Friday, August 15, 2014

Correcting Course: Have We Missed the Boat on our Clients’ Adverse Experiences?

A recent discussion on the ATSA listserv was worth following. It began with the simple question of what sorts of trauma-informed systems of care exist for adolescents who have sexually abused, and extended well beyond. One member basically asked why it is only now that the notion of trauma-informed care seems to be coming into vogue in our field. It is an excellent question with no clear answers for now. One member commented on how in the past many therapists noted that their clients seemed to excuse their abusive actions by claiming that they had themselves been abused. Clearly, a side effect of helping clients in the direction of becoming accountable for their behavior could be the therapist’s implicit or explicit minimizing of their past experiences. This ATSA member commented that while it can be necessary to help people move through defensive excuse-making into a more honest conversation, the original intent of holding clients accountable was never to dismiss the harm that had been done to them.

A case from the author’s experience is haunting and illustrative. In one agency that employs polygraph examinations, it was routine to polygraph clients on their disclosures of past victimization, apparently with the underlying assumption that their clients often sought to excuse their behaviors. While this use of polygraph could itself be the subject of many other discussions, an interesting situation arose when the therapist ordered a polygraph to verify the account of a client in treatment who claimed a lengthy history of sexual abuse as a child. He had received individual therapy for this over the course of a year. Upon failing the examination, the client said that in fact he had been lying to his therapist about this abuse all along. He went so far as to use uncouth language to assert that his treatment team were naïve and foolish for believing him.

Whatever the truth in the above client’s case (and setting aside other florid concerns about his functioning), one is still left with the question of whether other adverse, even traumatic, experiences in this client’s life contributed to his offenses and his behavior in treatment. What events in his background led him to believe that it was in his interest to interact with others this way? In other words, when we ask about abuse, are we asking the wrong questions? Often the question seems to be dichotomous: was he abused or not? Perhaps it’s better to explore all the formative events of one’s life. What are the many ways in which our clients might have been hurt? What sense did they make of these events? How have these events contributed to their views/schemas of themselves and others?

Very little research has shown a direct link between one’s victimization and propensity to abuse. Although controversial, authors as diverse as Susan Clancy and Bruce Rind have observed that not everyone who has been abused experienced their situation as abusive, and many believe that it had little or no effect on them. Certainly, the vast majority of people who are victimized do not go on to abuse others. Yet in our rush to treat only those factors that proximally contribute to re-offense risk (in adherence to the need principle) we could be overlooking important ways to make our treatment more meaningful to our clients (in adherence with the responsivity principle). Ultimately, the question is how effectively can individual clients build safer futures when they don’t have an adequate opportunity to transcend their own past?

A couple of recent studies are worth mentioning. Reavis, Looman, Franco, & Rojas (2013) administered the Adverse Childhood Experience (ACE) Questionnaire to 151 people who had been violent towards children, engaged in domestic violence, sexually abused, and had stalked others. They found that these types of offenders had significantly higher rates of adverse childhood experiences than men in the general population. Only 9.3% of the sample reported no adverse events in childhood, compared to 38% of the male sample in the ACE study, and 48% reported four or more adverse experiences, compared to 9% of the men in the ACE study. Sex offenders in particular had significantly higher ACE scores than the general population. Likewise, Levenson, Willis, & Prescott (2014) administered the ACE questionnaire to 679 adult males who had sexually abused. Compared to males in the general population, sex offenders had more than three times the odds of child sexual abuse, nearly twice the odds of physical abuse,thirteen times the odds of verbal abuse, and more than four times the odds of emotional neglect and coming from a broken home.

Of course, not everyone responds to adverse and traumatic events equally. Authors such as Geral Blanchard have written on the understanding of post-traumatic growth, that ability not only to integrate traumatic experiences, but to find meaning from them and flourish as a result. Many clients who have sexually abused simply enter treatment looking to prevent further abuse and are not interested in an archeological expedition into their distant past. If there is anything the trauma field has learned, it’s that people who have experienced abuse need to discuss and move beyond it in their own way and in their own time. Sadly, there is far more high-quality research into recovery from abuse than recovery from sexual violence.

Perhaps the biggest question our field has yet to ask is how adverse experiences contribute to the areas that can make meaningful change seem unlikely to therapists and clients alike. It is tempting to think of the sequelae of abuse as being only things like distress and nightmares. It is easy to forget that therapy-interfering factors such as restricted affect, memory problems, relationship issues, and avoidance of situations that remind one of abuse (such as treatment for sexual aggression) are themselves trauma symptoms and not always attempts to avoid responsibility.

So how is it that our field is only now talking about trauma? Perhaps because we’re finally moving past thinking solely in terms of abuse-abuser hypotheses and understanding the nuances of adversity.

David Prescott, LICSW

Gwenda M. Willis, Ph.D., PGDipClinPsyc

PS. This blog was written with advice and contributions by Jill Levenson


             Levenson, J.S., Willis, G.M., & Prescott, D.S. (2014). Adverse Childhood Experiences in the Lives of Male Sex Offenders and Implications for Trauma-Informed Care. Sexual Abuse: A Journal of Research and Treatment. Avance online publication.doi: 10.1177/1079063214535819.

Reavis, J., Looman, J., Franco, K., & Rojas, B. (2013). Adverse Childhood Experiences and Adult
Criminality: How long must we live before we possess our own lives? The Permanente Journal, 17,


  1. A thought-provoking blog, thanks for presenting various aspects of working with effects of adverse childhood expereinces