Fidelity to the Model or Fidelity to the Client? Reflections on Treatment.

By David S. Prescott, LICSW

I have had the very great privilege this year of training in many locations around the world. Again and again, it seems that the people in our field want nothing more than to end abuse by helping those who have abused. As others have often said, many of the people who benefit from this work will not know to say thank you because the potential abuse won’t happen. Many of the contexts in which we provide treatment, however, seem to work against us; living up to our full potential as therapists can be a challenge. Why?

Even the most conservative studies find that people who abuse are often at greater risk to commit non-sexual crimes. Still, programs tend to focus exclusively on preventing further sexual crimes. While this is certainly understandable, the fact that individuals who enter treatment all have different risk profiles for various crimes, sexual or otherwise, argues against one-size-fits-all treatment regimens. Yet, this is exactly what is now happening in many jurisdictions. The more refined our assessment processes have become, it seems, the less assessment-driven our treatment programs actually are. 

Scripting was a focus of at least one workshop at this year’s ATSA conference in Kansas City, including a debate on the merits of highly scripted treatments. One manual in use is scripted down to the level of client affirmations during exercises. It is not hard to imagine how treatment participants’ experience is less one of talking with a therapist, but more about the curriculum itself. Such circumstances should lead us to wonder if it would be more honest to jettison terms like “treatment”, “facilitator”, or “therapist”, etc. and replace them with “class”, “instructor”, etc. 

Throughout 2017, I met with countless people who provide treatment based on various strict curricula, some more recently developed than others. The most common questions always centered in the same area: How do I use actual therapeutic processes with a manual that tells me what I am supposed to be doing in every session? How do I ensure a strong therapeutic alliance when the curriculum dictates what I am doing and outside stakeholders are clear that they want me to use this curriculum? How do I provide assessment-driven, individualized treatment within a framework like the Good Lives Model when my professional training has always been about following the curriculum? What if I use motivational approaches that help my client meet some goals but not others? How do I interview someone to identify their Self-Regulation Model Pathway? 

These questions come naturally in an age of empirically supported treatment protocols, in which methods such as Aggression Replacement Training can be rigidly prescriptive (although the curricula typically used in our field can’t claim to be empirically supported). Indeed, these are the right questions for clinicians to ask when considering how best to deepen their practice in individual and group therapies, specialized case management, community supervision, etc. Still, I come to the end of 2017 wondering whether clinicians haven’t surrendered our responsibility to clinical decision-making based on the needs of each client in favor of getting through the curricula that directors and outside stakeholders want us to use. Again we come back to the fundamental question asked by a conference presenter many years ago: Are we personalizing our manuals or manualizing our persons? 

Whatever one’s work environment, my hopes for 2018 include that each person providing bona fide treatment:

• Can work not just within whatever framework they use, but actively attend to the therapeutic processes that decades of research have shown to work (e.g., warmth, empathy, hope, agreement on the goals and tasks of treatment) (Marshall, 2005; Prescott, Maeschalck, & Miller, 2017).

• Privileges the client’s voice and gets feedback from their clients.

• Remembers that every conversation is most effective when it involves active attempts by the         professional to connect, explore the subject at hand, and offer ideas about the way forward.

• Keeps in mind that the most effective treatments are collaborative and marked by agreement on the nature of the relationship (i.e. do the client and therapist agree on what the therapist’s role is?) as well as a shared vision of the goals of treatment and the means by which they are accomplished.

• Works to study each client and delivers truly individualized treatment no matter which curriculum they use.

• Remains committed to the task and rigorous in implementing treatment and supervision.

• Maintains an active dialog with external agencies in order to provide the treatment that each client needs rather than simply what each stakeholder wants.

• Choreographs each session to be a dance between the momentary presentation of each client and what research shows will keep treatment in line with the principles of risk, need, and responsivity.

• Keeps that focused sparkle in their eyes when working with even the most difficult client.

In short, my greatest hope is that the people doing this work will keep the humanity in human services. It’s not just a personal value; it’s what is demonstrated to work by all of our extant research!

International conference on innovations in sexual abuse research & practice

By Kieran McCartan, PhD, & Danielle A. Harris, PhD.

A few weeks ago, Griffith University (Brisbane, Australia) hosted a two day research conference on innovative international approaches to understanding and responding to sexual offending. The symposium was a collaboration between the Griffith Criminology Institute and the Griffith Youth Forensic Service with the objective of bringing contemporary international debates [from the ATSA, NOTA and ANZATSA conferences] on sexual abuse to Brisbane. In this blog we discuss the main points of discussion and outcomes of the event.

The two day conference was held straight off the back of the 2017 ANZATSA meeting to capitalize on the fact that so many international speakers were in our neck of the woods. Several presenters made the trip from Auckland (New Zealand) to Brisbane (Australia) to share the knowledge of sexual abuse research and practice internationally, and to highlight and discuss new and best practices. The first day of the conference saw presentations from a host of international speakers from the USA (Jill Levenson; Alissa Ackerman), New Zealand (Gwenda Willis) and the UK (Andrea Darling; Carlene Firmin MBE; Kieran McCartan). The speakers addressed: the impact of Adverse Childhood Experiences; the importance and promise of Trauma Informed Care; understanding the life histories of people who sexually abuse; the importance of the labels that we attach to individuals; the interaction between the survivor voice and service user voice; the experience and potential of vicarious restorative justice; female perpetration of sexual abuse in institutional settings; and how we can develop a rounded case management approach to understanding the contextualized risk of sexual offending among peers.

All presenters emphasized the individual nature of sexual abuse and, therefore, why we need to take this into account in responding to, managing, and preventing sexual abuse in the broader community. The speakers called on all attendees to break down our professional barriers and break out of our silos so that we can work together more comprehensively. The feeling in the room was very much in line with the theme of ATSA’s forthcoming conference in 2018 #bettertogether!

The second day of the symposium was more a practical research roundtable. The roundtable was attended by the presenters from day one, plus an invited group of local researchers, clinicians, and stakeholders. After a quick round of introductions, we shared the common themes that had emerged from the international meetings in our field, with a focus on key debates and emerging trends. Most had attended some combination of ATSA, NOTA, ANZATSA, ANZSOC, ASC and/or BSC. We then broke out into thematic groups based on our previously identified research interests. Folks spent the afternoon with the opportunity and space to plan and discuss ongoing and nascent research questions; brainstorm possibilities for collaboration and data sharing; and agenda setting that prioritizes the most important issues in our field today.

Bringing this second day to fruition was a long-term goal of Danielle’s. She often found herself excited and overwhelmed at the end of a conference, but then lacked the time to have any detailed, follow up conversations. She says she would often spend the flight home furiously consolidating notes scribbled on cocktail napkins or business cards. So this was a chance for a meeting of the minds between established researchers, emerging scholars and PhD candidates, as well as practitioners and policy makers all in one room. The feedback was very positive and folks were grateful for the slower pace and opportunity to have longer and deeper conversations and, as one delegate called it, “thinking time.”

The two day event reinforced the need for us all to work together and to recognise that sexual abuse is an international issue. It was also interesting to observe that there are many more things that unite us than divide us – for example, as the US grapples with the “Weinstein effect,” and as those Hollywood revelations make ripples in international news, it was clear to see that each of our countries, cities, neighbourhoods, and fields of expertise have their own such examples. Indeed, we are all in this together. Perhaps most inspiring was the feeling that while attendees had come and were eager to learn about the approaches from abroad, each of our international guests was in turn inspired by the many inventive, innovative, and creative methods that we have developed down under. As the world gets smaller and better connected, and we acknowledge that we are more similar than different, it behoves us to explore how we can all learn from each other. This two day conference reminded us that much can be gleaned from the success of unique initiatives that have been able to flourish under legislative landscapes quite dissimilar to those in the US. Similarly, there is much to be gained by understanding how different approaches have been able to develop in communities with healthcare systems or social circumstances that are distinct from those experienced by our American cousins. 

As we move into 2018, watch this space for more information on ways we can engage in an international knowledge exchange with the goal of making society safer. 

Leper or Messiah?: Words do Matter

By Christopher Lobanov-Rostovsky

Leper or Messiah? The answer is neither.

So when we talk about the adults…mainly men…who are sexually exploiting the vulnerable young people around them, what is the right question? That is too often becoming lost in all of the current media coverage in the United States related to sexual exploitation. 

It is truly unbelievable for someone who has worked in this field for 30 years to see all that has happened in the last 30+ days. I have devoted my professional life to stopping sexual violence in all of its forms by counseling those who commit sexual offenses. I never truly thought I would see the day where society would be so openly having this discussion. So I have decided that it is time to add my voice and perspective to the growing public conversation.

The horror of sexual violence is as old as society itself. We refer to it as sexual abuse, exploitation, or harassment, and use labels like pedophile, predator, and victim. For those who don’t really want to face the issue, it can be easier to see it as all being the same. And yet in my 30 years of experience, I have seen how this issue is infinitely more complex. So what was the question again? Is senatorial candidate Roy Moore more like the father of the Messiah, as a supporter has described him, or a pedophile (sexual attraction to pre-pubescent children), as others have said? Neither is accurate.

So what is the truth? For the first time in history, a large number of people in this country, including the women reporting Roy Moore for sexual exploitation, feel empowered to come forward with their stories of sexual exploitation. The media is publicizing these stories which has the ability to facilitate change of individual behavior and the underlying culture.

Given this media coverage, the challenge to ALL of us is to learn how to talk about this. I would like to offer a few suggestions about how to have these very difficult conversations in a way that is respectful and hopefully engages all of us. In doing so, we must allow for the attention to ultimately remain focused on those with the courage to come forward and those they accuse:

1)      All of us who are reading these stories would benefit from an accurate reporting, understanding and discussion of these unfolding events. Use of emotional-laden terms like pedophile, which does not appear to be applicable in the Moore case, distract from understanding what occurred. Correct information will help us have this conversation in a constructive and productive fashion.    

 

Potential Media Reporting:

“Senatorial candidate Roy Moore has been accused by multiple women of engaging in sexually exploitive behavior. One of the women reported being the victim of what would constitute sexual assault as the behavior would be a crime if committed within the statute of limitations. The other women described the exploitation as consisting of dating them while they were still minors, but above the age of legal consent in Alabama, when candidate Moore was in his thirties. All of the women described trauma related to their experiences with candidate Moore.”

 

2)      When people come forward with their personal stories of sexual exploitation, we should offer them support and validate their experience. This does not mean we automatically accept at face value what they are saying as proof of a crime and convict the accused without proper due process. Trauma does not always express itself in a straight forward and direct manner. We need to initially support individuals who come forward to share their experiences without judgment.  

 

Potential Response to Those Who Choose to Share Their Sexual Exploitation Publicly:

“I support the strength and bravery of (person reporting sexual exploitation) for coming forward and sharing his/her story. I would encourage (accused name) to step away from his/her role as (fill in position) to seek assistance in addressing this allegation.”

 

3)      Finally, how should someone accused of sexual exploitation respond? We have seen many different responses over the past month (outright denial, inability to recall, justifying the behavior, taking responsibility for how the person reporting sexual exploitation may have misinterpreted the actions which were not meant to harm or offend, etc.). A short statement of accountability without trying to explain or excuse would best serve both the person accused of sexual exploitation, as well as the person making the allegation.

 

Potential Accused Response:

“I, (fill in name), take full accountability for my actions involving (name of person reporting sexual exploitation) and the harm this behavior has caused. I will be stepping away from my role as (fill in position) in order to address my behavior and what I can do to cause no further harm to (name of the person reporting sexual exploitation) or anyone similarly in the future.”    

 

While it is important for society to have this larger conversation about sexual exploitation, it is equally important that we allow space for the accused and the person reporting the sexual exploitation to address what happened. For the person making the allegation, this may include learning how to manage trauma and live with what happened. For the person accused of sexual exploitation, this may include an opportunity to be accountable for the behavior and receive treatment to better understand the behavior and prevent its recurrence. IF we are going to support healing and accountability, then we must do it in the right way. Leper or Messiah is too easy. It lets us all off the hook in terms of truly listening and hearing how to do our part before it happens to any other young people. So let’s have the conversation and learn from it. What do YOU say?   

ANZATSA Bi-Annual Conference 2017

By Kieran McCartan, PhD, David Prescott, LICSW, & Alissa Ackerman, PhD

The bi-annual ANZATSA conference took place from the 28^th November – 1^st December in Auckland, New Zealand. The conference was a real mix of practice and research emphasising the role of prevention, risk management, protective factors and an emphasis for an understanding of the needs of aboriginal/traditional communities in working with perpetrators of sexual harm. The conference was very international in nature with speakers and attendees coming from New Zealand, Australia, pacific islands, Singapore, USA, UK as well as The Netherlands.

The plenary sessions  focused on the need to reframe sexual harm as being more than just a criminal justice issue, with speakers emphasising the need for a public health  approach (Elizabeth Letourneau, Jill Levenson, Maia Christopher); how we reframe the socio-political debate (Maia Christopher); a need to think about the role of trauma and Adverse Childhood Experiences in the lives of perpetrators (Elizabeth Letourneau, Jill Levenson, Alissa Ackerman); how we need to build protective factors into the management and rehabilitation of perpetrators (Elizabeth Letourneau, Jill Levenson, Michiel de Vries Robbe); the need to listen to and re-evaluate our understanding of sexual harm in the context of traditional/aboriginal communities (Bryon Seiuli, Marlene Lauw, Pam Greer, Linda Waimarie Nikora) and the importance of how we listen to victims/survivors and incorporate their actual lived experiences into how we respond to sexual harm (Alissa Ackerman). The plenaries emphasised that we have reached a watershed moment in international and transitional conversations around sexual harm and that we need to reframe these issues more appropriately.

 

As we have said before, there are more things that unite our experiences in the field of sexual harm than divides us. We just need to open our eyes, ears, and hearts to learn and adapt from each other’s good (and bad) practice. One tone that remained present throughout the ANSATZA conference was that anyone and everyone with knowledge about sexual harm knows that current policies such as registration, notification, and residence restrictions aren’t working in the USA, arguing strongly that these should not be imported as is to other countries internationally.

 

ANZATSA 2017 kicked off with a public engagement event prior to the start of the conference, where the film “Untouchable” was screened. The documentary screening was followed by a panel discussion with Jill Levenson, Alissa Ackerman, Mark Hutton and Marlene Lauw. It was developed and lead by Gwenda Willis as well as her colleagues in the “Advancing Sexual Abuse Prevention”. The event was a great success with members of the public mixing with attendees at ANZATSA and really emphasising the importance of informed and constructive sexual harm policies; therefore, reinforcing and emphasising the main themes of the conference.

 

Many of the conference breakout sessions and workshops this year seemed to emphasis treatment, risk assessment and risk management.  The conference had presentations on the management of individuals who have committed sexual harm, registration and monitoring (Shephard; Hutton, Laws, Derby & Ross), female sexual abusers (Darling), understanding the sexual abuser as the service user (McCartan, Prescott & Harris), desistence (Harris), protective factors (Dickson & Willis), risk assessment (Helmus), adolescents who sexually harm (Lambie &Tolcher; Kelly, Shumack & Evans; Tolliday; Firmin; de Larcerda Mottin), perpetrators from aboriginal/traditional communities (Tofaeono; Jamisetty, Tamatea & Boer), and the role, as well as  impact, of pornography (Pratt & Hollis; Fernandes; Prescott) to name a few.

 

Additionally, several sessions focused on the needs of survivors of sexual violence, including the need for trauma informed approaches to working with clients. This was an exciting aspect of the conference, as presenters represented multiple countries, including New Zealand, Australia, South Africa, and the United States.

 

Of course, the conference location (New Zealand) ensured that there would be an emphasis on the assessment and treatment of indigenous people. One can read about this in books, but there is nothing like the actual dialog of a conference setting. Conference Co-Chair Armon Tamatea, for example, made a number of excellent points as he examined the process of risk assessment both inside and outside the cultural space of Maori life. These ranged from the use of diagnoses developed well outside of Maori culture to the pathologizing aspects for indigenous peoples of considering risk in isolation from protective factors and the cultural context of community and family.

 

The primary take-away from these experiences for all of us is the importance of redefining the field of sexual harm to being an inclusive, multidisciplinary arena that talks across the reality of sexual abuse and allows us to share good practice and learn from each other. What became apparent is that we all agree that we need to change the narrative as well as perception around sexual harm and that now, with all the issues being addressed in society, is the time to start doing this collectively. Of course, a truly multidisciplinary approach starts with each of us being able to collaborate with one another.