By David Prescott,
LICSW, & Kieran McCartan, PhD
A conference presenter, who really
should remain anonymous, once adopted a faux Biblical tone in commenting on the
history of attempts to treat people who have sexually abused: “In the
beginning, there was relapse prevention.” This was inaccurate, of course; many
people, including Nicholas Groth and Albert Ellis had been developing treatment
methods prior to the adoption of relapse prevention (RP) from the addictions
world. However, many a truth is told in jest, and in this instance, the
presenter was completely accurate in recalling how the phrase relapse
prevention took hold of treatment programs as much as the model and methods themselves.
The lead author has vivid memories of a colleague in the 1980s exclaiming, “If
you’re not doing RP, you’re not doing treatment.”
Setting aside the competitive
jealousy and premature and incorrect assumption that there is a single right
way to do treatment, one has to have some sympathy for the professionals
operating at that time. There were no methods for classifying dangerousness and
little research to guide these efforts. There was talk of a “forensic sound
barrier” in risk assessment that might never be broken (set as a correlation of
.40). It was perfectly natural that at a time in which professionals knew less
about what they were doing than today, the field would focus, obsess even, on
risk and risk reduction.
Fast forward to just a few years
ago, and much had changed. By the late 1990s and early 2000s, professionals
involved in assessing and treating youth who had sexually abused were starting
to empirically examine “protective factors”, those elements in a youth’s life
that mitigate risk or assist him or her from growing beyond their past harmful
actions. In around 2002, when the second edition of the influential book, Motivational Interviewing, came out,
professionals began to adopt this approach as a part of their treatment
protocols. In each case, some professionals became early adopters while others
dismissed these methods as fads. Similar responses happened with the emergence
of the Good Lives Model and trauma-informed care.
An area that is rarely discussed,
however, is how adherents to one core idea or set of ideas seem to view other
sets of ideas as more different than they actually are. Although much
discussion is never published, it has not been uncommon to hear one claim that
motivational interviewing is nice but not strengths-based; one might just as
well criticize strengths-based approaches as being nice, but not addressing the
ambivalence that people often have about change, especially when addressing
sexual violence. The simple fact is that both approaches have very similar
features in common. Indeed, sometimes the greatest difference is in the
language used to describe them. Likewise, many have mistakenly described the
principles of effective correctional treatment (risk, need, and responsivity)
and the Good Lives Model as if they were irreconcilably different (in truth,
one can deliver treatment in a way that is adherent to both). The same goes for
resilience-based approaches and trauma-informed care. Each approach can be
implemented poorly, and each share (when properly implemented) a great deal of
their conceptual underpinnings.
It often seems we are describing
the same basic elements of treatment with different words. How can
professionals rise above this Tower of Babel? Perhaps the most important place
to start is by understanding the limitations of language itself. In recent
articles and presentations, Tony Ward has warned against reifying “factors”,
whether risk or protective, and focusing on the processes that underlie them.
In other words, if we only think in terms of factors, we may neglect the
processes that make up those factors. For example, if we think primarily of
relationship stability as it is defined within risk assessment measures, we may
take needed focus away from how that stability has manifested elsewhere in a
person’s life.
These problems extend beyond how
we talk about “treatment” and “factors” by treatment providers; it reflects a
big Tower of Babel issue across the field as a whole. Different parts of the
sexual abuse field including, but not limited to police, probation, parole,
treatment providers, and third-party organizations not only use the term
“treatment” to explain their processes but also
“rehabilitation”, “Risk Management” and “Public Protection”. This too is
problematic as the non-common language and definitions lead to one single,
problematic outcome measure – risk of recidivism. While “risk management” and “public
protection” maybe neatly lead to a reduction in reoffending, this is not the
main outcome of treatment and the main driver of factors involved with it. The Tower
of Babel issue in defining what happens with perpetrators by default shapes the
outcomes, success rates, and successful (re)integration of people who have
abused. Maybe we should try to stop calling everything apples and recognize
that we have a variety of fruit at our disposal. Those pieces of fruit look and
feel different but ultimately contribute to the same goal: our health! They
don’t all do it in the same way and that’s fine!
In the end, as we continue to move
from a nothing works agenda towards a what works one (all the while fighting a
backslide) all professionals will benefit from attention to both the continuing
evolution of our field as well as the subtleties of the language within it.
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