By Kieran McCartan, PhD, & David
Prescott, LICSW
Professional discussion about
preventing sexual abuse is often couched in absolutes, especially when it comes
to anti-social behavior. In our field, we often talk about eliminating abuse
and/or stopping people from abusing, whether before it starts or after it has
occurred. We find ourselves asking… is it really that easy? It is striking how rarely
our discussions focus on harm reduction or how we might influence the nature of
offending, offenses, or reconviction. By thinking in absolutes, we may be
cutting ourselves off from innovative research and treatment practices.
Ultimately, all of our efforts are
aimed at moving an individual from one end of a spectrum (offending) to the
other end (desistence) in a short, often pre-determined time. In reality,
meaningful behavior change takes time, faces unpredictable challenges, and has
its stumbling blocks; genuine change can be a messy process. All of this begs
the question of whether we are setting ourselves up for failure when we recognize
only black or white in the management and treatment of people who sexually
offend?
A client treated by the second author
(David) many years ago serves as an example. This young man entered treatment
after an extremely serious sex crime. After nearly two years of treatment, he
re-entered the community where he lived safely for one year. He then committed a
lesser property crime. It was at that point that he realized what lay ahead in
his future if he didn’t make even deeper changes. He lived offense-free as a
stable and occupied person for many years thereafter. What can we make of this
trajectory? Some would believe that his subsequent arrest is an indication that
treatment didn’t work. Others would be encouraged by the fact that the severity
of his behavior had decreased significantly. He would be coded as a recidivist
in some studies but not those focusing solely on sexual re-offense. We believe
his case highlights how a harm reduction perspective can be helpful.
Harm reduction policies and practices
build upon the notion that people desist from specific harmful behaviors one
step at a time, are guided in that process by professionals and the system is
set up in a way that enables positive change. In many respects harm reduction
policies are very closely linked to the notion of quaternary prevention (that
is, actions taken to protect individuals from interventions that are likely to
cause more harm than good). This approach is built on the understanding that behavior
change takes time. Harm reduction can be a perspective, approach, or outcome. The
key element is that the person in questions stops most damaging behavior and
engages in a process of working on their other problematic behaviors
systematically. A focus on reducing harm or the most problematic behavior, at
the expense of other behaviors, is not an excuse for offending or an
apology for it. It is a central part of many criminal-justice approaches (such
as with youthful offending), health care (for example, drug addiction) and mental
health treatment populations. Yet harm reduction is not fully embraced when it
comes to working with people who commit sexual abuse.
In treating addictions, professionals
do not expect a heroin addict to stop completely overnight. Instead, they
consider intermediate approaches such as Methadone or Suboxone. Likewise, with
alcohol abuse we talk about reducing an individual’s daily intake and enabling
them to cut down their dependence over time. When it comes to the field of
sexual abuse, the expectation placed on those who have abused is that they must
recognize and eradicate every aspect of their problematic behavior overnight. In
some areas, even minimizing the harm of one’s actions has been enough to deny
entry into treatment programs. Keeping people out of treatment doesn’t make
them less likely to cause harm.
Practitioners in our profession don’t
talk in terms of reducing harm, especially from a policy, political and public
view; instead we often talk about complete and immediate harm eradication. This
is likely because the narrative surrounding the reduction of harm in regard to
people who commit sexual offenses can be (and often is) misconstrued as an
absolution for problematic behavior. Harm reduction requires nuanced thinking
and practical approaches, and too often flies in the face of our more absolute
ideals.
Recalling the earlier example, yes, he
still committed an offense and still displayed problematic behaviors. However,
the level of harm was reduced substantially. This does not justify his property
crime, but history showed it to be a lesser crime on the road to desistance.
It seems worth mentioning that the
recent evaluation (2017)
of the prison-based Core Sex Offender Treatment Programme in the UK (which
ultimately lead to its being abandoned) demonstrated a reduction in harmful
behavior by participants. Within the outcomes, it found that there were a group
of service users that were reoffending, but not at the same level or in the
same fashion that they originally offended. Asking questions about the nature
and use of interventions that contributed to de-escalation of these people’s
offenses, and the time frames in which they took place would have been helpful.
Likewise, Karl Hanson recently spoke
at the ATSA conference about how risk is dynamic. He argued that with the
correct support and interventions, risk can drop from high to low over a 20-year
period. All of this begs the question, how long does behavior change take and
what does the journey look like?
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