Friday, January 22, 2021

Perpetration, Victimization, and Gender

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

Past editions of this blog have explored direct and indirect effects of sexual abuse on those who experience it. However, it can be difficult to quantify this impact; everyone responds to abuse differently, and one size never fits all.  While the individual impact of sexual abuse, varies with every incident, regardless of the gender, race, culture, or identity of the person who commits it. What we have seen over the years, however, is that who the perpetrator is can profoundly impact the narrative of the victim. This week the BBC published a story talking about how sexual abuse by females is still a taboo subject and that their victims do not get the support and help that they need. Unfortunately, this is all too true. 

Cross-culturally and transnationally we tend to have static views of people convicted of sexual offenses:  typically that they are deviant, abnormal, and an “other”—in other words not one of us. However, we know from research and practice that this is not true, as demonstrated by the prevalence of sexual abuse and the array of people arrested and convicted of it. We also see a gender divide in the way that we talk about people who commit sexual abuse with men often being predatory, violent, and aggressive. Females may be perceived as mentally and emotionally unwell, often portrayed as radically abnormal or victims unable to control their behavior. All of this adds up to an often-unspoken perception that the gender of the perpetrator matters in determining how damaging the abuse is to the victim/survivor.

This false distinction is made worse when we realize that the gender of the people victimized is perceived as mattering as well, with boys and young men often being viewed differently from girls and young women.  The media often presents stories about girls being groomed and manipulated by men for sex, whereas the same story with a female perpetrator may suggest that the boy initiated it, wanted it, or just got lucky. Ultimately, this skews the public’s perception of the role of gender, grooming, abuse, and the consequences of these issues by implying that boys are less damaged by female abusers than girls are by male abusers. This suggests that in terms of the perpetrator/victim relationship the female victim of a male perpetrator is more deserving of sympathy than the male victim of a female perpetrator. A false perception of who the real victims are is problematic in the reporting and conviction of people who commit sexual abuse, and their eventual treatment, because it means that boys will be less likely to report sexual abuse by a female and ultimately less likely to get the support they need. 

How do we fix this? How do we level the playing field so that all victimization and perpetration is seen for what it is, regardless of the gender of either party? More research is one place to start: Empirical studies are highly needed to feed an evidence-based discussion on the topic of female sexual abusers. Interestingly, a recent study emphasizes the lack of differences regarding the motivations, characteristics of the abuse, and the modus operandi of male and female teachers who have sexually abused students. Such insights may start changing our perception. But this is a slow process that may not have a tangible effect on this conversation for long. This is proven by the fact that empirical insights on the effect of female sexual abuse of boys have been there for a while now but are still too often ignored or forgotten.

One of the most important and simplest things that we can do is recognize the abuse for what it is and its impact upon the victim, not how the demographics of who the victim and the perpetrator are. It’s not that these factors do not matter, but the focus should be on the abuse. As individuals and communities, we must stop inferring additional contexts, issues, and reasons for abuse. We need to stop implying there’s any difference in what victims and perpetrators are “worthy” of our sympathy, help, and support. How do we do this? We listen, understand, and speak up. We treat all victims the same and we talk with and to them in a way that they want and can hear. 


Thursday, January 14, 2021

Race Power and Privilege Social Media Campaign

#ATSARPP #ATSAPrevention

By Joan Tabachnick and Jannine Hébert

ATSA’s Race, Power and Privilege (RPP) subcommittee (a part of the ATSA Prevention Committee) has explored ATSA members’ relationship to these important issues.  Over the years, we have discovered a rich conversation that we want to share with ATSA members and others interested in how RPP may affect our work through a new social media campaign. 

Although many ATSA members have been talking about the impact of RPP on clients’ needs, interventions, and their engagement in services for decades, the more intentional conversations as an organization began in earnest in 2017.  ATSA’s Prevention Committee sponsored an evening panel at that 2017 conference titled “Dismantling Racism:  The Relevance to Prevention.”  We heard from attendees that these conversations are important and should not be relegated to a workshop or two at our national conference.  In response, the Prevention Committee formed a workgroup to further explore RPP in our work.  In 2018, we conducted a targeted survey of the ATSA membership and found that 87% of members agreed that issues of RPP had an impact on perpetration, survivor’s healing process and prevention.  Furthermore, just over three quarters (76%) agreed that ATSA should address RPP.  In 2018, the Board of Directors of ATSA responded with the following commitment. 

The board formally “recognized that race and privilege impact ATSA’s work and the work of ATSA members.  Furthermore, the board voted to ensure that ATSA commits to incorporate privilege and race issues into all of its strategic goals.” 

Each of ATSA’s committees also made a commitment to look at how RPP affect their mission and its’ implementation.   

The Prevention Committee subcommittee on RPP did not stop there and continued with weekly meetings, conducting surveys and interviews with ATSA members, and ultimately developing a series of infographics that we are now disseminating through social media.

The attached infographics contain quotes from ATSA members who were interviewed regarding RPP. We invite you to share the infographics via social media and in your personal/professional networks.  You can use either #AtsaRPP or #ATSAPreventon.  You can also join the conversations through any of our handles: 

·         Twitter: @MakeSocietySafe

·         Facebook:

·         LinkedIn:

We hope that some of these reflections inspire you to share and reflect on how RPP impacts your work.  Please take the time to share, retweet, or like these infographics and conversations.  Please help us dive into this important conversation more deeply. 

Here are some example social media posts.    

We would like to acknowledge the ATSA members who have been meeting weekly for the last year to make this happen.  In addition to the authors of this article, we want to acknowledge a fantastic group of individuals including Charles Flinton, Tyffani Dent, Ariel Berman, Lori Ho-Cheng, Maia Christopher, and Aniss Benelmouffok.


Thursday, January 7, 2021

2021: Building the new “Normal”?

 By Kieran McCartan, Ph.D., David Prescott, LICSW, & Kasia Uzieblo, Ph.D.


2020 was a challenging and difficult year all around, with 2021 having some teething issues (i.e., Brexit and the riots on Capitol Hill in the USA) as well as rays of hope (i.e., the COVID-19 vaccine). 2021 provides opportunities to redefine the socio-political landscape and develop a new “normal” with the positive aspects of the previous normal as well as the chance to change the problematic aspects. In this blog, we will each offer our perspectives on what we should focus on moving into 2021.

KIERAN: 2020 highlighted the centrality of community, collaboration, and coalition to our everyday life. The COVID-19 pandemic and resultant vaccine have demonstrated, very clearly, that we all need to consider other people in our actions and behaviors. The COVID-19 virus is spread through contact and interaction. Therefore, “Hands, Face, Space”, and lockdown is as much about self-protection as it is about protecting other more vulnerable people. We are being asked to say away from others to protect them and not spread the virus. This reminds us that we are part of a community and that we need to think beyond others beyond ourselves and the unintentional consequences of our behavior. This resonates with the field of sexual abuse in terms of how we prevent abuse, rehabilitate those who offend, and integrate them back into the community. The most effective way to tackle sexual abuse is to create a supportive, inclusive, and proactive community. In 2021, we need to develop more inclusive communities that recognize the importance of individual actions and their impact on collective wellbeing. Therefore, the more that society recognizes the reality of sexual abuse, its impact, and has knowledge of how they can build safer communities with those who have abused as well as those who have been victimized, the better.

DAVID: If there was anyone series of events that shaped (or should shape) our research and practice agenda for the future, it would be the shootings of George Floyd, Breonna Taylor, and Jacob Blake (and others) by police officers. The lack of accountability manifested by few if any, charges or corrective practices by the police has laid bare the realities that many of our client’s face – and have faced – since long before there were technologies such as smartphones to record them. It doesn’t need to be like this; the city of Newark, NJ, where police officers received effective training in de-escalation techniques saw no shots fired by police this past year.

Our field has a wealth of research and knowledge about disparities in arrest, sentencing, probation and parole that people from minority backgrounds face every day. Practitioners are rightly coming to consider racism and discrimination its own category of trauma and adverse childhood experience. Still, we have been ineffective at getting policymakers to understand and act on the widespread disparities that exist. Even the word “disparity” seems a cruel understatement when people are dying, communities are experiencing more poverty and violence and not less, and the US Justice Department is seeking to undermine (at the 11th hour of the current administration) to undermine the Civil Rights act. Of critical importance is that the US is not the only nation ambivalent about addressing its abusive past. 

Although this may seem a purely a political statement, the effects of the current climate on our clients in treatment, many practitioners, and our practices themselves can no longer be denied. While we may differ on the end game of combating these inequities, the events of 2020 have shown that the time to act is long past due. 

KASIA: One of the most confronting issues that arose during the pandemic was the fact that despite all our efforts we still fail to protect numerous children and adults from (sexual) violence. In order to protect society members from a deadly virus, authorities across the world have imposed curfews and lockdowns. However, these measures seem to have unwittingly elicited a rise in domestic violence cases, including a rise in sexual abuse cases. The combination of exacerbating stressors at home and at work, self-isolation, and fear are believed to underly this surge. Victims were forced to stay home with an abuser to avoid contracting the virus. Many perpetrators have also abused the situation by threatening their victim(s) to throw them out onto the streets if they would not obey and by using the public safety measures to isolate their victim(s) even more. Consequently, the measures have led to more limited opportunities for victims of violence to seek out and receive support from formal and/or informal resources. Police officers tell me that several adolescents -victims of domestic violence- are reluctant to seek help during the pandemic out of fear that this action would tip off their abuser and would only result in retribution. Many victims also fear to leave the house to seek help after the curfew out of fear of being arrested.

Thanks to early warnings of numerous organizations, including the World Health Organization (WHO), services, and advocates we have seen many initiatives at local and national levels is swiftly implemented. For instance, in Belgium, additional space was created in a hotel for females and children who needed to escape their violent home situation. In several countries, including France, Spain, and Belgium, codewords for victims of domestic violence were being implemented so they could discretely summon police help in pharmacies. These efforts were widely applauded in the media; policymakers were immediately patting themselves on the back. It’s not my intention to spoil the party here, but I’m afraid it is just far too soon to be blowing our trumpets. The fight is clearly not over yet and many concerns remain. To name a few: These initiatives are accessible for many victims but not for all. Many victims do not know of these initiatives; they do not read papers or listen to the news or don’t have any access to the internet. Also, the pandemic has revealed our stereotypical thinking about domestic violence even more. During (but also before) the pandemic, males are consistently portrayed as perpetrators of domestic violence and females and children as victims, even by leading organizations like the WHO. Such portraying will not encourage male nor female victims from female violence to step up and seek help. In addition, media coverage and the calls for initiatives are mainly focused on cases of intimate partner violence and child abuse, often neglecting other types of domestic violence, like sibling and elder abuse. Consequently, victims of these types of abuse will not feel addressed by these initiatives.

As the world remains under siege from the pandemic, it is high time for us to tackle the challenges ahead. We need to be more creative and to be more critical about our efforts to prevent violence. Professionals, researchers, and policymakers should clearly invest in evaluations of our campaigns and initiatives: How can we reach more victims? How can we facilitate their help-seeking behavior? Is what we are doing enough? How can we protect public health without causing this much collateral damage? We should also invest more in primary and secondary prevention. It goes without saying that all the tertiary prevention strategies being implemented, are highly needed. But shouldn’t we also prevent violence before it happens, even during a pandemic? So how can we help vulnerable couples and families in developing non-violent conflict resolution strategies and proper coping behaviors to address stress and negative feelings? How can we facilitate help-seeking behavior in violent perpetrators and in people who are at risk of becoming violent?

One thing is certain in these uncertain times: One day we will be able to protect ourselves from the COVID-19 virus and our society will overcome this pandemic. But how wonderful would it be if we could also assure all children and adults that one day we will be able to protect ourselves from the violence that is holding the world hostage for far too long now.

Thursday, December 17, 2020

Therapy to Prevent Abuse or Therapy as abuse?

By David S. Prescott, LICSW

Our recent blog on conversion therapy prompted lively discussions in social media.  While efforts around the world seek to end practices aimed at changing people’s sexual orientation, therapists working with individuals hoping to prevent further offending often use methods developed to help clients manage their sexual thoughts and urges. As we suggested in our earlier blog, it is important for professionals to consider the aims of the methods they use. Unfortunately, many laypersons only hear of these methods outside of the context in which treatment occurs. Research has long shown that the context of treatment matters. Used in the wrong context, treatment methods can cause harm. A scalpel that saves lives in surgery can become a murder weapon when used in a bar fight. Not all treatment contexts are alike.

The simple facts are: There are many people in the world who feel a sexual attraction to children but do not want to act on that interest. For them, many elements of daily life are challenging, and they often experience shame and self-hatred resulting from attractions they didn’t ask for and sometimes feel they cannot entirely control. Some of these individuals attempt to live as quietly as they can, while others seek out services, support groups, and other types of help. This has all been documented elsewhere and serves as the foundation to what follows. To be clear, however, sexual interest in children is not something that people ask for or a choice they make.  

While some degree of overlap in methods used in helping people manage sexual urges may also be employed in conversion therapy, there are substantial differences between programs that treat people with a sexual interest in children and conversion therapy as the world has come to understand it. One major difference is that behavioral treatments are only one component of a broader, a more comprehensive approach to helping people lead better, more self-determined lives.

The vast majority of programs treating individuals who have abused others regard their behavioral treatments as methods to help people to manage urges or fantasies that would lead to further harm to themselves or others if they acted on them. On the other hand, conversion therapy seems to hold out some kind of promise that the client will become a different person as a result of this treatment, viewing being gay as an accident to be cured, remedied, etc. It’s easy to write those words in a paragraph, but how they play out in the social context of the client and their alliance with the clinician can be quite another matter.

For example, the client who says, “Please can you help me. Even though I have some attraction to people my own age, I also have this strong desire for kids. I do not want to take the chance of hurting anyone. My thoughts about kids often interfere in my relationship with my girlfriend, which is already tenuous enough. I really want to do anything I can to manage these urges. Please can you help me?” In cases like this, where the client is asking freely and independently, there is the possibility that some of those methods may help, at least in the short term. Can we really compare that to the pain and suffering this video of this man who experienced conversion therapy as some kind of torture? And if there are things that might help, should we really put them off-limits? We’ll come back to that point.

Reading about the contexts in which conversion therapy has taken place can be horrifying. There are good reasons why these approaches, too often delivered intrusively and with prejudice and ignorance, are unethical in most places and illegal in many. But it’s not just the actual methods: They are often provided by people whose knowledge of sexuality harken back to a less enlightened era, and the professionals violate all the tenets of the therapeutic alliance. Further, they blithely ignore the principles of informed consent. These treatments are often unethical on their face in the ways that they run roughshod over clients’ autonomy and beneficence (central to the codes of ethics of all the helping professions).

All of this calls to mind some of the things that Thomas Szasz said in 1961: that therapy can only be ethical when the client comes to the therapist for help and is willing to pay out of their own pocket. His point (as someone who had fled then-communist Hungary) was that we should all watch out for the negative consequences that can occur when the state gets involved in providing treatment.  He might have added the family and societal pressures brought to bear on clients as well. We’ve written elsewhere on how these conflicts can be managed.

The techniques for helping clients manage their sexual behaviors are far less important than whether the treatment experiences:

·         are consistent with the client’s goals; goals that are personally meaningful and relevant, held strongly, and arrived at independently.

·         take place in an environment in which the client feels heard, understood and respected.

·         consider whether the client believes that the techniques of treatment are a good fit for him.

·         include informed consent for treatment that is reviewed frequently.

·         occur in context such that clients view the therapist’s role as that of a helping professional and fellow traveler.

One colleague expressed it like this: “I can’t change what people want; I can only help them to change how they behave around what they want.” Likewise, in describing Motivational Interviewing, Miller and Rollnick (2013) have said that, “Treatment is something we do for and with clients, not to and on them.” These two quotes embody the fundamental differences between legitimate treatments offered to individuals who have abused them and the more controversial conversion therapy that appears in the news and social media.

There are still reasons to be vigilant about implementing any kind of treatment under conditions where personal liberties hang in the balance. How consensual is the treatment when the informed consent was signed under the duress of being imprisoned longer? In addition, the therapist believes it’s important to use these methods. At the same time, the client is going along with the process in order to complete treatment even though they don’t want to. On the other hand, millions of us have signed consent for medical procedures that we didn’t want, that caused us pain and anguish, but that added many years to our lives. There are many, many nuances involved.

Ultimately, professionals have an obligation to consider all aspects of treatment that they deliver, including the context in which treatment occurs.

Thursday, December 10, 2020

It’s not the cure, but the delivery system that matters: the importance of community


By Kieran McCartan, Ph.D., David Prescott, LICSW, & Kasia Uzieblo, Ph.D.


This has been a frustrating week for writing. With respect to developments in our field, it seemed as though the goalposts kept moving; the blog could have been on anything and nothing. As the week started, we were looking at recent reports (The Sun; Complex;  New York Times) about the reality of Pornhub was, despite their protestations, all is not happiness, smiles, sanitized sex, and sexuality; instead, there is a dark side. It wasn’t long before Pornhub took remedial action; we will have to wait to see the results.

Next, the blog was going to examine the unintended impact of new encrypted messaging policies and practices that can put children at risk for grooming and abuse (The Guardian; The Children’s Commissioner for England). This promised much to discuss. However, that debate has been moved down the agenda, in the UK at least, with increased discussions around Brexit and COVID-19. important messages and conversations are getting overshadowed. Stimied again! However, this is a topic that we will return to in the new year, as it highlights the balancing act between risk and safety in child protection with an evolving frame of online protection.

The third and final, blog that we were going to write is about the balancing act between internet filters and prevention messaging after Kieran attended a meeting that discussed whether the cost of implementing such tools was an appropriate and relevant investment. Interestingly, this meeting went round in circles and it was decided that more research and evidence was needed. All of this highlights and focuses the challenge of prevention: do we prevent and try to stop what might happen or do we respond to what is happening? This, in turn, feeds into larger debates and reflects previous blogs on this site, so it felt like retracing old ground.

Another day brought headlines reporting the first people in the UK–first in the world – outside of clinical trials to be vaccinated against COVID-19 with the Pfizer jab, which was great news! Interestingly, the news coverage throughout the day and ensuing discussions about evidence, effectiveness, patient safety, and rollout highlighted the lynchpin that brought all these potential blogs together. The real issue is not necessarily the vaccine itself, but the mechanism through which the vaccine is delivered. The biggest challenge is changing public minds, education, prevention, engagement, inclusion, and community building. All these same challenges confront us in the field of sexual abuse.

Like COVID-19, preventing sexual abuse means understanding and responding to it directly (and does not involve behaving as though it does not exist or will go away on its own). Also, like COVID-19, sexual abuse can be overwhelming, omnipresent, and presents challenges for individuals, communities, and society. This means (again like COVID-19) our response is often divided – even divisive – and results from a spectrum of belief and acceptance. Beneath this are considerations of people’s knowledge, understanding, trust in the system, belief in science, and hopes for the future. In many circumstances, we find ourselves at a stalemate: in recent years, the field of addressing sexual abuse has tried new approaches to tackle the issue, including prevention, reframing messages, groups of people reaching out to the public, and listening systematically to who people who have abused – and those who have been abused – have to say.

Each of these efforts has worked to a greater or lesser degree. We can see the same pattern, the same approaches, and the same frustration in these debates as we do in the rollout of the COVID-19 vaccine. The question then becomes, what now? Do we all need radical overhauls in our approaches? Is the answer to preventing sexual harm in doubling down on our current approaches and seeking out more evidence and opinion? Or is it a return to control and regulation? These are difficult questions with no obvious answers.

The one common element that arises in both the challenges around sexual abuse and COVID-19 – the element that ties together the threads of Pornhub, encryption, and filtering software is the community. Our communities. Sexual abuse is a community issue and therefore communities need to understand it better to respond to it more effectively and prevent its spread. Punishment and restriction do not stop sexual abuse. While such sanctions can help in some cases, awareness and support can do much more.

We are all members of our communities and society beyond, and together we shape the debates and actions that move us forward. Our greatest successes come when we work together, and our greatest failures happen when we resist new information and cooperative efforts. This is true across the board, from child protection to immunization. In many ways, especially in the political arena, our community is more fractured than ever before. While advances in accessing knowledge and resources have brought so much of the world together, they have also happened at the very times that many of us have become increasingly entrenched in our own echo chambers. If services to prevent abuse and rehabilitate those who have abused are the primary issues, then how do we respond? It seems safe to say that we need a new delivery mechanism and new ways to think about moving forward.

The challenge as we move in 2021 is how do we immunize ourselves against sexual abuse, the way that we are immunizing ourselves against COVID-19? And how do we immunize ourselves against both the panic and apathy that violence and the pandemic can bring? How do we get the “cure” out there (in COVID’s case, that means the Pfizer jab, and in sexual abuse, it is the education, knowledge, and understanding we need) in a more effective way? It is a challenge, but as a community, we can work together to solve it!

Thursday, December 3, 2020

QAnon and the Hard Work of Preventing Sexual Abuse

 By David Prescott, LICSW, Kasia Uzieblo, Ph.D., and Kieran McCartan, Ph.D.

 According to Wikipedia,QAnon is a far-right conspiracy theory alleging that a cabal of Satan-worshipping pedophiles is running a global child sex-trafficking ring and plotting against US president Donald Trump, who is fighting the cabal. QAnon also commonly asserts that Trump is planning a day of reckoning known as the "Storm", when thousands of members of the cabal will be arrested. No part of the conspiracy claim is based in fact. QAnon supporters have accused many liberal Hollywood actors, Democratic politicians, and high-ranking government officials of being members of the cabal.

As scientists, practitioners, and academics, the authors have continued to marvel at the fact that QAnon has gained so much traction. They command an audience in the absence of evidence and when there is so much evidence that they could turn to if their aim really were to prevent child abuse (and we have no evidence of that, either). This raises significant questions about the role and significance of research, evidence, and expert knowledge in the world currently.  Tom Hanks and Hillary Clinton and others may be a lot of things, but calling them pedophiles detracts from the very serious work that at organizations such as ATSA and Stop It Now! (to name only two) are involved in.

In a recent blog post, Marty Klein stated that QAnon is “replacing child protection groups – who should blame themselves.” This comes as a surprise to many organizations committed to preventing abuse, who have mostly read about QAnon in the headlines. To our knowledge neither interest in their work nor their support from charitable foundations and concerned individuals has changed very much. Marty Klein actually only mentions two organizations, Save the Children and the National Center for Missing and Exploited Children (NCMEC), about which he had blogged in 2017. His argument is that, in particular, NCMEC has created the very conditions that allow QAnon to thrive by what he refers to as its scare tactics and “used statistics in a cynical fashion—with concepts like “at risk for exploitation,” “potential victims,” and “children gone missing.” While we are not defending NCMEC (and they can defend themselves), we believe that not every prevention-oriented organization is the same, and that the vast majority do so ethically.

In another blog, Jeremy Malcolm of the Prostasia Foundation offers very different insights, beginning with a description of the evolution of the origins of many of QAnon’s statements and beliefs. Malcolm also takes issue with NCMEC, noting for instance, that “A NCMEC figure that QAnon sources commonly quote is that 800,000 children go missing each year. Less often acknowledged is that in over 99% of those cases the child returns safely, often within hours.” Malcolm’s blog for Prostasia also examines the panic around Satanic cult abuse (which many readers will remember) from the mid-1980s into the 1990s. In the end, when we visited to NCMEC’s website in preparing this blog, we did not turn up any wildly inflated facts, although its aims are clear. We have concluded that there are many points worth noted in these blog posts, and while we may differ in some key areas, we respect the authors’ work very much.

What can we take away from these passionate disagreements? While there is no shortage of overt disinformation in QAnon’s efforts, everyone in these debates appears to agree that the sexual victimization of children should be prevented. That might be a place to start.

 In our view:

·         It’s important to examine the evidence base in deciding what directions we take in any course of action. We need to make sure that people with deep knowledge of the issues are at the table and being listened to. This leads to the question of how we can best “reframe” or “relaunch” expertise in a way that captures the imagination of individuals who are more susceptible to conspiracy theories?

·         Conspiracy theories are not helpful in preventing abuse, especially when so much credible evidence about effective approaches already exist.

·         Accusing people of child abuse has a deep and long-lasting impact; even when the accusation is withdrawn afterward or no proof is being offered, the suggestion will linger for a long time and will remain a stain on someone’s reputation.

·         Groups like QAnon are making the work of preventing abuse more difficult for all of us through their spreading of information for which there is no evidence.

·         Individuals and groups that focus passionately in one specific area are at risk for not taking other perspectives into consideration.

·         Missing from many mainstream and social media accounts is that child abuse is preventable, that many people have developed and tested ways to prevent it, and that knowledge about prevention is there for the taking.

·         A fact that often goes missing in these debates, especially among organizations, is that ordinary individuals can play a powerful role in preventing abuse.

·         Ultimately, all people will be able to prevent abuse most effectively when they are in possession of high-quality knowledge and are willing to speak up and speak out about abuse prevention.

In the end, we need to reaffirm that sexual abuse is an individual, interpersonal, community and a societal level issue; which means that we all need work collectively to prevent sexual abuse and the existent of conspiracy theories undermines this collective working.

Thursday, November 26, 2020

In the News: Conversion Therapy in the US and Beyond

By David S. Prescott, LICSW, Kasia Uzieblo, Ph.D., & Kieran McCartan, Ph.D.


According to Forbes and other media outlets, a federal appeals court in the US recently struck down local ordinances prohibiting conversion therapy. This has happened at a time when conversion therapy has been condemned in many locations around the world, including Germany this past spring and then Israel in the summer. As many readers will know, the term “conversion therapy” (also known as reparative therapy) is used to describe “any attempt to change a person’s sexual orientation, gender identity, or gender expression”. (This is taken from the GLAAD website’s description, which is worth reviewing, as is this document from a United Nations Independent Expert.) We freely acknowledge that we are not lawyers; we are interested in this case as professionals in the area of preventing sexual offending.


A quick Google search on the term “conversion therapy” identifies many ways that it harms people, despite a robust literature showing that it is ineffective. The American Psychological Association and the American Psychiatric Association have issued statements condemning it, as have numerous other professional organizations. In the US, 14 states and the District of Columbia have put laws into place protecting LGBTQ+ youth. There is a considerable historical context that is beyond the scope of this blog, involving the medically and psychologically false idea that LGBTQ (and for that matter, gender-diverse individuals) are sick or pathological, just as there is a long history of severe pain and suffering resulting in long-lasting psychological and physical damage. Conversion therapy continues to take place in a multitude of countries, in all regions of the world.


This last point, regarding conversion therapy with youth, could be worthy of an entire conference, given the numerous questions of what would actually constitute informed consent. For example, young people who may be unable to judge the risks and benefits for themselves and the question of parental consent for various forms of treatment, may signal pressure on the youth, whose identify and wellbeing may hang in the balance.


In the main, however, it’s important to clarify that the federal appeals court in this case has struck down laws, but made no changes to the ethics codes of the numerous professional organizations that render the practice of conversion therapy unethical. Practicing conversion therapy and holding a license to practice psychotherapy no longer mix, and rightfully so. We are not advocates of conversion therapy as it has been practiced (which has often involved undue coercion either by the therapist, family members, or both). In fact, earlier this year, the Independent Forensic Expert Group (IFEG) of health specialists, declared that conversion therapy is a form of deception, false advertising, and fraud.


There are implications, however, of these and related legal proceedings for people working with those who have abused and have sexual disorders. The rationale of the federal appeals court centered on free speech. Number one on the list of freedoms in the US Constitution’s Bill of Rights, free speech is near and dear to the vast majority of people in the world, and not given to many. People have fought and died for it and other freedoms. The court used as one example, that other free-speech cases have involved a Florida law that prevents doctors from talking with their patients about gun ownership (for example, a doctor would not be allowed to talk about the potential health hazards of weapons access where children are present despite the empirical research regarding weapons access and ownership; does free speech end at the door to the doctor’s office?).


What are some potential implications of the federal appeals ruling for professionals who work with those who have offended? At the front lines, a number of possible questions emerge. We know that sexual orientation as a broad term is different from sexual interest, sexual arousal, and sexual behavior, but at the front lines of practice, the situation can be more obscure. For example:


Between the ethical codes of my profession and the laws protecting free speech, in what ways might I be at risk for treating people who have sexually abused others? There would seem to be a difference between conversion therapy and helping people who have a sexual interest in children, but do I possess the requisite scholarly papers to make a case should I be accused of practicing a variation of conversion therapy? Conversion therapy has traditionally been about changing someone’s same-sex interests; where is the line with changing someone’s age-related interests? I understand that changing someone’s sexual orientation is unethical, but what about changing someone’s sexual interests? How possible is that really? Am I in a safer position trying to help people manage those sexual interests without directly influencing them? Or do I need to think about all this differently?


Further, there has been debate about whether pedophilia is a sexual orientation; am I at risk for ethics complaints or prosecution under the wrong conditions? Can I work to change someone’s sexual arousal patterns? Is there a clear line between these and orientation? How would I communicate that to a licensing board? Is it really different when the sexuality I am attempting to influence has to do with harming others (as opposed to traditional conversion therapy focusing on gender-related orientation? Where is the line between influencing someone’s sexuality and helping them to manage urges, thoughts, and fantasies? What are the implications when working with a client who is not their own guardian?


We wish to emphasize that we have neither all the questions nor all the answers. To our minds, this is a discussion that has not yet occurred in any meaningful fashion. Questions about pathologizing sexuality will likely exist well into the future, including to what degree various elements of sexuality are innate and biologically based versus learned. Our point in bringing this discussion to the fore is to encourage all professionals to think about the broad dimensions and diversity of the questions that emerge in the assessment, treatment, and prevention of sexual offending.