Tuesday, January 30, 2018

What Can We Learn from the Case of Larry Nassar?

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

Larry Nassar should spend the rest of his life in a place where he is unable to have contact with children and teenagers. Whether one approaches this case from a criminological or clinical perspective, experts agree that Nassar’s behavior was brazenly predatory, incredibly harmful, but both unique and typical at the same time. In this week’s blog, we discuss the Nassar case, what we can learn from it, and how we can do better.

Nassar is unique in several ways. First, his position was one of privilege and he utilized this position as a means to sexually abuse patients in his care, often while other people were present in the room.  He is also atypical because of the sheer number of people he harmed, the high-stakes role he played in their lives, and the size and scope of the venues in which he operated. There is no doubt about it, listening to the testimony of those he victimized, illuminates the level of trauma and pain caused by Nassar’s actions.

At sentencing, the judge in this case told Nassar that she had signed his “death warrant”, although some have expressed concern about this and other actions that took place in court.  Clearly, it is essential that we listen to the stories of each person that Nassar harmed. We need to validate their experiences and their pain. Many have applauded Judge Rosemarie Aquilina for her treatment of each person who wanted to give an impact statement. However, questions about whether Aquilina was impartial in the sentencing of Nassar remain. We agree that judges are entitled to their own opinions, as we all are, but we argue that the judiciary and the overall legal system must remain impartial. In this case, the vocabulary and intention behind Judge Aquilina’s statements were not neutral; they were loaded, and therefore problematic. While we can all agree that Larry Nassar should receive a prison sentence for his offenses and that the sentence should reflect the severity of his crimes, the judgement should be unbiased, appropriate and considered. By suggesting that she was signing his “death warrant” Judge Aquilina was not being neutral.

In addition, we must consider other variables before we make the statement that Nassar should never get out of prison. We should further question whom the best person is to make such decisions. Is it the court? The judge? Sentencing guidelines? Sex crimes experts? A range of other professionals?  Judgements in court and the comments given by Judges when sentencing are important as they can have long lasting consequences for the victims, their families and the convicted person (as demonstrated by the release of John Warboys in the UK); therefore care, consideration and neutrality are very important. A major question is what we can learn from this case to prevent future abuse; so far, the media has not addressed this with the same fervor that they have in their coverage of the trial.

From a clinical perspective, there are fundamental questions about what we can learn from Nassar. In some ways, his patterns of behavior are well-known. By all appearances, his actions were carefully planned and purposeful. He possessed expertise at gaining the trust of these young women and those around them. Unlike many (perhaps most) people who break the law, he does not appear to have been impulsive or reckless in his modus operandi. Ironically, his apparent self-management skills actually argue that he could be kept safe under strict community supervision more easily than others who are clever but do not think before they act. Likewise, his age, verbal abilities, and interpersonal skills make it likely that he could participate effectively in treatment.

While these last points may seem contrary to the sentiments of most who feel that Nassar should simply be punished, they address key concerns in the way forward for Nassar. Many who have experienced sexual violence want the person who harmed them to understand and come to terms with what they have done; effective treatment can do this and be of assistance to those who have been victimized. An unfortunate reality of life in prison is that it can be too easy simply to enter what is known as the “psychological deep freeze” where one lives moment to moment without regard to the past. Others who have been victimized want those who abuse to get help and stop the behavior. Treatment programs can be more effective in this regard than prison. Whatever one’s immediate beliefs about the proper response to sexual violence, the needs of survivors can be more nuanced than the desire to “throw away the key.”

From a criminological perspective, it is crucial that we recognize that life in prison goes against the key components of incarceration – people who are incarcerated go to prison as punishment and prepare for release during incarceration through education, treatment, and reentry supports that they need to successfully integrate back into society.  With Nassar it has been determined from the outset that he is beyond redemption and therefore should not engage with anything while in prison, including treatment or rehabilitation.

In addition, we understand that both general and specific deterrence offer little in terms of prevention. First, punishment on its own does not and cannot address the underlying etiology of Nassar’s behavior. Perhaps more importantly, believing that punishing Nassar to a lengthy a prison term somehow shows others that they should not sexually offend is na├»ve.  Decades of research attest to these facts.

Most importantly, while this particular case revolves around one man and the trauma perpetrated by his hands, we must remember that sexual abuse, especially of this nature, does not happen in a vacuum. What happened in this case was an institutional failure of epic proportions, not unlike what we have seen in other institutions where abuse was rampant. Abuse of this magnitude can only happen when others turn a blind eye. Ongoing investigations are under way to find out what others knew and what actions they did and didn’t take. What this and other cases show is that those who turn a blind eye to abuse come from all backgrounds and are not limited to one gender or age group.

Larry Nassar should spend the rest of his life behind bars. His behavior caused undeniable harm to over 150 girls in his care. The majority of these girls spoke at sentencing. We heard their voices and the court validated their experiences in a watershed moment that most people who experience sexual abuse never get. This validation offers an enormous step toward healing, but healing doesn’t end with Nassar behind bars. If we believe that justice comes only from a long prison sentence, we are sadly mistaken.

Thursday, January 25, 2018

We want conversation, not conflict!

By Alissa R. Ackerman, PhD,  Kieran McCartan, PhD, & David Prescott, LICSW
Tarana Burke first used the term “Me Too” to 2006 to elevate the conversation around sexual violence. The conversation around the ubiquitous nature of “sexual misconduct” came to a head in late 2017, when Alyssa Milano tweeted that anyone who has been sexually assaulted or harassed should reply to the tweet with “Me Too”. This marked a changing tide that empowered individuals who had experienced any form of sexual misconduct to speak up. We should celebrate the fact that so many people have found their voice and are willing to share their story. We should also understand the nuances inherent in the movement which is a debate involving feminism, equality, collaboration, and interventionism as well as sexual abuse, harassment and victimization. Each of these areas have seen long standing battles being fought on many fronts, therefore it’s important to realize that #metoo has not come out of nowhere.
We must recognize that there are many forms of harassment, and that the impact, consequences, and legacy of harassment change with the individual people in question. Like sexual violence, harassment does not take the same emotional, psychological, and behavioral responses toll on those affected by them. While recognizing the that we cannot dictate the impact of sexual harassment, we must recognize that while all sexual harassment, sexual abuse, and sexual assault  carry an unacceptable risk of harm, they are not the same thing. We can honor the voices, stories, and pain that stem from all forms of misconduct, while also recognizing that, perhaps, they are parts of different, but equally important conversations. Therefore, we need to think about context, situation, personality, resilience, and support in all cases.
This past week, the website Babe.net, which uses the tagline “babe is for girls who don’t give a fuck”, published an account of an alleged nonconsensual sexual interaction between a young woman named “Grace” and comedian Aziz Ansari. A few days after the Babe account was published, Ansari responded. In part, he stated that he believed that the encounter was completely consensual and that when he heard this was not the case for her, he was surprised and concerned.
Some are calling the Babe account nothing short of “revenge porn”. Importantly, the published account has sparked debate about what constitutes sexual assault vs. a “bad date”. Perhaps this is the wrong conversation. Perhaps this type of conversation is what keeps people stubbornly in their silos, screaming over one another, or passionately stating that this is a “war to be won”. In addition to this we need to continue to think about what we pay attention to in respect to consent, because we often think in terms of recognizing verbal cues, but what about non-verbal cues (i.e., a change of tone, silence, different body language, etc)? Quite often we look to hear “no” or “stop” rather than recognizing disengagement, a change of tone or a lack of interest.
It is true that the #metoo movement has sparked debate, as well as dialog. It has opened doors to conversations and disclosure that otherwise would have remained unheard and unaddressed. Sadly, movements like this will not end sexual victimization. Calling people out and shaming them for their behavior does not change that behavior if there is little to no understanding about what the wrongdoing is.  Calling attention to the issue does not prevent the issue from occurring. Education, connection, and mutual understanding will cultivate a shift toward prevention. We need to change the conversation, we need to start it earlier and use a different means to have it. We need to think about how we educate children, families, peers and communities more effectively. In addition, we need to look at the narrative coming from the media and what TV, Film and the press say about these issues.
Were Ansari’s actions potentially harmful? Yes. Did Grace provide verbal and non-verbal cues that she wanted to stop the sexual activity? Yes. Does that mean Ansari understood those cues? No. This is where the conversation needs to shift.
So often, we hear young people, particularly young men, stating that they thought sexual activity was okay because, “she didn’t say no”. Our conversations about consent must go beyond the fact that not saying no does not mean yes. One way to shift the conversation to help young men understand this better is to talk openly about why someone might not say no.
In the end, however, it is our fervent hope that the #metoo dialog will move beyond those most immediately affected by harassment and abuse and include marginalized populations. After all, rates of abuse and harassment in and around marginalized and underprivileged communities, including Native American and other ethnic minority communities. Likewise, LGBTQ people experience higher rates of sexual violence. Conversations within and between these communities must be elevated in the conversation. If we are ever to truly approach sexual violence and harassment as a public-health issue, these voices need our attention as well. Hatred and vitriol get us nowhere.

Thursday, January 18, 2018

Author Q & A with Sarah McMahon discussing “Campus Sexual Assault: Future Directions for Research”

McMahon, S., Wood, L., Cusano, J., & Macri, L .M. (2018). Campus Sexual Assault: Future Directions for Research. Sexual Abuse. iFirst.

Campus sexual assault (CSA) has received unprecedented attention over recent years, resulting in an abundance of federal guidance and mandates. In response, efforts to address and prevent CSA at Institutions of Higher Education (IHE) across the country have grown quickly, including the development and implementation of programs and policies. Because the changes on campuses have occurred at such a rapid pace, a number of gaps exist within the field of CSA research. To ensure that changes on IHE are evidence-based, there is a need to review the existing research available and the inquiry still needed based on key areas outlined in federal guidance, the expressed needs of campus community members, survivors, and students who commit sexual offenses on college campuses. The purpose of this review is to summarize the empirical research related to CSA gained from the past two decades and identify areas in which further work is needed, specifically related to key areas identified in recent guidance provided to IHE. This article concludes with guidance for research moving forward to help strengthen response and prevention efforts.

Could you talk us through where the idea for the research came?

There are a few reasons that motivated this article. First, while the topic of Campus Sexual Assault (CSA) is not new, the attention provided to the issue has been elevated in recent years. This is due to a number of factors, including student activism as well as federal mandates and guidance.  The Obama-Biden Administration identified campus sexual assault as a priority issue, and convened a task force which issued a report in 2014 that has served as a primary document for providing guidance.  Although many institutions of higher education have embraced the call to action to better address CSA, the research in terms of best practices lags. 

Second, the timing in our culture is ripe to further address CSA. The current time period provides a unique window where universities and colleges are finally addressing CSA and there is accountability demanded by students, families, and the public. Clearly, the #MeToo movement continues to shine a light on the issue of sexual violence and it appears to be a “watershed moment”. This presents an opportunity for researchers to engage in work to help develop the evidence-base for the implementation of practices, programs and policies that will be meaningful and impactful. 

In addition, it is clear that one of the major gaps in the field relates to research on students who sexually offend. There currently lacks information about the predictors of offending within this group, their trajectories, and best practices for intervention and prevention efforts.  The discussion about these gaps at the ATSA conference in 2016 and learning from others in the field was also a motivation for writing this article, as there is clearly a need for those who work with individuals that commit sexual offenses to contribute to our body of evidence on CSA.

What kinds of challenges did you face throughout the process?

The most challenging part of the process was trying to funnel the massive scope of the issue into a manageable and organized manuscript.  The field of sexual violence prevention is wide and complex, and research in this area is relatively new so there are numerous gaps that need to be addressed.  We used the guidance provided in the Obama Administration’s Task Force to Protect Students from Sexual Assault as our organizing structure.  They addressed a number of different policies, practices, and programs that need to be implemented at institutions of higher education, yet the field has not caught up with having solid evaluation to help inform these efforts. I was also fortunate to work with an excellent team of researchers to help review the literature from the field as our foundation.

What do you believe to be the main things that you have learnt about campus sexual assault?

It is an exciting time for those who work in the field of CSA because of all the changes occurring, but writing this article clearly illustrated the gap between practice and research.  At this point, there is a push for institutions of higher education to move quickly to address CSA which is obviously a good thing, but research has not kept the same pace and therefore we are in real need of rigorous studies that examine a wide range of CSA policies, programs , practices and prevention efforts.

Through writing this article, I appreciated the opportunity to learn more about those that work with individuals who commit sexual offenses.  Of the many areas needing research related to CSA, figuring out how to better work with students who offend appears to be critical and severely lacking. I am hopeful, however, that those who have conducted research on sexual offenders more broadly will be interested in bridging their work onto college campuses, as their expertise is needed and would make an important contribution.

Now that you’ve published the article, what are some implications for practitioners?

I think that good research-practitioner partnerships are invaluable.  Within the arena of CSA, the development of these partnerships seems essential.  The research needs to be informed by what is happening in real time and on the ground, and it would be best if these practices were informed by evidence.  I would encourage both researchers and practitioners to seek each other out to figure out how to collaborate to address the many issues needing attention within the field of CSA.

Thursday, January 11, 2018

The Missing Link of Adversity

By David S. Prescott, LICSW

A recent BBC documentary highlights the work of a school in Glasgow, Scotland, to help young school children manage their aggressive behaviors. On its surface, the video is inspiring: with little to no resources, a group of dedicated teachers and behavior specialists design “nurture rooms” where these children can get specialized attention and guidance. This approach reduces the use of empty “time-out rooms” where adults sit with children who have no choice but to stew in their own challenges. The video ends with questions about how best to fund similar programs in the future. It can’t be easy; even the “comments” section of the video highlights the attitudes of many in the public. One viewer states, “A boy’s ears are in his backside. Bring back corporal punishment.”

Interestingly, 89% of the teachers in the video state that they blame the parents for their children’s behavior. There is no discussion of the ways in which the school environment itself may contribute to the children’s problems. Perhaps most revealing is that there is no mention whatsoever of the fact that many of these children likely have histories of adverse and traumatic experiences. It’s as though the same schools that would build handicap access for children with physical disabilities would not make similar accommodations for young people with the less obvious disabilities that can arise from growing up in adversity. Under these circumstances, blaming parents is perhaps less helpful than examining the broader context in which abuse and adversity occur. Parents should, of course, be held accountable for their actions. However, helping prevent further harm means understanding adversity and assisting people in moving beyond it.

These are not simply ideological statements. Research on complex trauma and aggression in secure juvenile justice settings – the obvious next step for the young people in the BBC video – by Julian Ford and his colleagues describes the extraordinarily high rates of traumatic experiences in the backgrounds of  incarcerated youth and the connection between formative events and future aggression. The study describes interviews with clinicians treating 40 youth who had perpetrated sexual abuse, finding that 95% of them had at least one traumatic experience in their past and that 65% of them met the diagnostic criteria for Post-Traumatic Stress Disorder. The clinicians viewed traumatic experiences as having set into motion the sex crimes of 85% of these youth. In other words, while many in the general public may see only the backsides in need of corporal punishment, a deeper examination of these youth reveals a much more disturbing truth. It should be no surprise that punishment-only responses don’t work.

Even among adults, it can be easy to overlook the amount of trauma and adversity in the backgrounds of men and women who sexually abuse. Levenson, Willis, and Prescott (2015; 2016) found elevated rates of adverse experiences (including over 13 times the odds of verbal abuse) in the backgrounds of these individuals. As lawmakers and the lay public talk about getting ever tougher on crime in the name of assisting victims, it’s easy to miss seeing how many of those who have abused have themselves been victimized. Indeed, the deeper one digs into research on people who abuse, the clearer it is that the forces driving abuse cannot be easily dismissed by statements such as “they should have known better.” As many have said before, recognizing abuse as a public health issue rather than simply trying to punish it away will be a good start.

In the “flashbulb moment” that comes in the immediate wake of abuse, it is easy – perhaps even natural – to experience the desire to destroy both the abuse and the abuser. Likewise, it can be easy for prison officials, supervising agents, and treatment providers to view irritating features of those in their charge, such as irritability, hypervigilance, emotional numbness, and apparent memory problems as efforts to avoid responsibility when they are also diagnostic criteria for PTSD. The real questions for all professionals include: How can we best understand the totality of our clients’ experiences and not simply view them as merely the sum of their worst behaviors? Can we stay true to our mission of assisting those who have been abused by including those who have also abused others? Can we go beyond holding people accountable and also teach them about accountability? Can we exercise the same compassionate working alliance (central to all of the world’s religions and successful forms of psychotherapy) with people whose actions can seem separate from their histories? Ultimately, can we accept the person in front of us even as we don’t accept abuse?

Understanding trauma in the lives of others has been a difficult undertaking in mental health practice since the time of Freud. Just the same, human beings have helped one another move forward from trauma as long as there have been traumatic experiences. Not everyone who has been traumatized needs specific treatment, but it seems that the majority of those who might be inclined to cause harm can benefit from trauma-informed care. 

Friday, January 5, 2018

As we move into 2018, are we still in a room without a view?

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

The start of a new year is often a time of reflection and hope. We think about our experiences as well as practice over the last year and learn from poor practice as well as build upon good, existing practices. Having a solid, reliable, evidence base is central to all aspects of life, personal and professional!

Thinking back over the last 12 months, 2017 has been an interesting year to say the least with the common factor being one of ideology and “common sense” understandings winning out over an established evidence base many times. A recent example was the United States’ Centers for Disease Control emphasizing that it would not accept funding submissions that contain words such as “evidence-based”, “transgender”, etc. Although we all have ideologies, thoughts, and beliefs that govern our lives and practice, the majority of the time these are not based on facts, outcomes and analysis. Rather, these can be based on perceptions and collusion with friends, family and/or peers. This might be fine if we are deciding which diet to use, airline to fly or coffee shop to visit; but, are these the best metrics for deciding on larger, societal scale decisions? All too often it seems that we agree with science primarily when it supports our views.

This reliance on ideology has often times led – especially in northern hemisphere westernized countries – to a rejection of expert knowledge as well as evidence. In 2017, in our opinion, this resulted in a return to lay knowledge and ideologically driven theories, policies and practices. In other words, sometimes going backwards to debunked beliefs and practices!

Let us be clear here: we are not being elitist and saying that expert knowledge is the only way to develop policies and practices, because it is not. Instead, we are saying that in order to develop best practice we need to listen, to hear, and to understand all the voices in the debate without shutting any down. The transition away from evidence based policy and practice is worrying because it means that we are not listening to all the available information and are basing our ways of working purely on ideology. We want our taxes spent appropriately and we want governmental decisions to be realistic, appropriate and fit for purpose. We should want evidence based decisions, policies and practice! Why? Because it means that we are not spending time, money and resources blindly or causing harm along the way; we have an idea of what works and what does not work, therefore we can be more measured and realistic in terms of social, political, practice and policy change.

However, in many current northern and western hemisphere countries with right wing, or at least right-leaning, governments’ evidence is not the metric that they want to use in their policy and practice shifts, they want it to be ideological. Clear examples of this can be seen in the UK (via Brexit). Clear examples also abound in the USA. The best example is perhaps the election of Donald Trump during a year of campaigning not known for its reliance more on ideas than on evidence. Other examples include changes to Obama-care (which many people have found undesirable, but which provided millions of people access to healthcare), refusal for the CDC to fund research from transgender issues and the effects of gun violence, and defunding of the National Registry of Evidence-Based Programs and Practices).

In the field of sexual abuse, evidence based practice is central and needs to remain central. We have seen the cost and consequences of ideologically driven policies and practices on the ground, from funding of policies that don’t reduce risk (e.g., public registries and residence restrictions) to increasingly scarce funding for those that can reduce risk (e.g., treatment and supervision). As one example, in the state of West Virginia, probation officers specializing in supervising people who have committed sex crimes have lost their jobs at the same time as the state’s Supreme Court justices spent astronomical sums on office furniture.

Evidence tells us, if we do research well and in the most appropriate way for the question at hand, we can discern what works and what does not. Sometimes we don’t like what the research tells us and sometimes we do. Despite the outcomes of research the most important thing is that, whether we like it or not, we are called as professionals to do what actually works!