic therapists and others reporting rejection. The idea that therapist empathy is critical to successful treatment goes back to Carl Rogers and earlier. Moyers and Miller (2013) reviewed the evidence and concluded that low therapist empathy can be “toxic.”

In the author’s experience, one of the best ways forward can be to use the components of the therapeutic alliance to ensure that one isn’t tacitly rejecting their client while working to remain empathic and compassionate. This is not easy. Many therapists enter treatment assuming that their number one goal at each step is to prevent offending. At the same time, clients can have other needs that go addressed. For example, one client in a discussion group described a situation along the lines of, “I told my therapist about how I went to see the new superhero movie. They asked if that was a good idea given that there would undoubtedly be children present. They went straight to, “What are your triggers there?” That wasn’t the point. I needed to talk about the cravings for alcohol I was having at the time and what I did to keep myself sober. But my therapist kept coming back to prevention, prevention. I’m not a ticking time bomb, at least not all the time. I wish I could get help for my other issues.” It is entirely likely that attention to elements such as alcohol use and cravings can be as effective in the prevention of abuse as well as other undesirable outcomes.

It often seems that in our rush to prevent abuse quickly, we can easily overlook the crucial foundations of our interventions, including the working alliance, as defined by Edward Bordin in 1979. Practitioners and programs might work to create a culture of feedback and get feedback from their clients, asking in essence:

— Are we working on all the goals that are important to you?

— Do we have agreement on how I fit into your life and how we work together?

— Is my approach a good fit for you?

These may seem like obvious questions, but it is amazing how rarely clinicians actually ask them. From there, it can be possible to have discussions about what is and isn’t working. There is certainly a time and a place to suggest that going to a particular movie likely doesn’t serve a client’s long-term interests. However, there is no reason this can’t take place in a context in which the client’s other needs are met. Given the current state of trust between clients and their therapists at present, and the often challenging context of treatment, returning to the basics of the working alliance has never seemed more important.

Preventing abuse by offering help is critical to healthy communities. For all of our knowledge about what works in treatment, the question for practitioners is how best to be the therapist that each client can respond to.