Friday, July 26, 2019

Prevention of sexual abuse and the treatment of people who have committed sexually violent behavior: A current state of affairs

By Kasia Uzieblo, Jeffrey Lauer, & Minne De Boeck (Dutch Chapter of ATSA, NL-ATSA)

Five years ago, two colleagues, Wineke Smid, Jan-Willem van den Berg (Van der Hoeven kliniek, Utrecht, the Netherlands) and Jules Mulder (De Waag & Stop it Now! Netherlands) dreamed of founding a Dutch Chapter of ATSA (NL-ATSA). With this chapter, they wanted to enhance Dutch and Flemish practitioners’ knowledge on evidence-based and best practices in prevention, assessment, and treatment of sexually deviant behavior. They also wanted to encourage and facilitate a fruitful two-way interaction between North-American and Dutch speaking researchers and practitioners. A mere five years later, NL-ATSA has become a fully-fledged chapter of ATSA. Moreover, the chapter can be regarded as a prominent player in both the Netherlands and Flanders (Belgium), when it comes to informing practitioners about the scientific understanding of sexual violence and the treatment of people who have committed sexual offences. Proud of its achievements, NL-ATSA doesn’t want its fifth birthday to pass quietly and organizes two events to place this festive year into the spotlight.

A first event took place on the 25th of June. This event was entirely devoted to a special edition on sexually deviant behavior published by the Dutch Journal of Sexology which was edited by former and current NL-ATSA board members, Jan Willem van den Berg and Kasia Uzieblo. During each conference, session experts elaborated on a topic depicted in the special edition by zooming in on best (research) practices within this particular field.

The first presenter, Eveline Schippers (De Waag, Utrecht, the Netherlands), described the results of her innovative study on creating sexual deviance through incentive transfer in a male community sample. Antisocial behavior and sexual deviant interests are regarded as two important risk factors for sexually deviant behavior. However, current knowledge on how these sexual deviant interests originate is very limited. The Incentive Motivational Model (Smid & Wever, 2018) describes sexual arousal as an emotion, that is triggered by a competent stimulus signaling potential reward, and comparable to other emotions coupled with strong bodily reactions. According to this model, sex can be used to regulate emotional states, and emotions can be used to consciously or automatically regulate sexual arousal. Excitation transfer implies that one emotion triggers or reinforces another. But there might also be a sexual component to it. An example of sexual excitation transfer is when athletes become sexually aroused when they won a competition (i.e., when euphoria leads to sexual arousal). With the current study, Schippers aimed to examine whether people become more sexually aroused when experiencing a strong positive and/or negative emotion than when they are in an emotionally neutral state. Her first results suggest that mainly movie clips depicting aggressive content seem to elicit sexual excitation transfer and that genital excitation transfer might not fully align with the subjective (thus self-reported) experience of sexual arousal. This coupling between emotion and sexual arousal could provide interesting new avenues for treatment programs.

The importance of prevention strategies was highlighted in the second plenary session by Minne de Boeck (University Forensic Centre and Stop it Now! Flanders, Belgium) and Jules Mulder (Stop it Now! Netherlands). Taking into regard the high prevalence rates of child sexual abuse and the gravity of the impact of sexual abuse on someone’s life, it is astonishing that only a few programs focus on the prevention of sexual abuse on a primary -and even- secondary level. Notably, most of these projects focus on (potential) victims and on the environment (e.g., parents and school) of potential victims - and exceptionally- perpetrators, but not so much on the (potential) perpetrator him-/herself. Also, most of current prevention programs focusing on the (potential) perpetrator are situated on the tertiary level and hence focus on the prevention of recidivism, and not on preventing sexual abuse of ever happening in the general population (i.e., on the primary level) or in specific risk groups (i.e., on the secondary level). The presenters emphasize that if we want to be serious about preventing sexual abuse, all stakeholders (e.g., schools, sports clubs, practitioners, and policymakers) should start thinking in terms of prevention on the three levels and should start developing initiatives accordingly. De Boeck and Mulder presented three real-life cases (a case of child sexual abuse in a daycare center, sexual abuse by Jehovah’s witnesses, and sexting). These illustrations elicited inspiring discussions with the audience on the benefits and limitations of preventive strategies.

In the third and final plenary session Zohra Lkasbi and Daniƫl Neves Ramos (ZNA University Psychiatric Center for Children and Youth, Antwerp, Belgium) discussed the assessment in and treatment of minor perpetrators of sexually violent behavior. It is astonishing to note that this topic receives so little attention in literature and practice. Current theoretical knowledge on this issue remains very limited. And in practice they are often confronted with denial from different agencies: even for professionals, it seems to be difficult to acknowledge the existence of such behavior in minors, with all that this implies for the treatment of these minors. The presenters described the limited empirical knowledge on prevalence rates, the risk and protective factors for sexual violent behavior in minors, and interventions. The presenters illustrated the problems they are encountering in practice by describing a clinical case. With this case, they demonstrated that their patients are often minors who exhibit a wide range of psychosocial problems and risk factors. It also became clear that many of these patients have experienced traumatic events and that treatment programs should sufficiently take these traumas into regard. Finally, these clinicians often struggle with pharmaceutical interventions given that little is known about the efficacy and side effects of these interventions.

In the afternoon, four workshops took place. In a first workshop Jan Willem van den Berg and Marc Lexmond (Van der Hoeven kliniek, Utrecht, the Netherlands) presented “A Positive Life Plan”, which is a treatment plan developed by van den Berg and colleagues. With this treatment, plan practitioners are offered a tool to develop a treatment module that adheres to the principles of the Good Lives Model (Ward & Stewart, 2003). In the second workshop, Els Van Daele and Kris Vanhoeck (I.T.E.R., Brussels, Belgium) focused on the factors that might facilitate the development of a therapeutic alliance with clients who have committed sex offences. Through role-plays with the participants, they developed suggestions on how to avoid pitfalls and create opportunities to develop such an alliance with their client. The third workshop of Kasia Uzieblo and Eelco van Doorn (Van der Hoeven kliniek, Utrecht, the Netherlands) aimed to counter the most prominent myths about psychopathy and to illustrate that positive treatment outcomes can be obtained in patients with psychopathic traits. In the final workshop, Kim Ellen Biesmans, and Lieke Nouwen (STEVIG, Forensic Care and Centre of Expertise, the Netherlands) introduced a treatment program that they developed for individuals with intellectual disabilities who committed a sexual offence. This treatment program uses the Integrated Theory of Sexual Offending (ITSO; Ward & Beech, 2005) as a reference point.

This successful, sold-out event was again a reminder of what Wineke Smid, Jan Willem van den Berg and Jules Mulder have accomplished: Five years after the launch of NL-ATSA, the chapter plays a crucial role in building bridges between the production of knowledge and its diffusion to Dutch and Flemish practice and broader, to society. Hence, we are in great debt to the founders of NL-ATSA.

And for the curious readers amongst you: Our second birthday event will be a four-day conference on the assessment and treatment of sex offenders, which will take place from February 4 until February 7, 2020, in Antwerp, Belgium. More information is coming soon!

Smid, W. J., & Wever, E. C. (2018). Mixed emotions: an incentive motivational model of sexual deviance. Sexual Abuse, doi: 1079063218775972.

Ward, T., & Beech, A. R. (2006). An integrated theory of sexual offending. Aggression and Violent Behavior, 11(1), 44–63.

Ward, T., & Stewart, C. A. (2003). The treatment of sex offenders: Risk management and good lives. Professional Psychology: Research and Practice, 34(4), 353–360. http://dx.

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