Wednesday, November 27, 2019

When Others Decide the Effects of Abuse

By David S. Prescott, LICSW, & Kieran McCartan, Ph.D.

A vital study that appeared a few weeks ago has attracted surprisingly little attention. Esme Fuller-Thompson (from the University of Toronto) and her colleagues examined 17,014 survey respondents, including 651 known to have a history of sexual abuse as children. From their findings:

Remarkably, two-thirds [65%] of the childhood sexual-abuse survivors in our sample met the   criteria for complete mental health -- defined as being happy or satisfied with life most days in the past month, having high levels of social and psychological well-being in the past month, and being free of mental illness, suicidal thoughts and substance dependence in the past year. While the prevalence of complete mental health among childhood sexual-abuse survivors is higher than we had expected, it is still substantially less than that found in the general population [77%]. (p. 6)

Not surprisingly, the study found that factors such as social isolation, chronic pain, and substance dependence were impediments to “complete mental health” (a term that describes the study’s goals accurately, but may be conspicuously, even amusingly, absent in the daily life of many readers).

These findings are far from surprising. Many of those working with people who have been traumatized are familiar with post-traumatic growth, with some professionals having experienced it personally. As our colleague Alissa Ackerman has observed, “You are never more than a stone’s throw away from a survivor of abuse.”

On the other hand, these are findings that challenge traditional beliefs about abuse. The familiar refrain of abuse leaving people “scarred for life” can be harmful in its own way, including when those who have been abused hear this from friends, family, therapists, or prosecutors seeking a conviction. The simple fact is that we need a more nuanced approach in understanding abuse. The problem isn’t that all forms of abuse cause inevitable harm. The problem is that abuse poses an unacceptable risk of harm. No one has the right to state categorically how abuse affects others.

What might be most fascinating about this study is its historical context. It has only been 20 years since the 1998 meta-analysis by Rind, Tromovich, and Bauserman was condemned by a US Congress formal resolution and sparked significant controversy. They had produced similar findings, although they framed their study quite differently. From the abstract: “negative effects were neither pervasive nor typically intense, and that men reacted much less negatively than women”. Obviously, how one frames the issues contributes to how they are understood by others.

These lessons in controversy appeared again in 2009, with the publication of Susan Clancy’s book, The Trauma Myth. Clancy, too, experienced substantial push back in the media, and spent considerable time explaining her work. By this time, and in the wake of rejection by the academic community in the US, she had emigrated to Central America.

All these facts and findings suggest that understanding the nuances of harm and trauma can take years of dedicated study and practice to comprehend. Even the most seasoned professionals often find themselves surprised by what they learn in their ongoing practice. The lessons of how research findings are presented are no less significant. How we frame the issues matters, especially regarding sexual abuse where victims offer feel unheard and/or unrecognized by the system. Forcing victims into frames that help us respond to their abuse without necessarily helping them is problematic. We need to hear and respect what victims say about the abuse they have experienced and the way that it has impacted them. Musician Frank Zappa may have expressed it most succinctly when he said that, “The most important thing in art is the frame.” In this case, that means hearing and respecting the voices of those victimized.

Friday, November 22, 2019

The importance of international collaboration

By Kieran McCartan, PhD, & David Prescott, LICSW

Last week our blog focused on the ATSA conference and some of the interesting plenary addresses, preconference presentations, and concurrent workshops that occurred throughout it. Of course, this is not the only conference that we have blogged about this year. We have highlighted the NOTA, ANZATSA, CoNTRAS-TI, and NL-ATSA conferences as well. The primary take-home message from these blogs (as well as the conferences themselves and the people who make them happen) is the volume of work that its going on internationally in the field of sexual abuse and the potential for collaboration.

Collaboration and sharing good practices is essential to moving any field of work forward, but it is particularly important with respect to the global issue of sexual abuse. Sexual abuse does not respect borders, and everyone has the potential to be impacted by it. Therefore, it’s important that we learn from each other. The purpose of collaboration is not to use research, risk assessment, risk management, treatment and/or prevention in a way which imposes westernized, or anglophone, ideas around sexual abuse; but rather to exchange new ideas, alternative solutions and helpful suggestions.

True collaboration can be very hard to accomplish. Every program and conference takes place in a different cultural context. Understanding and appreciating this context and the people involved is crucial to the success of any collaboration. Once established, however, collaboration encourages adoption and contextually appropriate responses that help reduce the likelihood of recidivism and promote safeguarding. We have seen this at a higher level in ATSA with collaborations with similar organizations, like NOTA (UK & Ireland), ANZATSA (Australia & New Zealand), IATSO (Europe), NL-ATSA (the Dutch Chapter of ATSA), CoNTRAS-TI (Italy) and Les Centres Ressources pour les Intervenants auprès des Auteurs de Violences Sexuelles (CRIAVS) (France), as well as at a practical ground level in research and practice collaborations.

In practice this means that one country, professional, or program might see a challenge that they face from an alternative perspective forcing them to reconsider their approach. One example of this is in New Zealand, as discussed by Margret Ann Laws at ATSA 2019 and published in the recent edition of the ATSA Forum, where the register for people convicted of a sexual offence is constructed and run in a proactive fashion. In New Zealand, all police officers are trained in risk assessment, and register is conceptualized as a tool to support people in their desistance from sexual offending. Therefore, the register in New Zealand is characterised as being supportive rather than punitive, the way that it is conceptualized in other parts of the world. By flipping our perceptions of existing frameworks and ideologies we can move towards a preventive, prosocial approach to sexual abuse. 

In addition, collaboration is also about working together, as well as sharing innovative practices, and thinking about how we can push the field forward and/or redefine challenges. At conferences and related events, one often hears conversations about the start of new collaborations, research projects, replications and innovations to training/development. This is great and long may it last! We are seeing this in the newly implemented international project on treatment efficacy with leading researchers and treatment professionals coming together to develop and streamline the best approaches.

Friday, November 15, 2019

ATSA Annual Conference 2019

By Kieran McCartan, PhD, & David Prescott, LICSW.
The annual ATSA conference took place from the 6th-9thNovember in Atlanta, Georgia. The conference was a real mix of research, practice and engagement with over 1,200 participants from the USA, Canada, UK, Australia, New Zealand, Sweden, Netherlands, Norway, France, Belgium and Israel to name a few. In this blog we are going to take you on a whistle stop tour of the event.
The 2019 ATSA conference had 31 preconference presentations covering a range of topics including Risk Assessment, online offending, youth who sexually offend, treatment and interventions as well as a session for students on training and career development. The keynotes this year where by Professor Teresa Gannon (Are treatment Programs for sexual offending effective), Professor Paul Bloom (Against Empathy), Linda Dahlberg (Going Upstream: The fundamentals, evolution, context, and practice of primary prevention) and a conversation between Kurt Bumby and Kristen Houser on communication/messaging about working in the field of sexual abuse. The main conference had 100 workshop presentations and 36 poster presentations, with approximately 200 speakers presenting, covering prevention, victims, youth, adults, learning disabilities, minor attracted youths, policy, assessment, risk, management, and community engagement. In addition, this year saw the lifetime significant achievement award go to Jill Levenson, the Gail-Smith Burns award go to David Fowers, and the Early Career Award go to Kelly Babchishin, Congratulations to all!!!
For Kieran, the highlight of the conference was the first two keynotes, Teresa Gannon’s & Paul Bloom’s; although very different they talked to core ideas surrounding treatment and intervention. Teresa Gannon gave us an overview of her recent meta-analysis on the success of treatment programs, which showed that treatment can work but to do so the skills and the training for providers matters. Treatment success is about more than just program structure and integrity, the human delivering the treatment matters! This complemented Paul’s keynote on against empathy, which really made us focus on what empathy is and how effective it is in treatment and risk management. Empathy is a controversial topic in treatment programs and interventions for people convicted of a sexual offence, so it was pleasant to hear about it from a philosophy-political-social-psychological point of view, rather than just a treatment one. Do we need our clients/service users to have empathy for their victims to stop them re-offending or even to stop offending in the first instance? Is it compassion, insight and self-regulation that we are really looking for in them? Also, how much empathy do we need to have to be competent and skilled therapists, treatment providers and researchers? It was an interesting talk that went beyond pure semantics and allowed us to think about the role of empathy in the field and everyday practice. To Kieran, these keynotes set the tone of the conference as ATSA has always been about reflection and being a critical friend to each other.
The international roundtable this year was focused around risk assessment, risk management and treatment/interventions with 7 speakers from 7 different countries (USA, Canada, UK, New Zealand, Israel, Netherlands, Belgium). The session ran differently this year with the roundtable focusing on 4 topics and the speakers addressing how each topic was handled in their country, therefore we could see the comparison first hand. Which worked well and stimulated a lot of debate. Again, as in previous years, the roundtable really cements ATSA as an international conference!
The entire conference was a high point of the year for David. Although pinpointing specific moments is next to impossible, this year was noteworthy for the quality of the participation. At a workshop titled “The Pornography Debate”, those in attendance proved the axiom that intelligence often comes in asking the right questions rather than having the right answers. In this case, these questions came in the form of “Is any porn user ever entirely satiated” and “Is it possible to have a sexual encounter that does not involve at least a little objectification?” Likewise, participants in a workshop on the often traumatic effects of the legal system on clients were open to discussion in ways that are far rarer in other conference situations. This year was a lesson that not only does ATSA boast some of the best workshop experiences in the field, it also has amongst the most knowledgeable and thoughtful attendees.
One of the primary benefits of being an ATSA member and attending the annual conference is the opportunity to connect with friends, colleagues, and collaborators from around the world. The primary take-away from these conference experiences for the two of us was the importance of working together towards common goals so we could participate in “shaping the future”, as the conference theme appropriately described it. We are looking forward to ATSA 2020 in San Antonio, Texas!!