What’s the goal with treatments for Pedophilic Disorder?

By David S. Prescott, LICSW

A recent media storm focused on attempts to modernize laws relating to sexuality, including the Take Pride Act in Minnesota (https://tinyurl.com/4sm8jure). Here is the relevant text from the law. It seems to remove attraction to children as part of the definition of sexual orientation.

“Subd. 44. Sexual orientation. "Sexual orientation" means having or being perceived as having an emotional, physical, or sexual attachment to another person without regard to the sex of that person or having or being perceived as having an orientation for such attachment...”

Whatever one thinks about that definition, what was taken out of the law was:

“…or having or being perceived as having a self-image or identity not traditionally associated with one's biological maleness or femaleness. "Sexual orientation" does not include a physical or sexual attachment to children by an adult.”

Where the definition of sexual orientation once excluded a sexual attraction to children, this seems to remove that exclusion, leaving open the possibility that sexual attraction to children could be interpreted as an orientation. Multiple media outlets described this as “normalizing” pedophilia, while others said that it was nothing more than removing language. It’s no wonder media pundits get confused (especially with double-negative language involved).

The predictably polarized media coverage has led to private conversations with some professionals expressing doubts about the scope of their practice in the future. The sponsor(s) of the bill have been vocal that they don’t intend to open the door to pedophilia as an orientation, but the law is not written with our field in mind. At a time when conversion therapy continues to be reviled, is it possible that some providers may be liable for helping their clients with sexual attraction to children? In many ways, this seems completely far-fetched since treatment providers in our field typically try to help people manage their urges and have long recognized that they likely can’t change someone’s innate sexuality. In the absence of any universally agreed-upon definition of “orientation,” perhaps there is a lawsuit waiting to happen.

 On the one hand, we might argue that we are helping people who have consented to treatment manage (not change) their sexual interests and urges. On the other hand, some may argue that the mandated nature of treatment or even the social climate of treating these individuals raises questions about truly informed consent given freely. If anything, though, it seems many professionals will want to be clearer than ever on the aims of treatment.

I believe that lawsuits against professionals or agencies for practicing conversion therapy with clients who are attracted to children would be a losing endeavor under almost all circumstances. Most people can understand the difference between helping clients in treatment manage their behavior and attempting to change their innate sexual orientation. Still, lawsuits are expensive and stressful, and I respect the opinions and concerns of those in our field who want to do the work of helping people build healthier and offense-free lives.

As the saying goes, an ounce of prevention is worth a pound of cure. It might be worthwhile for professionals to revisit their policies and clarify in writing and with their clients that using treatment approaches with people with pedophilic disorders is about managing urges and behaviors and not an attempt to change the innate qualities of someone’s sexual orientation. One colleague aptly referred to treatment approaches in this area as similar to techniques others might use to manage anger. Whatever the case, ongoing attempts to clarify informed consent with clients at every turn will be vital.

New York State ATSA Delivers Once Again

 By David S. Prescott, LICSW

ATSA’s New York State chapter has put on annual conferences since at least the late 1990s. For most of that time, they have collaborated with the New York State Alliance for the Prevention of Sexual Abuse.  The settings have varied from the Hunter Mountain resort in the Catskills, the Turning Stone Casino in Verona, the outskirts of Albany, Corning, and for the past several years, a conference hotel in Saratoga Springs. It’s worth mentioning that Saratoga is a popular destination, with natural springs in a large park nearby and close to world-famous horse racing (Carly Simon sang about it in her classic hit, “You’re so Vain”) and numerous visitor attractions.

This year’s pre-conference workshops provided an excellent balance of material with top-shelf experts. Jane Fleishman talked about sexual wellbeing, and Mark Olver talked about therapeutic approaches with high-psychopathy clients. Although I could only be in the latter training, attendees were mightily impressed with both. Dr. Olver is able to make statistical analysis come alive, and with humor (“Some people enjoy rice and beans for dinner; I grew up on Cox regression”). Dr. Fleishman provided both safety and humor (laughter from her audience was audible in Dr. Olver’s presentation: “they’re having fun while we’re doing survival curve analysis”). As always, Dr. Olver’s presentation style is a fine balance of clinical skill and statistical prowess. Not every presenter is able to pull this off.

Dr. Olver opened the conference with a keynote address titled Empirical Models of Evaluating Change in Sexual Offenders: Linkages to Risk Assessment and Management. Among the many highlights, I was struck by the fact that so many of the people who attended a self-care workshop by Janet DiGiorgio-Miller returned for a closely related workshop on mindfulness in the next session. I attended a workshop by Elaine Vuong, who examined the role of culture and its relationship to the responsivity principle. She used a well-structured approach to illustrate the ways that culture is addressed in the principles of effective correctional rehabilitation and the Good Lives Model. She next described how her agency, the New York Office for Mental Health and its STARC program, are using this information to improve services to its clients.

On the second day, Kelly Socia provided the plenary address titled Using Language to Avoid Landmines: How to Convey Scientific Facts and Cut Through Myths. This was an update of the brilliant plenary address Dr. Socia gave at last year’s national ATSA conference in Los Angeles. As always, his presentation was captivating and persuasive, balancing deep knowledge of policy and personal experiences. Dr. Socia then gave a talk on tips for getting published in academic journals.

The atmosphere at this year’s conference was an inspired mix of continued relief at finally being back together in person after two years alongside an influx of newer members to the field. Speaking for myself, I felt sentimental as Kelly Socia showed a video containing interviews with Rob Longo and Barbara Schwartz to an audience comprised of many early-career professionals unfamiliar with the work of these highly influential progenitors in the field.

As a conference, NYS ATSA/NYS Alliance has long been run by the very best that New York has to offer. Per their website, the current board of NYS ATSA includes Bud Ballinger, Jennifer Cinicolo, Kelly Bunt, Larry Menzie (who also leads the NYS Alliance), Chris Farrell, Dina McManus, Gilian Tenbergen, Justyna Rzewinski, Amy Gaddor, Shoshanna Must, and most recently, Katie Baker. Of course, they were preceded by other great contributors to NYS ATSA such as Ken Lau and the late Richard Hamill. It was great to be back.

Advanced Sexual Technology: A Cause for Concern?

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NOTA 2023 Annual Conference review

 

By Kieran McCartan, PhD.

 

The annual NOTA international conference took place in Cardiff, Wales, this week. There were over 230 attendees, across three days, with six keynotes and 36 parallel breakout sessions. For this blog post, we talk through the highlights of a successful, engaging, and thought-provoking conference.

 

The conference kicked off on Wednesday morning in a sunny Cardiff with a keynote from Professor Melissa Grady on the use of trauma informed practice in working with people convicted of a sexual offence. Professor Grady emphasized the importance of understanding past trauma in the populations that we work with to develop the correct conditions and process for treatment and rehabilitation. She indicated that we as a profession are trauma-aware but may need to go further to be truly trauma informed. Additionally, she highlighted the importance of attachment and the links between maladaptive attachment, trauma, and sexual abuse. This theme was restated throughout the conference. Professor Grady’s talk was followed up by a roundtable discussion on the use of restorative justice in cases of sexual abuse, an often debated and sometimes challenging topic. The roundtable had representation from across the UK with Clifford Grimason laying out the position of HMPPS to Restorative Justice, both in general and in respect to cases of sexual offending; Stephen Barry talked about some of the practice and therapeutic work being done by the BE Safe Service in Bristol with children and young people who have sexually harmed; and Ashley Scotland from Thriving Survivors and David Russell from Midlothian Council talking about the innovative work going on in Scotland around the development of restorative justice approaches to sexual abuse cases. The panel was varied in their views and the roundtable opened the opportunity for a nuanced debate on an under discussed response to cases of sexual abuse, with the final comment being the need for a sensitive and individualised approach, as well as a promise to continue the conversation.

On Thursday the conference started with Pat Brannigan, Shelley Shaw, & Jennie Hammond talking about the development and roll out of Together for Childhood, a project in Plymouth and in Stoke. Together for Childhood is a place-based approach to the prevention of child sexual abuse led by the NSOCC in conjunction with local and regional partners. The talk emphasized that sexual abuse is a community issue and that we need a community-building approach to prevent and respond to it. This was followed by another place-oriented keynote with Dr Sophie Hallett on innovative approaches in preventing Child Sexual Exploitation in Wales. Dr. Hallet discussed the social and political construction of child sexual exploitation before discussing why a child-centered approach was essential in understanding and responding to sexual exploitation. She asked the audience to consider whether we as professionals listen to the voices and requests of our child clients enough.

 

The final day of the conference started with Dr. Wendy MacDowall on research from the National Surveys of Sexual Attitudes and Lifestyles (AKA NATSAL), wherein she discussed the changing sexual lifestyles in the UK, the increasing inclusion of sexual abuse questions in the survey, and the new sexual competency measure that is being introduced in the current live version of the NATSAL. One of the topics that Dr. MacDowell discussed that stood out the most was research from the NATSAL on the importance of sexual education in school and its links to sexual behavior and abuse.  This led to the final keynote of the conference by Professor Clare Allely on her recent research on neurodiversity, autism, and sexual offending.  Professor Allely gave an engaging and thought-provoking talk on the relevance of understanding autism in clients in terms of assessment, sentencing, and treatment. She reminded us that problematic sexual behavior in autistic and neurodiverse individuals may not be simply sexual deviance but could be a symptom of their diagnosis that is of a sexual nature but not done for sexually motivated reasons (she gave the example of an individual who as a child in crisis situations would drop their pants as they knew they would be removed from that situation, but as an adult that took on a different meaning and consequence).

Across the Wednesday and Thursday afternoon we had 36 breakout sessions covering topics as broad as research and treatment on sibling sexual abuse, harmful sexual behavior in young people, restorative justice, campus climate surveys, masculinity and sex education, circles of support and accountability, treatment, desistence, and updates from HMPPS on current policy as well as practice. In addition, we also had an international roundtable on the assessment, treatment and management of people convicted of a sexual offence with speakers from leading professional organizations that work with people convicted of a sexual offence from England & Wales (HMPPS), Scotland (Stop it now Scotland/NOTA), Northern Ireland (Leonard Consulting/NOTA), France (CRIAVS),  the Netherlands (NL-ATSA), Latvia(Dardedze), and Italy (CoNTRAS-TI).

 

This year the conference had a special online edition of the Journal of Sexual Aggression curated by Dr. Nadine McKillop; readers are invited to go to the journal website and twitter account for more information.

 

Finally, we had a changing of the NOTA guard, with Professor Sarah Brown stepping down as NOTA Chair and Stuart Allardyce stepping into the role. Thanks for all your hard work and leadership Sarah and good luck to Stuart as he leads NOTA forward. In closing, the conference was a great success. It was a great opportunity to reconnect and reengage with colleagues as well as learn about innovative research, policy, and practice.