The New World of Telehealth: The Challenges and Benefits.

By Janet DiGiorgio-Miller, Ph.D.

Whether you have decided to take a hybrid approach or do all virtual therapy sessions you have come to find that there are challenges as well as benefits to telehealth. I moved out of my office on July 31st, 2020 after 18 years. It was a three-room, third-floor office space in a 1929 building with beautiful big windows in a bustling little town in New Jersey. It felt like a safe and secure place for my clients and for myself.

While I missed that office, I soon came to appreciate my home office with my furniture and my paintings and all the benefits that come with staying at home during the day. As my practice became totally virtual, I thought that I would begin to write down what worked and did not work. I also asked my clients. The following are the challenges and benefits of virtual therapy. Please feel free to continue this blog by posting your thoughts.

Challenges:

Telehealth presents challenges for both the provider and the client. Probably the most challenging issue is working with young children. It is difficult to keep their attention by just talking. Usually, when you are working with a child you have some play materials to assist in the conversation. This is a task that is exceedingly difficult to replicate virtually. In addition, teenagers may be viewing more than one screen at a time or multitasking. When this issue presents itself, it is good to address it and ask the client if they are attending the session. Another issue that I found is that you cannot see the whole person’s body and sometimes cannot tell if they gained weight/ lost weight or are fidgeting and or distracted.

The biggest challenge for some clients is to have a private conversation and worry if they are being overheard. This concern has led some to clients doing sessions in their car.

Another challenge is that parole officers will not allow a client to use the Internet to have a virtual appointment. Some clients have had their attorney lobby for this privilege and other clients must use the telephone to have appointments.

As we all know, you can have technology/internet issues. It is helpful to watch YouTube videos of the technical issues and find tips there. It is also helpful to remind ourselves that we as well as our clients are learning more and more about technology. So, I tell myself to be patient (with myself and others) which is one attitudinal foundation of mindfulness.

Benefits:

The biggest benefit by far is the convenience for clients. Therapy is now available for any client who has 45 minutes to take out of their day. Previously a client would have to find a therapist in their area, drive to the therapist's office, park and/or pay, find the office or suite, and then drive back to home or to work. Instead of taking 45 minutes to find a private place to talk clients have to take at least two hours out of their day to have a therapy appointment. It is easier for clients who work a regular job or work overnight to find 45 minutes. It is also easier get approval from their supervisor to leave for 45 minutes as opposed to two or more hours. They also save money on gas and parking. In addition, if a client forgets their appointment, I can text them and remind them and we can have a session instead of missing an appointment. I can also text clients to remind them of their appointments. Or if the client cancels an appointment at the last minute, I can fill the slot with someone who is waiting for an appointment. Another benefit is that client does not have to find childcare to attend their appointment. I had one client turn the camera away and breastfeed a baby while she was speaking in therapy.  

Teens and millennials are extremely comfortable using the computer as a forum to talk. Many times, I see adolescents and young adults in their hoodies, on their beds with a cup of tea talking. In fact, some people eat their breakfast and lunch because they are in a hurry to get to work or to get back to work. I have noticed that you can see a person’s personality when they are talking from different parts of their home. You can ask them about their surroundings to get to know them better. It is also a perfect forum for clients who have been in your care and then go off to college in a different state. They have continuity of care since telehealth. You can also invite other family members to join a session.

Another benefit is you can see different people throughout your entire state/territory as opposed to having geographical limitations regarding clients coming to your office. That means the expertise is spread throughout the state or territory. This is extremely helpful since therapists with expertise in treating sexual abusers are few and far between. Another benefit is that you can evaluate and treat clients in a safe place.

Telehealth is ideal for anxious clients. Clients who have anxiety are worried about getting to the office, finding parking, being on time, and then having to settle down to discuss their anxiety in therapy.

You can still use certain tools such as reading cards, sharing screens to test clients, and showing books to suggest that they read. You can also meditate virtually. You can do your progress notes while talking to a client in a discreet manner. You can also refer to the last session notes to have a point of discussion if needed.

One unexpected benefit is that the US government is supporting telehealth by waiving copays for mental health for most insurance companies

Clients Perspective: 

Some clients find telehealth extremely convenient and useful however some clients indicated that they like in person sessions because it is a space for them to feel safe talking about their issues. One client told me that on one hand “It is a designated safe space to have a conversation however due not having it, it allowed me to work on several safe spaces (in and around) my home to talk.”

My/Therapist Perspective:  

It is nice to be able to eat healthy food and have no commute. It also a pleasure that my husband is home more often. I can come down to my office at any time to do my work instead of having to drive anywhere. All my documents are in one place. I have more time to balance my work and self-care.

To summarize, I have found that telehealth primarily benefits clients. I do not see a difference in live or virtual therapy regarding rapport with clients or having them open up to discuss their issues. In fact, they seem more comfortable in their own home discussing personal issues. In addition, they do not have to worry or stress about getting to an office. Regardless of the shift of their work they can find 45 minutes a week to be available for a therapy session as opposed to over 2 hours if they would have to leave their home and go to the office.

I have chosen to continue doing telehealth as it is the best option for clients and has the added bonus of being home. Another major advantage of staying home is saving money by having no rent or additional expenses related to having an office, and less wear and tear on my car.

The lack of commute is a definite bonus.   

I think telehealth is convenient, benefits clients, and is here to stay. So, embrace the change, notice the benefits, and enjoy.

 

Double Standard, Human Rights, and beyond?

 By David S. Prescott, LICSW and Kasia Uzieblo, Ph.D

The week before last we wrote about the apparent double standard involved in a European singer’s affair with a 15-year-old. We took note of how many in society condemn sex with underage people even as they seem to make exceptions for those who are well-to-do and/or celebrities. Within hours of its publication, we learned of a related news item in the USA. In this case, a state senator seeking to replace a member of the US House of Representatives openly acknowledged impregnating a 14-year old who he later married (and divorced).

Recognizing that sexual misconduct is not the province of any one political party and that it has often appeared to be rampant in some governments, it was hard not to notice the shifting of blame in this case. The person involved blamed the political status quo. To some, his account may seem familiar:

"Everybody has something in their life that they did ... We’ve all had these problems. Why is this a big deal?" .... So, bottom line, it's a story when I was young. Two teenagers, girl gets pregnant. You've heard those stories before. She was a little younger than me, so it's like the Romeo and Juliet story," he said.

The news account further states, “He said he tried to ‘do the right thing’ and told the paper he married the girl when she was 15. They later went through what he described as ‘kind of a bitter divorce,’ … the ex-wife died by suicide when she was 20.” There is no description of her motivation to take her own life and so readers can only speculate. The aspiring politician says he tried to do the right thing but never says what the right thing is. Strikingly absent is the perspective of those who have other perspectives, in particular those with less power

It’s been the authors’ experience that some readers comment on how men marrying adolescent females has, at times throughout history, been commonplace. Many of these marriages end up being described and/or remembered as happy. We don’t doubt that this is the case; happiness and fulfillment can occur under all kinds of circumstances. Even in cases of chronic abuse, victims are struggling with the fact that they sometimes also experience positive emotions toward the person who abuses them – which confuses them even more. These observations, in turn, lead to further questions which are worthy of reflection for all seeking to prevent abuse from (re)occurring.

The first question is whether there are bright lines discerning abuse from non-abuse in situations like this and the celebrity we discussed last week? We suspect that there will always be situations that don’t fit into neat categories. Humans, and the lives we lead, tend to be too complex for that.

Still, the question that follows from there is what price young women pay when married off at an early age. Were they able to provide anything close to informed consent? Are the cases we hear about situations in which people made the best of circumstances that didn’t go their way? Did anyone ask the young women involved whether they saw or preferred other options? Did the young women have the opportunity to ask what part of their full potential they would not live up to through sexual behaviors and/or marriage in mid-adolescence?

Given the stakes involved in this recent news item, where the wife took her own life at the age of 20, we are reminded that the outcomes of sexual relationships in early and mid-adolescence are never entirely known. Whatever has unfolded in the past, it seems that all young people should have the chance to make these decisions in a fully informed way as well as in accordance with the law. Our collective years in working to prevent abuse has led us to conclude that unless we are working to uphold others’ autonomy we may be preventing them from living up to their full potential.

These cases highlight how far we’ve come as a society and how far we still have to go. The first author (David) had a great-grandmother who was considered “insane,” in large part because she insisted that her brother had forced her into having sex; this did not fit with her family’s wishes. Her circumstances would, hopefully, have been far more fortuitous today. Nonetheless, the news item described here, in which the voice of the young wife who killed herself is absent, reminds us how important it is to listen to our most vulnerable members of society outside the often implicit paradigms that belong to the past.

Double standards in our acceptance of sexual abuse.

By Kasia Uzieblo, PhD, David Prescott, & Kieran McCartan, PhD

In April a four-part documentary about the life of André Hazes, one of the most famous artists of The Netherlands, who passed away in 2004, was broadcasted in the Netherlands. This year André Hazes would have turned 70. Hence, it was deemed that it was a good moment to look back on the special life of the singer. The documentary was special in many ways. Haze was described as a man of extremes, who on the one hand enjoyed the attention, but who at the same time was extremely insecure, lonely, jealous, and self-destructive. The documentary depicted many well-known stories about the artist. But one story that was never revealed before, stood out.

Rachel Hazes, his wife, gave testimony stating that they met when she was 12 years old. When she was 15, she became the babysitter at André (34 years) and his then-wife Ellen’s home. Although it was a public secret that André and Rachel had feelings for each other when Rachel was very young, it was not known that they also shared the bed in that period. Rachel describes their first sexual experience together as follows:

“Ellen was not at home, I had gone to bed. And then André came into my bedroom at some point. Then something happened, so to speak. Then we really had sex for the first time. André was my first boyfriend with whom I made love…It caught me off guard. I had no intention of going to bed with André…When I was 15, I was not thinking about that. It really happened to me.”

When Ellen discovered that André had an affair with the 15-year-old Rachel, Rachel decided to break off contact with him. They met each other again five years later at one of André’s concerts, started a relationship. They married when she was 21 and he was 40.

When one of the authors, Kasia Uzieblo, saw this testimony, she expected outcries from the community, an avalanche of negative, angry, and condemnatory responses online. But she was surprised that this was not the case. There were a few reactions on social media, condemning André’s behaviour, calling him a pervert, a pedophile, but besides of that: deafening silence. This observation led to a discussion with colleagues from NL-ATSA, who was, like Kasia, bewildered.

Of course, it is not our intention to state that aversive reactions on stories like that should be promoted or stimulated, on the contrary. Stigmatization of people who have committed a sexual offence or of those exhibiting sexual interests in minors is a societal problem, given that it hampers their resocialization process, and it leads to their isolation with all the consequences thereof. Nor is it our intention to state that relationships between adults and minors should be approved.

But the lack of reactions, in this case, is again proof of our double standards in our acceptance of sexual abuse: Whereas we are very quick to condemn the average man when who engages in sexually violent behaviour, we do not do so, or to a much lesser extent, in the case of well-known people of social standing. In our clinical practice we also encounter men who are convicted of sexual abuse, but who maintain that it was not abuse, that the minor and he had an intimate relationship that could have developed into something lasting if he had not been arrested. One of the authors recalls, for instance, such a case in which the victim who was 14-15 years old at the time of the offence, also stated that she had a profound relationship with the ‘offender’, and that her parents approved this relationship. There were indeed indications that her ‘partner’ who eventually received a prison sentence, was regularly invited into their house and was even allowed to stay overnight.

So, this makes one wonder, what is different between André and other people who have committed a sexual offence? Does it all come down to social status? Do we have a blind spot for people who are socially significant yet who cross boundaries? Is it easier for us to dismiss this behavior as we think that we know these people, that we identify with them, and maybe idealize them? Do we want to victim blame or negate allegations because it means that we may need to look at ourselves and our values, beliefs, and/or attitudes? It is easier for us to point the finger at the stranger in the street who commits sexually transgressive behaviour than it is to condemn similar behaviour of someone with societal status because we do know and/or identify with that individual. It is simply striking that sexually transgressive behaviours committed by someone known can be easily minimized and even ignored by society, often -but certainly not always- until stark and significant evidence is presented. To illustrate, one person commented as follows in the section below Rachel’s story stated: “Everybody makes mistakes.” Why is it that we emphasize the talents, the strengths of these famous individuals but do not for anyone who commits a sexual offence? Why do we, like in André’s case, use the talents of famous people as an excuse, or justification to minimize their transgressive behaviours. We can see their strengths in a way that we do not with the “run of the mill” individual who has committed sexual abuse, which runs contrary to the goals of treatment, rehabilitation, and reintegration.

Additionally, the case of André provides us with an escape clause as he went on to marry Rachel and therefore it's easier for us to say that it is not abuse as they ended up together in the end. But the question that we need to ask about that narrative, as we would with anyone else, is that is this a case of grooming, manipulation, and coercive control/brainwashing? Or have our societal values and views regarding age differences between partners become too restrictive over time? Are we nowadays too quick to label sexual relations that do not fall within our current norms as deviant and criminal?

The truth is that we are struggling with cases like this. We do not really know what attitude to take with cases like these.

Our clients also observe these double standards and doubts, which may, in turn, facilitate or strengthen cognitive distortions (“if others do it and don’t get punished nor condemned, this behavior is OK”), and/or feelings of hopelessness, anger, and inequality (“Why me and not them”). Which can increase the likelihood of reoffending and damage community integration strategies.

Professionals need to play a role in leading the conversation that all people who commit sexual abuse have both similar risk and protective factors which do not necessarily change with social status, but what social status does is change access to victims and increase opportunities to dismiss/disregard allegations.

‘It hasn’t had much effect on me… social contact has been limited since arrest’: part 2

 By Kirsty Teague

Please note that Kirsty Teague, Lecturer in Criminology and Doctoral Candidate at Nottingham Trent University is supervised by Dr. Nicholas Blagden, Professor. Belinda Winder, and Dr. Paul Hamilton. This is part 2 of a 2 part blog, part 1 can be found here. Kieran   

Parts 1 and 2 of this extended blog post provide reflections and realisations as a result of conducting face-to-face (F2F) data collection over a 6-month period during the COVID-19 pandemic. Whilst Part 1 focused specifically on participant recruitment and participant vulnerability, Part 2 explores barriers to engagement with meaningful others experienced by men with sexual convictions during the pandemic. The latter part of the post looks at the impact conducting f2f research had on the researcher during this time.

Restrictions preventing engagement with meaningful others

Have you even lived through the COVID-19 pandemic if you haven’t had to participate in a video call and/or online quiz with family and friends?

Video calls and quizzes have been elevated to lifeline status over the last 12 months and considered a key source in maintaining social connection. However, for those with a sexual conviction (regardless of offence type), licence restrictions can prevent (i) access to the internet; and/or (ii) ownership of a smartphone which can take or download photographs/video and have the ability to live stream. This has meant that throughout the pandemic there has been a proportion of individuals effectively cut off from the new virtual world we find ourselves in. Something that has received little to no attention or consideration by those who craft such restrictions and policies.

As such, initiatives such as the Corbett Centre have become even more valuable than ever before; a physical place where everyone is safe, respected and not judged. As someone who belongs to the LGBTQI+ community, the role and value of ‘safe spaces’, I appreciate all too well. Having allies is also important. This leads me to Ben’s March 19^th blog post titled: ‘reflections on the challenges of “true” community integration post-conviction’, where put forward the following:

‘The solution is still to humanize sex offenders and tell their stories of trauma and childhood adversity, as often and as loudly as possible, so that they are no longer feared. As the fear goes away, so will the hatred and the othering. Creating empathy for sex offenders, in wider society, will not be easy. You will be accused of being soft on crime, but it must at least be attempted’.

As researchers and practitioners, this is something that we must be committed to doing to reintegrate those with sexual convictions back into their communities. The pandemic has meant that men with sexual convictions feel like outsiders, more so than they do usually, not just due to the pandemic, but due to structural barriers in place to prevent their reintegration. These barriers send messages of difference, fear and risk to society, creating a sense of hostility.

The vulnerable researcher

Conducting f2f research during the pandemic has been energising and de-energising in equal measure.

Hearing and promoting the voices of those who too often don’t get to tell their stories has been energising, and something which I’ll do until there is tangible and meaningful change for the better in how society and criminal justice agencies respond to those who have sexual convictions.

However, there has been emotional and psychological strain in conducting this research. Something which I’ve reflected on more so in recent months is the role that gender plays in conducting research with men who have sexual convictions. As a female researcher, I wonder about the extent to which there is parity with researchers of other genders in the nature and extent participants offload both general and specific wellbeing related issues, but more specifically in a COVID-era.

However, sensitivity and receptivity to issues of exclusion and isolation on my part is also likely to be impacted (and be perhaps elevated) as a result of the pandemic. My partial experiences (by comparison) of exclusion and isolation have made me more sensitive to my participants experiences of such. However, this begs the question, do we need to have experienced something in order to understand it? There are some parallels here to other realms of social life. For example, people now likely have a greater understanding of the difficulties associated with teaching since home-schooling children during the pandemic. One thing that transcends most issues, however, is that during challenging times, socio-economic status insofar as access to resources and support goes, can either perpetuate or protect against structural disadvantage.

On a related note, many discussions in the interview context related to social isolation, and the idea of becoming ‘socially inept’ - de-skilled from building social connection due to a lack of opportunities for relationship building. This often led to concern for the participants given the exacerbating nature I knew the pandemic was having on this issue. Reminded of the trust and hope placed in research to help make positive change, this was often a mitigating tool not just for me, but for the participants undoubtedly too.

Participant 11 diary entry: ‘April 30th: This started as recording something to be grateful for each day and I appear to have moved away from that.

So today I am grateful for the great people at the Corbett Centre. Helping with the research is so interesting, I always find out something about myself’’

Finally

Whilst social distancing, sterilising of surfaces, lateral flow testing and face masks mark a sign of the times, not least in research and educational contexts, they shouldn’t be seen as barriers to meaningful connection. Occupying the same physical space is more so important, especially in eliciting people’s life stories and lived experiences.

 

‘It hasn’t had much effect on me… social contact has been limited since arrest’: Reflections on conducting Face 2 Face research with men who have sexual convictions during the COVID-19 pandemic

By Kirsty Teague

Please note that Kirsty Teague, Lecturer in Criminology and Doctoral Candidate at Nottingham Trent University is supervised by Dr. Nicholas Blagden, Professor. Belinda Winder, and Dr. Paul Hamilton. This is part 1 of a 2 part blog. Kieran  

Participant 10 diary entry: ‘Sunday 27^th December, just spent my worst Christmas on record and Covid did not help. Since last Thursday I have not spoken more than ten words to anyone, I am beginning to hate it here, and I think not being aloud to speak to my next-door neighbour is rather pathetic, and the persons who agree with it need to get a life. It must go against everything equality stands for. I very rarely get angry and I’m not angry now but I do get emotional and at the moment I feel emotionally drained, tired and for want of a better word unloved, not that I wish to be loved but it would be nice if someone actually cared’

In England, March 23^rd, 2020, October 31^st, 2020, and January 4^th, 2021 will be remembered for marking three distinct national lockdown phases resulting from the COVID-19 pandemic. Whilst for many, we were entering unchartered territory of social isolation and reduced autonomy, for some of the most vulnerable in society this was not new. For men with sexual convictions, life post-prison is too often marked by isolation and restrictions.

Whilst we were shielding the clinically vulnerable, those who were vulnerable as a result of their offence history were becoming more isolated than ever before. For many men with sexual convictions, relationships with family and friends are too often replaced by professional relationships, not least with probation services. However, in March 2020 even face-to-face (F2F) meetings were replaced by digital supervision, with only probationers deemed high-risk warranting a doorstep visit. Whilst of course this was deemed necessary to control the infection rate, the impact of a lack – and for some a total loss of – human contact has been evident, especially in a research setting.

My PhD research is exploring how men with sexual convictions construe and relate to ‘community’ by looking at social cure and social curse processes that help or indeed hinder, reintegration post-prison. This is done through a combination of methods including interviews, repertory grids and diaries. From November 2020 through to April 2021 I commenced face-to-face data collection. Below I outline my reflections and realisations throughout.

Participant recruitment

The new and innovative Corbett Centre provides the hub for this research, including participant recruitment. From the outset, many service-users of the centre were keen to participate. However, with the rapidly changing nature of the virus and responses to its control, I anticipated engagement would dip, no matter how well-intentioned service-users where, to begin with.

What followed, however, was an unbridled enthusiasm to engage with the research. Fourteen participants engaged with two interviews (one semi-structured; and one repertory grid), with the opportunity to maintain a diary as well. Throughout the pandemic, the centre has been COVID-secure and risk-assessed, making it a place of safety, in its widest interpretation. During the pandemic, ‘community’ and being ‘together apart’ have been critical for social connectedness. The necessity to understand the bearing of these concepts on men with sexual convictions provided plenty of discussion at a time when they felt somewhat disconnected. In practical terms, this led to lengthy discussions which often meant that it was sometimes difficult to round up discussions and prepare for subsequent interviews. There was often a conversational spillover which warranted a coffee and a chat after, or the need to switch off from an emotive discussion on lacking social belonging (which featured a lot) to then learn a card game before they left the centre. It was at these junctures I reflected on Prof. Belinda Winder’s, take on research ethics being an ‘iterative cycle of ethics and care’. 

Participant 3 diary entry: ‘Saturday 16^th January – ‘… had my interview at CC and it made me realise how much I enjoy being there. With work and not living too close it isn’t somewhere I get as often as I would like but it is one place I feel truly relaxed as myself ‘warts and all’. Ok Kirsty’s company, coffee and mini-egg chocolate do have a bearing on that but even so it’s nice to have a proper conversation without being guarded about my past…’ 

Participant 7 diary entry: ‘03/02/2021 – Wednesday – ‘I went over to the Corbett Centre today… I had a chat with Dave and Kirsty too. It was nice to have a bit of social time. I did some shopping on the way home too’

Vulnerable participants

Any researcher will be familiar with the banal and ritualistic (but, yes necessary) providing debriefing sheets to participants following a research encounter. However, conducting this kind of research, during these times, required humanistic and relational encounters. Many participants commented on how few people they’d had a meaningful interaction with, in the preceding days and weeks before engaging in research. Taking the time to have a chat about the mundanities of life, but also to discuss how they were coping was incredibly important.

Participant 10 diary entry: Friday 18^th December, staying in and being sort of isolated for the last four days and not speaking or seeing anyone, a few thoughts came to mind, one being, if I never speak to or see anyone in my life, do I really exist. I sometimes feel like I’m in sort of a ground-hog day, not moving forward like I should be, sometimes it even feels like I’m moving backwards

The pandemic has provided fewer opportunities for us all to have meaningful encounters with people, and those with sexual convictions sometimes more so. It was also often during a research encounter that issues were presented that perhaps wouldn’t pre-COVID. One participant hadn’t slept the night before coming to the centre due to him finding out his mother was too scared to leave the house as a result of neighbours learning of her son’s offence history. For this reason, we spent much of the morning discussing the next steps and wellbeing-related issues. Whilst for many, the pandemic has provided an opportunity for reflection on what is important in life, violence (symbolic, structural and bodily) continues for those who have a sexual conviction, and those they are close with. Being there to listen and provide moral support (scaffolding appropriate practical support) throughout the pandemic has been essential.

Part 2 will discuss barriers to engagement with meaningful others experienced by men with sexual convictions during the pandemic and the impact conducting f2f research had during this time on the researcher.

 

 

 

Where do we go from here?

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

The world watched last week as Derek Chauvin was convicted for the murder of George Floyd. Tragically, 16-year-old Ma’Khia Bryant was shot minutes before the ruling was announced. A few days later, Kenosha, Wisconsin police officials announced that the officer who shot Jacob Black in the back would not face any discipline.  While many felt relieved in the wake of the George Floyd ruling, we all know much more needs to be done to bring an end to the violence in our communities; violence that studies find disproportionately affects people of color. It is not an easy topic to address succinctly in a blog post, and yet it is a critical time in our field’s history as we work to prevent abuse. What makes this such a difficult area for open dialog?

At first glance, there may not appear to be an obvious connection between the experience of people of color in respect to violence and sexual abuse, but there is.  One of the biggest common denominators in the lives of people convicted of a violent offense (including sexual abuse, which is a form of violence) is their frequent dual status as both past victim and current perpetrator. International research on the risk factors related to offending indicates that people who commit violent crime have a greater likelihood of having experienced past trauma and/or adverse childhood experiences. These experiences have impacted their development and lifestyle.

Too often, we choose to ignore these individuals’ backgrounds and vulnerabilities, focusing instead on their behavior. This is approach fails because we are looking at the severity of the crime and not the nuance of the person. The challenge is how we talk about violence, including sexual abuse, across diverse communities where experiences and practices, and opinions about violence are vastly different. The important word here is “community,” because there are several communities with differing perceptions all grappling with their response to violence and sexual abuse. These include the geographical community, the victims’ community, the political and press community, and the professional community. This diversity highlights the importance of an intersectional approach to understanding and responding to violence and sexual abuse. There are many challenges: Kieran grew up in Northern Ireland during the peace process and saw firsthand how challenging it was to change social norms, ideals, and cultural beliefs. The important thing to remember is that violence and sexual abuse, in all their forms, are community issues and that we need an engaged and united community to tackle them.

From a professional perspective, changing social and cultural norms, as well as beliefs, can present additional challenges. Being on the front lines of social justice means recognizing flaws within the system while working steadily and proactively to reduce them. Our clients suffer, often in silence, understanding that they are measured on scales that may be biased against them, particularly with factors like a past criminal record and substance abuse.  Meanwhile, too many professionals of color have their own experiences with such biases, maybe even with violence, and may have reactions to these events that they can’t share openly with others. Far too often, we are blind not only to our clients’ everyday challenges but to those of our colleagues, too.

It is encouraging that so many conferences in recent years have had pre-conference workshops and keynote addresses that examine the backstories behind racial bias and violence. The apparent dearth of open dialog about these matters elsewhere is unfortunate, even as it is understandable. The intersection of sexual abuse, discrimination, racism, and prejudice creates a perfect storm that can cripple professional teamwork. If we as a global community don’t feel comfortable talking about these issues with our most trusted friends and colleagues, why would professionals in the field be any different? Individual professionals are members of many communities and may only discuss these issues within receptive communities, but that part is easy. We need to make the hard choice to talk about these issues across all of the communities we belong to so we can learn from each other’s experiences and perspectives in order to develop a better understanding of these different communities and their experiences. This presents its own challenges because

-     people often enter such dialogs with firmly entrenched opinions and beliefs;

-    people tend to make assumptions about what others have to say without asking for clarification;

-    many people listen to others primarily with the goal of responding and making their own points;

-    people often fail to listen to others with the goal of truly understanding; and

-     one of our colleagues expressed it well several years ago when he said that professionals should     assume ethical intent and practice among our colleagues until we see evidence to the contrary. Otherwise, it is too easy for discussions to go off the rails.

This places all of us in a quandary: On one hand, the expression that “silence equals violence” may never have been more true. On the other hand, it is not difficult to imagine being pilloried for speaking up and speaking out.

Too many of us were raised with conversational taboos on certain subjects (religion, spirituality, and politics come immediately to mind).  The unfortunate result is that many people have never learned how to have difficult discussions. The challenge in having difficult conversations is significant, but the payoff can be significant as well. Social change takes time.  While we should not expect it to happen overnight, it’s vital that we keep trying.

Another exposé: “Why Do We Let Corporations Profit from Rape Videos?’

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

The past several weeks have seen many events in America that have the potential to influence the work of professionals in our field, both nationally and internationally. Many have been horrific, such as the rising tide of gun violence and the grief, anger, the outrage felt around the world in response to the murder of George Floyd and, despite the trial of Derek Chauvin and its historic outcome, the ongoing killings by police officers. Each new headline is a reminder that the people we serve often experience the world very differently than many professionals do. We all find ourselves in a dilemma: If we are to heal in the wake of world events, we need to be able to talk about them on the one hand, and on the other hand, many people are either too anxious to dialog and/or too exhausted to try.

With this in mind, a New York Times exposé appeared this week focusing on the porn industry. Where erstwhile journalistic investigations once examined the conditions of professional production of sexually explicit materials, the Times’ focus is on how the so-called “tube sites” of the modern era are run. These include Pornhub and several other sites that followed the YouTube example (readers might recall that YouTube’s original slogan was “broadcast yourself”).

In this article, Nicholas Kristof describes many examples of what until recently was commonly referred to as “revenge porn” (that term does not appear in this article, presumably because of recognition that there are other motivations than revenge, including profit and the perceived thrill in causing harm to others). These are situations in which (mostly) women are coerced or cajoled into producing sexually explicit media which are then uploaded to the tube sites. In many (but by no means all) cases, the person who is victimized in this way is underage. As Kristof observes, the video may be brief, “but the attack on dignity becomes interminable.” He provides numerous examples of people who pleaded unsuccessfully to have their videos taken down.

We need to be clear – as other professionals have noted – that the actions of the people uploading these videos are acts of violence; referring to it as pornography diminishes the experience of those harmed. It's important to note that posting “revenge porn” is committing an offense, it is not necessarily linked to a paraphilia or mental illness. We need to be careful about not pathologizing people when it's not appropriate. In many cases “revenge porn” speaks more to society's attitudes and understandings of sex, consent, and sexual harassment.

Many questions about these tube sites follow, which have implications for the ethics of sex, relationships, and business. As on many other occasions, we have more questions than answers. For example:

·         When is consent truly consensual? How is consenting to sex being recorded different from consenting to sex?

·         Can this consent be withdrawn as it can be with research, mental health treatment, or medical interventions?

·         How should businesses account for the harm that they cause under these circumstances?

·         What can we learn about human relationships from all of this? How many sacrifices do people make, in the moment, for their relationships that they will later regret? How do we raise young men to be more than the video equivalent of trophy hunters? And how to we raise our girls to remain attentive all the time and to be assertive, also towards boys who are older and whom they admire?

·         How do we prevent violence while protecting free speech?

·         How do we enable freedoms more broadly while keeping vulnerable individuals safe?

Another issue raised by this article is the apparent lack of empathy and concern in our society. The businesses are in it for the money; that much is clear. Nevertheless, one wonders who is running these businesses. Are all of these people as callous they seem? Do they only have an eye for the money? How can they look the other way? And what about the viewers?

The video of the rape of Heather Legarde, described in the article, has been watched by 200,000 people. One in eight videos on three major tube sites depicts sexual violence or nonconsensual conduct; hence, there is an audience for these videos. These figures should give us all goosebumps. This is not just a small fraction of society that seeks out these videos for sexual pleasure. It appears there is a double standard here, one worthy of examination. We are all repulsed by people downloading and watching images of child sexual abuse.; isn’t this equally serious? Shouldn’t society invest in preventing this cruelty through education, sanctions, and other means to give a clear signal that this is not acceptable? And finally, what about us? Where do professionals fit into this? What can we do?

The first author posted a link to this article in a number of places around social media and received only two replies in total. The article has not gotten the attention that Kristof’s first article did. Are we witnessing a process of desensitization to the harm that people experience? Is it all becoming part of the much-discussed ‘new’ normal?