By Marije Keulen-de Vos, Minne De Boeck & Kasia Uzieblo (Dutch Chapter of ATSA, NL-ATSA)
On March 26th NL-ATSA, the Dutch Chapter of ATSA organized a symposium in Utrecht (the Netherlands) on the impact of working with sex offenders. Colleagues from police and forensic hospital settings addressed the issue of secondary trauma. Secondary or vicarious trauma relates to the behavioral and emotional consequences of exposure to the traumatic events experienced or inflicted by others. These traumatic experiences in professionals may include changes in the professional’s sense of self, interpersonal relationships, and behavior. Individuals working in mental health care are among the occupational groups identified as being at high risk of secondary trauma (Moulden & Firestone, 2007). Nevertheless, there is fairly limited research on this topic, let alone on traumatic experiences in professionals working with sex offenders.
The first presenter, Henk Sollie (Phd., Twynstra Gudde, the Netherlands), focused on the mental resilience of police offers who investigate cases involving child sexual exploitation material (CSEM). Based on observational studies and semi-structured interviews, he examined what CSEM investigators consider demanding working circumstances and how they cope with these burdens. Henk Sollie’s studies show that many police officers may experience signs and symptoms of vicarious trauma at some point in their career as they often experience great internal and external pressure to cover the overwhelming number of leads that they receive, to substantiate cases, and to save lives. Many of these investigators voice a firm unwillingness to “abandon” the victims by changing work assignments. Also, exposure to disturbing photographs and videos, and intense contact with perpetrators and victims have an enormous impact on their well-being and on their personal life. For example, many remain preoccupied with (old) cases, many experience sexual problems within their own intimate relationship and/or struggle with the enjoyment of physical contact with their children. An important element in being able to deal with the emotional impact of CSEM investigations is mental resilience. Henk Sollie defines resilience as “the outcome of a coping process in which internal and external resources enable a criminal investigator to continue to function throughout stressful situations and to recover from such situations in a sustainable manner while retaining their motivation to carry on with their investigative work”. The stress associated with exposure to such traumatic events as child sexual abuse can be mitigated further by applying adaptive, proactive coping strategies such as compartmentalizing one’s emotional response to the disturbing content, pressure regulation (i.e., workload prioritization), task autonomy and social support. These strategies also depend on organizational resources, for example, joint instead of single case responsibility, classification software and design of the workplace. Henk Sollie concludes that the everyday mental resilience in these officers does not come from rare and special qualities but should be rather considered as the result of the everyday magic of ordinary resources.
The second presenter, Anneloes Huitema (De Waag, Utrecht, the Netherlands), focused on the prevalence and severity of aggressive incidents in a forensic psychiatric hospital. Her study is part of Nienke Verstegen’s Ph.D. research (Vander Hoevenkliniek, Utrecht, the Netherlands). They have retrospectively analyzed over 3600 aggressive incidents by using the Modified Overt Aggression Scale in both forensic patients who are judged being legally insane and patients who have received forensic mental health care under civil law. Prevalence rates of incidents are substantially higher in the latter group. The latter group is often admitted to the hospital when they experience a crisis situation, which may explain these higher rates. Of all types of incidents (verbal, physical, sexual), verbal transgressions are most common with 2667 reports. Only a minority of incidents, 157 out of 3600 incidents, are characterized by sexual transgressions (e.g., rape, indecent remarks). Also, female patients are responsible for a relatively higher number of incidents than male patients. Remarkably, forensic patients who have committed a sex offense seem to cause less aggressive incidents compared to non-sex offenders. Notwithstanding these interesting findings, it is important to realize that these numbers probably regard an underestimation of the true prevalence of aggressive incidents in the forensic psychiatric hospital.
In the final two presentations, Nicole Strijbos (de Rooyse Wissel, Venray) and Maarten Hoogslag (Dutch Institute for Psychotrauma) discussed how professionals can stay “healthy” when working with sex offenders. Nicole Strijbos is a member of a peer support and guidance committee in the forensic psychiatric clinic De Rooyse Wissel. This committee offers collegial support when colleagues experience aggressive incidents. In case of an incident, the committee provides immediate care and support and subsequently schedules three meetings with the colleague(s) in question. The first meeting (after 24 to 72 hours after the incident) focuses on structuring information, exploring current symptoms (e.g., poor sleeping, reliving the incident) and providing tools on how to deal with these symptoms. The second meeting is after one to two weeks after the first meeting. The aim of this meeting is to reflect on the situation and to explore possible symptoms of trauma. Four to six weeks after the incident, the third meeting takes place. In this meeting, the processing of and giving meaning to the incident is being addressed. If necessary, colleagues are referred to as a licensed trauma psychologist. The main purpose of this support system is to help those involved regain control and attribute meaning to events. Nicole Strijbos presented real-life case examples and discussed several do’s (e.g., respond to feelings of colleagues, ask open questions) and don’ts (e.g., encourage recovery and try to offer an immediate solution).
The symposium closed with an interactive workshop. In this workshop, Maarten Hoogslag elaborated on possible self-protective skills for professionals working with (sex) offenders. Two actors were re-enacting real-life therapist-client interactions in which the bounds of the therapist were being overstepped by the client. Throughout the plays, participants were invited to provide input for these reenactments. Hoogslag’s take-home message was to always address the situation at hand, to set clear bounds, and to assess the nature of the aggressive behavior in the patient (i.e., is it personal or not) in order to enable a more efficient and self-protective response to this behavior.
The fact that this symposium was sold-out, as well as the grateful feedback during and after the event, illustrates that many practitioners are struggling with how to deal with aggressive behavior in (sex) offenders. Opportunities to share best practices and more research to obtain an in-depth understanding of these aggressive behaviors in forensic patients and their impact on the professional’s well-being are clearly highly needed.