Thursday, November 26, 2020

In the News: Conversion Therapy in the US and Beyond

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


According to Forbes and other media outlets, a federal appeals court in the US recently struck down local ordinances prohibiting conversion therapy. This has happened at a time when conversion therapy has been condemned in many locations around the world, including Germany this past spring and then Israel in the summer. As many readers will know, the term “conversion therapy” (also known as reparative therapy) is used to describe “any attempt to change a person’s sexual orientation, gender identity, or gender expression”. (This is taken from the GLAAD website’s description, which is worth reviewing, as is this document from a United Nations Independent Expert.) We freely acknowledge that we are not lawyers; we are interested in this case as professionals in the area of preventing sexual offending.


A quick Google search on the term “conversion therapy” identifies many ways that it harms people, despite a robust literature showing that it is ineffective. The American Psychological Association and the American Psychiatric Association have issued statements condemning it, as have numerous other professional organizations. In the US, 14 states and the District of Columbia have put laws into place protecting LGBTQ+ youth. There is a considerable historical context that is beyond the scope of this blog, involving the medically and psychologically false idea that LGBTQ (and for that matter, gender-diverse individuals) are sick or pathological, just as there is a long history of severe pain and suffering resulting in long-lasting psychological and physical damage. Conversion therapy continues to take place in a multitude of countries, in all regions of the world.


This last point, regarding conversion therapy with youth, could be worthy of an entire conference, given the numerous questions of what would actually constitute informed consent. For example, young people who may be unable to judge the risks and benefits for themselves and the question of parental consent for various forms of treatment, may signal pressure on the youth, whose identify and wellbeing may hang in the balance.


In the main, however, it’s important to clarify that the federal appeals court in this case has struck down laws, but made no changes to the ethics codes of the numerous professional organizations that render the practice of conversion therapy unethical. Practicing conversion therapy and holding a license to practice psychotherapy no longer mix, and rightfully so. We are not advocates of conversion therapy as it has been practiced (which has often involved undue coercion either by the therapist, family members, or both). In fact, earlier this year, the Independent Forensic Expert Group (IFEG) of health specialists, declared that conversion therapy is a form of deception, false advertising, and fraud.


There are implications, however, of these and related legal proceedings for people working with those who have abused and have sexual disorders. The rationale of the federal appeals court centered on free speech. Number one on the list of freedoms in the US Constitution’s Bill of Rights, free speech is near and dear to the vast majority of people in the world, and not given to many. People have fought and died for it and other freedoms. The court used as one example, that other free-speech cases have involved a Florida law that prevents doctors from talking with their patients about gun ownership (for example, a doctor would not be allowed to talk about the potential health hazards of weapons access where children are present despite the empirical research regarding weapons access and ownership; does free speech end at the door to the doctor’s office?).


What are some potential implications of the federal appeals ruling for professionals who work with those who have offended? At the front lines, a number of possible questions emerge. We know that sexual orientation as a broad term is different from sexual interest, sexual arousal, and sexual behavior, but at the front lines of practice, the situation can be more obscure. For example:


Between the ethical codes of my profession and the laws protecting free speech, in what ways might I be at risk for treating people who have sexually abused others? There would seem to be a difference between conversion therapy and helping people who have a sexual interest in children, but do I possess the requisite scholarly papers to make a case should I be accused of practicing a variation of conversion therapy? Conversion therapy has traditionally been about changing someone’s same-sex interests; where is the line with changing someone’s age-related interests? I understand that changing someone’s sexual orientation is unethical, but what about changing someone’s sexual interests? How possible is that really? Am I in a safer position trying to help people manage those sexual interests without directly influencing them? Or do I need to think about all this differently?


Further, there has been debate about whether pedophilia is a sexual orientation; am I at risk for ethics complaints or prosecution under the wrong conditions? Can I work to change someone’s sexual arousal patterns? Is there a clear line between these and orientation? How would I communicate that to a licensing board? Is it really different when the sexuality I am attempting to influence has to do with harming others (as opposed to traditional conversion therapy focusing on gender-related orientation? Where is the line between influencing someone’s sexuality and helping them to manage urges, thoughts, and fantasies? What are the implications when working with a client who is not their own guardian?


We wish to emphasize that we have neither all the questions nor all the answers. To our minds, this is a discussion that has not yet occurred in any meaningful fashion. Questions about pathologizing sexuality will likely exist well into the future, including to what degree various elements of sexuality are innate and biologically based versus learned. Our point in bringing this discussion to the fore is to encourage all professionals to think about the broad dimensions and diversity of the questions that emerge in the assessment, treatment, and prevention of sexual offending.

Friday, November 20, 2020

Under the same sky, seeing different horizons

By David S. Prescott, LICSW


An interesting situation arose at a program where I consult on treatment for people with complicated backgrounds and complex needs. At the start of the flu season, many clients were declining to have a flu shot. However, these were the same clients who routinely take antidepressant and antipsychotic medications are known to have fairly significant side effect profiles. At first, this made no sense to me. I wondered whether this was due to historical concerns about the effects of vaccinations that have since been loudly debunked, but they were unfamiliar with those concerns. In some cases, they stated that they didn’t want the irritation of the shot itself. Others said they were concerned about side effects such as flu-like symptoms. In my mind, very little made sense until I considered the interpersonal circumstances. The clients had worked closely with a specialist to determine the most effective medication regime. The professional involved had worked to gain their trust by providing information, asking questions, and – importantly – discussing side effects as well as reminding them of their rights in order to obtain truly informed consent.


The flu shots, in contrast, were offered by different staff members who did not take these processes as seriously and had a very different relationship with the clients. All of this reinforced research findings regarding the importance of building alliances in establishing treatment compliance. In order to come to terms with the surface issue of flu-shot motivation, it’s necessary to understand a much broader background of trust, mistrust, and the processes by which each is earned. As the saying goes, we all live under the same sky, yet see different horizons.


Of course, this is just one example of the effects of trust and trustworthiness on activities that contribute to health. It shows that the one recent survey, conducted on behalf of The Undefeated, sheds light on the experiences of people of color as well as those from majority culture backgrounds. Among their findings:


·         “About half of Black adults say they would not want to get a coronavirus vaccine if it was deemed safe by scientists and freely available, with safety concerns and distrust cited as the top reasons. By contrast, most White adults say they would get vaccinated, and those who wouldn’t get a vaccine are more likely to say they don’t think they need it. Majorities of Black adults also lack confidence that the vaccine development process is taking the needs of Black people into account, and that when a vaccine becomes available it will have been properly tested and will be distributed fairly.”


As with the clients I encountered in treatment, considering the context is vital:


·         “The share of Black adults who believe it is a good time to be Black in America has plummeted in recent years . . . Just a quarter of Black men now say it is a good time to be a Black man in America, down from 60% in 2006, and just a third of Black women (34%) now say it’s a good time to be a Black woman, down from 73% in 2011. Yet almost six in ten Black adults (57%) believe the current protest movement and fight for racial equality will lead to meaningful change that will improve the lives of Black people in the United States.”


Given that this represents the views of so many people, it’s hard not to imagine that it represents the views of the clients of color who are in our treatment programs. It is not difficult to imagine that both our current situation in the US and elsewhere (which we have blogged about here and here) and past horrors, such as the forced sterilization of black women and the Tuskegee Syphilis Study, live on in the memories of many.


Meanwhile, a recent study appearing in The Lancet, has found that the presence of psychiatric concerns within the past year is itself a risk factor for COVID-19. Although perhaps not surprising, it highlights the deep connection between physical and mental health, for better or worse.


What are the implications of these recent findings?


First, unless we are directly asking our clients for their perspectives, we may be missing important information about their experiences, and therefore not have the working relationship with them that we believe we have. Where many treatment providers may see “treatment-interfering factors” our clients maybe seeing a legacy of harm and guarding against it.


Second, when we do not have a comprehensive understanding of how they view the world and haven’t taken their perspectives into account, we should not be surprised when our attempts to develop treatment and safety plans fail. Although we may comfort ourselves saying that our clients are responsible for their actions and should be bringing their concerns to us, this is simply not how these things work.


Most importantly, it is crucial for majority-culture clinicians to develop an understanding the history of interventions used against People of Color rather than for their benefit.


Unless we (evaluators, treatment providers, supervising agents) can create a safe space, we may end up in the same place that the study of history finds. Our clients of color have not forgotten the lessons of history, will be under the stresses of inequity, unfairness, and outright racism, and therefore be more prone to the physical and mental health conditions that lead to COVID-19 and other illnesses resulting in foreshortened futures and early death. They will be less likely to engage fully in interventions that have historically been used against them, or worse, will create an appearance of going along to get along with the goal of returning to less restrictive conditions as soon as they can. 


These conditions serve no one. Meaningful participation in treatment can build healthier lives and safer communities. If we are not addressing the very real conditions that clients of color face, how can we consider ourselves to be effective? 


We may think that these conditions don’t apply to us as individuals, but recent events show otherwise, from Selma, Alabama, to Ferguson, Missouri, and from Breonna Taylor to George Floyd.

Thursday, November 12, 2020

"They judge but they don't know what it is like": The isolating experience of being a close associate of someone convicted of a child sexual abuse imagery offense.


This blog was written by an individual from the UK who wanted their story heard but wishes to remain anonymous.

This is a blog in a continuing series about the impact of the arrest & prosecution of individuals convicted of having Indecent Images of Children on their families. The author of this blog also wrote a previous blog on their experiences and this is a continuation. Kieran

In 2015 the father of my 2 young children pleaded guilty to Downloading Indecent Images of Children (IIOC) & received a 3-year Community Order plus 5-year SHPO

In my experience the Fear vs Reality of Negative Community Response is equally oppressive. It adds unprecedented stress within an already intensely emotional situation.


At the start it is all about managing the suspect's suicide risk. Regardless of the outcome of the investigation if the accused is dead there is no satisfactory conclusion for anyone. As my ex felt great shame after his secret online behavior had been uncovered, I was told unreservedly how important my silence was: the additional loss of control of who knew could push him over the edge.

Police warned me that if I broke confidentiality then this could trigger physical vigilante response such as spray-painting vile comments on my property. They advised me to gather evidence of any personal threats as that would make me a direct victim of crime therefore facilitating a referral to support services.

Children Services encouraged me to not tell anyone by explaining the impact on the kids: playdates might stop & my boys be excluded from class parties. Especially for older children, there is a risk that they could be bullied for potentially having the same predilection.

Media exposure when the case got to Court was a constant threat to the anonymity that I spent months protecting during the investigation stage: I had no way of influencing or minimizing this. The thought that something could be shared indefinitely on social-media platforms is horrible. My kids would never be able to control the level of disclosure to their peers & exposure is just a Google search away.


My ex did not commit suicide however, I believe it was an outcome we swerved. There was no vigilante action as I maintained our privacy about the investigation. Nothing has happened which required Police involvement. Luckily, his case was not reported in the media. As no-one knows, unless I tell them, the impact of Negative Community Response for me manifests in a more subtle & undermining way.

Early on I found socializing too daunting as I felt like I was constantly lying about my own life. I was profoundly lonely. I relocated before it went to Court because the level of isolation, I felt in my hometown was making me overwhelming anxious about the future. When I first moved for our fresh start in a new place I optimistically thought, as I would be known separate from him, that I would feel less judged about my past. I was wrong.

Over the years I have attempted to build a support network for my little family by carefully choosing who to trust with the truth however, I find people fall into 3 categories after disclosure:

1.       Some completely disagree with my decision to allow my children to have ongoing fully supervised fortnightly access with their Dad. A lady I considered a close friend expressly told me that as a mother, she felt that I was wrong so no longer wanted to maintain contact. Others listen to my story, give sympathetic statements such as “I respect your decision but if it was me I wouldn’t let him anywhere my kids” however their conflicted feelings about this issue mean it remains an avoided topic & in time they melt away.

2.      I have had people in my inner circle change their stance significantly over time which feels like my foundations keep shifting. Initially, my ex-sister-in-law stated she would never speak to her brother again & if she became legal guardian to my boys that she would not uphold my wishes that they see their Dad: a bereavement in the family prompted her to reconsider & he is back in the family fold. Whilst I was trying to resolve a school safeguarding breach two valued friends, who I thought understood the long-term ramifications, surprisingly minimized the risk factor he presented so did not agree with my response to the incident.

3.       I can count on one hand the precious few I perceive to have my back. They empathize with my struggle, & support my autonomy without condition, restoring my faith that I can trust my instincts.

The risk of potential negative community judgment becomes self-limiting. I still feel humiliated that people might think I was complicit as he committed the offense in the family home.  In time experiential evidence demonstrates that disclosing my family’s circumstance, to create meaningful connections carries the real possibility of losing a friendship which would compound my isolation further. My biggest worry is when my sons come of age they will learn of their father’s crime & this burden will slowly make them become as socially reclusive as I am now. They face the same long-term battle with maintaining their mental wellbeing with no funded support. As the number IIOC investigations rise exponentially, accelerated by COVID-19, more families will be affected. Society is not ready to see us as victims of a crime because currently, authorities do not recognize that we are.

Thursday, November 5, 2020

Talking Tech, Teens, and Sex: Rewiring Our Approach

By Alex Rodrigues, PH.D.


With the arrival of the Internet, society has been provided an ever-expanding catalogue of digital applications.  Although digital technology has proved to be an invaluable tool in combatting social ills, it is just that, a tool, and like any instrument, the Internet and associated technologies are neither inherently good nor bad.   The Internet can simultaneously provide conflicting, and sometimes dangerous, sexual information.  It is for this reason that those interacting with adolescents need to become more knowledgeable about the evolving digital landscape and the various resources and risks that teenagers encounter online. 


Before identifying helpful interventions, it is important to stress that purely prohibitive approaches are unlikely to work. While there are unique circumstances where it is entirely appropriate to shut down a teenager’s online access, such an approach is only suitable in select situations where risk is imminent.  Conversely, parents, caregivers, child advocacy specialists, teachers, and clinicians are encouraged to consider adopting the following steps to address adolescent use of digital sexual media. 


1.            First, adults need to familiarize themselves with the resources and risks that encompass the digital world.  There is a plethora of online resources that adults can quickly access to gain insight into this issue.  Two online resources that provide comprehensive information for laypeople and professionals alike include Common-sense and Children and Screens.  Both platforms offer user-friendly websites that are packed with reliable, scientifically based information that adults can immediately start to implement at home.  Aside from informative websites, there are free podcasts that can provide parents with relevant information.  Tech Stuff and This Week In Tech (TWIT) are two podcasts that regularly cover tech-related issues.  One can quickly search either podcast’s show catalogue for a specific issue and become familiarized with the topic before his or her commute is over. 


2.            An additional intervention involves adults sitting with adolescents and having the youth serve as a digital tour guide.  Simply put, an adult asks the teenager to show them their favourite websites, social media personalities, and applications.   Treatment professionals can use the same intervention in their offices.    I have personally used this approach with enormous success.  This is a great way to quickly build rapport, set a new client at ease, and glean valuable insight into a teenager’s inner world.  During this exercise, the adult should ask what about the digital content is appealing to the teenager, whether the content seems reliable, and whether there could be any harm associated with the material.


3.            For social media applications, adolescents need to be reminded that individuals sometimes present differently online than they do in the physical world.  In the social media world, one runs the risk of falling victim to catfishing (luring someone into a relationship by using a fake online persona), doxing (publishing someone’s private information online), and sextortion (the use of nonphysical, online methods to blackmail a person).  Adults need to teach adolescents how to screen for online threats and determine whether someone is being genuine.  For instance, it is easy to do some harmless detective work to verify an online persona.  A large amount of public information on the Internet has made it nearly impossible to hide from Google’s watchful eye.  Adolescents should be discouraged from invading peoples’ privacy or engaging in subterfuge, but they should learn how to look for consistency across a person’s social media profiles. For instance, do the pictures on a person’s Facebook page match the pictures on his or her Instagram account?  Also, does a person’s responses match the content in his or her digital profile?  Most Internet cons can’t withstand even the smallest degree of scrutiny, and many adolescents would benefit from adopting a stance of respectful scepticism when confronted with online strangers. 


4.            Lastly, there are many free and commercially available monitoring systems that can provide adults an additional resource in managing adolescents’ online behaviour.  Although I discourage adults from using such software as their only means of defence, it can be helpful for adults to have a digital ally to call upon.


With thoughtful consideration and research-supported interventions, society can ensure that teenagers are getting credible information as they navigate their sexual awakening.  


Thursday, October 29, 2020

ATSA 2020 Conference

 By Kieran McCartan, PhD, David Prescott, LICSW, & Kasia Uzieblo, PhD 

The year 2020 has been a strange and challenging year personally and professionally; we have all had to adapt to new ways of working. One of the highlights of the normal research and treatment calendar is the annual pilgrimage to ATSA, which was meant to be in San Antonio but, like many other major conferences in psychology, criminology, social work, and across the social sciences it moved online. 

ATSA 2020 was delivered via an online platform running on 21- 23 October on Pacific Standard Time (PST) with all the talks and workshops being captured and placed on demand. The conference had a full day of pre-con sessions on Wednesday with the conference proper happening on Thursday and Friday with 2 plenaries (Shannon Moroney & Michael Seto) with over 45 workshops, 30 poster presentations, online discussion/interest groups, an exhibition hall, chat lounge, online book store and a virtual hospitality suite. The fact that the conference was online didn’t mean that the awards presentations were canceled, instead, they were pre-recorded: So congratulations to Drew Kingston (Early career researcher award),  Briana Ponte & Ariane Faerman (Pre-doctoral student research award) as well as Michael Miner (Lifetime significant achievement award)!

The platform was easy to access and navigate, with the on-demand function allowing people to attend as many workshops after the fact, which is particularly relevant for international delegates because of the time difference (for instance, Kieran is based in the UK and 8 hours behind PST and Kasia is based in Belgium 9 hours behind PST). Additionally, it meant that you could view as many workshops as you wanted to means that you could engage with the whole program, not just a few as the on-demand service is available until the 26th of November. What follows are some of our individual conference highlights.

Shannon Moroney’s plenary on the reality and impact of being the ex-partner of a person convicted of a sexual offense – she was unaware of his offending behavior and not directly sexually abused by him herself, but she was impacted by and victimized as a result of his actions– was excellent. Understanding the experiences of non-offending partners is an important area of research and practice. It is encouraging that this under-researched experience and this too-often unsupported population was given a voice. The second plenary address, by Michael Seto, crystalized where we are at as a field in understanding online sexual offending, which is particularly salient given the current pandemic.

One of the most obvious highlights was the improved poster presentations and sessions, being able to watch the video footage, view the poster, and have an online Q&A with the authors was brilliant. Attendees felt that they could experience these sessions at their own pace, take them in, and not feel rushed. This is part of the online conference experience that improved upon the in-person version. As such, it begs the question, do we need to adapt the traditional poster sessions?

Other highlights included an excellent presentation by Apryl Alexander on cultural humility. In it she examined sociocultural factors that are relevant in the assessment and treatment of people who sexually offend. Ainslie Heasman presented on ethical considerations with minor-attracted persons. This is an area of great concern for many professionals. There is the possibility of helping people who recognize that they have an attraction to people to prevent acting on their interests. At the same time, there are mandatory reporting laws, which can vary from one state to the next, and from country to country. Ainslie Heasman reviewed relevant ethical codes and statutes and presented three case vignettes to explore the possibilities and perils of this work. This list of highlights is certainly not exhaustive. As we’ll view the on-demand sessions, we’ll certainly be inspired by many more. 

ATSA 2020 participating from home and working remotely was an innovative approach to a very real problem. The ATSA staff and conference team did a brilliant job of pulling together a successful conference, in an innovative way, that allowed the ATSA family to reconnect in troubling times. As we look to ATSA 2021 we start to think about what that holds, will it be the same as ATSA 2020, be more like ATSA 2019, or a hybrid of the two? 

Friday, October 23, 2020

Standing on the shoulder of a giant: Remembering Scott Lilienfeld

 By Kasia Uzieblo, Ph.D., David S. Prescottt, LICSW, & Kieran McCartan, Ph.D.

I think we all agree that 2020 will not easily be forgotten, and not only because of the pandemic. Our field also lost many great scholars and colleagues this year. And when you think it just cannot go worse, it does: 2020 will also be remembered as the year we lost another giant, Prof. Dr. Scott Lilienfeld (Emory University). He was only 59 years old when he lost his battle against pancreatic cancer.


Some ATSA members might not be familiar with the work of Scott Lilienfeld, given that his primary research focus was psychopathy. Notwithstanding, he did publish several papers related to sexual violence. As a personality researcher, he was mainly interested in how personality traits, and mainly, psychopathic traits were related to sexual violence and relevant correlates, including attitudes toward rape victims and sexual objectification.


But he did not only spend his time on exploring the psychopathic mind. He also liked to question things, … many things. No psychological theory, no practice was safe for him. He made it his life’s work to expose pseudoscience in psychology by tackling numerous myths in popular psychology and by encouraging critical thinking in students, researchers, and practitioners.


No doubt that Scott Lilienfeld was viewed as a troublemaker by many. He was not afraid of questioning concepts and theories that psychologists tended to take for granted, including repressed memories of trauma (see David Prescott’s contemplations on this issue), and he was very critical about the evidence-base of psychotherapy. Although he might have touched a few nerves here and there, his aims were noble: He wanted to expose therapies that do more harm than good and to raise the bar for evidence-based practice.


We could sum up the probably uncountable number of papers, chapters, and essays he has written. We could list the number of presentations he has given worldwide – although I’m afraid that is just a hopeless task. But Scott Lilienfeld was more than these numbers. He was a mentor many could lean on, a trustworthy colleague, and a warm friend, who was always available for others who needed him or just wanted to pick his brain about a new idea, paper, or research project.


So let’s honor the impressive works of Scott Lilienfeld and the many pathways he paved for us by continuing to question our practice and our research, by continuing to address all the issues we are uncomfortable with, and by never assume we are there. Because we are not.

Friday, October 16, 2020

Let’s talk about emotions: An NL-ATSA webinar

By Minne De Boeck, Rosa Oranje, Cathy van Harten, & Kasia Uzieblo

Emotion regulation in the treatment of people who committed sex offenses (PCSO) is a topic that has long been underexplored in practice and especially in research. Initially, the assumption was that sexual offending behavior originated mainly, if not only, from sexual deviant fantasies. In line with this assumption, the main aim of the early behavioral interventions was to recondition sexual offending behavior through for instance aversion therapy. Treatment programs of PCSO’s gradually started to focus more on cognitions and self-control. Hence, we started to abandon the mere stimulus-response principle by paying more attention to other psychosocial factors such as attitudes, beliefs, and interpersonal relationships, and the way these factors may underly the client’s offending behavior. Today, cognitive-behavioral therapy (CBT) is the most widely used therapy for PCSO’s and has to date received the strongest empirical support compared to other approaches (see for an overview of its history, Moster, Wnuk, & Jeglic, 2008). But CBT is not all about cognitions and behaviors. CBT techniques also help individuals to gain control of emotions. Although this component of CBT seems to have been a bit neglected over the years, there seems to be a recent uptick of interventions that focus on emotion regulation in these clients (e.g. emotion-focused therapy, mindfulness). Given the importance of emotion regulation as a risk factor for sexual recidivism, the Dutch-speaking association of ATSA, NL-ATSA, organized an online conference on emotion regulation. The aim of the conference was to share best practices in emotion regulation interventions. Three therapists were given the opportunity to present their interventions to 100 practitioners from the Netherlands and Flanders (Belgium). 

The first session was presented by Sabine Noom (Msc) and Marc Lexmond (Msc), who work in the Van der Hoeven Clinic, a Dutch inpatient treatment center for offenders with psychiatric problems, including PCSO’s. Their unit provides treatment to medium- and high-risk PCSO’s. The treatment duration usually ranges from 6 months to 2 years. The goal of the treatment is to reduce dynamic risk factors and increase protective factors. Their treatment program focuses on (1) behavior through role-play and psychomotor therapy; (2) the connection between patients and therapists on the one hand, and amongst patients on the other hand; (3) learning how to take care of each other and how to communicate with one another; (4) creating a positive life plan; (5) acknowledging the person behind the perpetrator; and (6) learning how to behave in a prosocial way by the process of trial and error. The therapists also develop a workbook 'My Emotions' with the patients. This methodology is based on schema therapy. They most often start with the so-called ‘side model’, by exploring the healthy side of the patient, his/her fighter and destroyer side, and his/her protector side among others. The client learns how to talk to his/her different sides after identifying which side is claiming a big role in specific situations. This way clients learn to understand their offending and present behavior.

In the second presentation, Ellen Gunst (PhD; FIDES) focused on Emotion-focused therapy (EFT), a therapeutic approach based on the premise that emotions are key to identity and which emphasizes the adaptive nature of emotions. The primary focus of EFT is to promote the client's instantaneous experience. This framework postulates that controlling emotions cannot be learned consciously but can be acquired implicitly (e.g. by experiencing emotions and experiences). Hence, the aims of EFT are to create a genuine empathic valuing relationship and deepening the client’s experiencing in therapy. In order to facilitate intimacy and connectedness in their patients, various EFT techniques can be used. During her presentation, Ellen Gunst illustrated the so-called Two-Chair Task. This task aims to resolve the intra-psychic conflict within by evoking emotional responses in the client. This technique was illustrated with a case example. This patient was initially difficult to motivate for and engage in therapy, but after a year the therapists succeeded in forming a minimal form of connection with the patient. The two-chair technique was applied to help him gain insights into his anger, frustration, and sadness. With this case example, Ellen Gunst demonstrated that it is possible to teach these patients how to acknowledge their feelings and to facilitate their empathic abilities. 

In the final presentation, Martine Ruijter (Msc; Antes) explained how she applies visual techniques of visualization with PCSO’s. According to Martine Ruijter, PCSO’s are more open to discussing their behavior, thoughts and feelings by making them visible. The focus lies on the patient’s story, not the interpretation by the therapist. The advantage of this therapy is that in case a proper therapeutic relationship does not ensue, the client can still focus on the material, which in turn might help to (re)build therapeutic contact. There are four levels on the ‘expressive therapy continuum’, namely: (1) Kinetic to sensory, (2) Perception to affect, (3) Cognition to symbolic, and (4) Creativity. The goal is to get the client to the fourth level and to create balance in his emotional experiences. Martine Ruijter also observes some remarkable differences between different PCSO’s in their artwork: the artwork of patients who have committed rape seems to be more chaotic and often cracks are drawn, whereas patients who have abused minors seem to be more creative but difficult to reach throughout the conversation. According to Martine Ruijter visual therapy should be regarded as complementary to CBT.

Important take-home messages were that in therapy we sometimes need to pay more attention to non-verbal expressions of emotions. Clients need to learn how to regulate their emotions through practice (e.g. visual therapy, role play). Therapists should also dare to slow down, explore the emotional experiences in-depth, and pay attention to physical experiences and traumas. The interventions that focus on emotional expression can be considered as a valuable addition to CBT interventions that focus on cognition and behavior. However, all presenters also emphasized the need for empirical insights into the efficacy of emotion regulation interventions in terms of the well-being of PCSO’s and the risk of recidivism.

Friday, October 9, 2020

Researching sexual abuse in the “new” normal.

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

As we move towards the end of 2020, we all find ourselves in a challenging and unique position, with fluctuating restrictions, local lockdown, and talk of a vaccine but no sign of one. We keep hearing that we are entering an as-yet-undefined “new normal”. It is a new normal that poses many questions, challenges, and opportunities in many areas. This is especially true in the fields of sexual abuse, domestic abuse, and interpersonal violence. How do we create and maintain an evidence base when the landscape in which we do our research has changed? 

Researching sexual abuse involves many research methods and tools, all of which have their purpose and tell different research stories that are valid and important in their own contexts. Generally, we use quantitative and qualitative research methods, with a case study approach being a close third, all of which have been impacted by the pandemic in different ways and. We, therefore, need to recognize these issues and think about how we adapt to them. This post spells out some of the challenges that we face as researchers in the field. 

Ethics: Developing and using good ethical practice in research has become central when conducting all research midst, the pandemic and moving into the “new” normal in all fields, but especially in the field of sexual abuse. In broad terms, the process of doing ethical research has shifted with the timeframe for getting ethical approval has lengthened, with more information being asked for, especially in terms of data collection, data storage, participant safeguarding, researcher safeguarding, and partnership arrangements. In regards, to sexual abuse research ethics the nature of our field indicates that our research participants may be in a vulnerable or shielded population, as well as the fact that lockdown may mean that participants are trapped in an abusive relationship, maybe in a situation that triggers there victimization or preparation, or that they maybe feel more psychologically on edge. All of this means that we need to think more about ethics and good ethical practice in our research than ever before.

Safeguarding: In the “new” normal we need to think about the added impact of doing sexual abuse research at a distance, in terms of the researchers and the participants.  

  • Researchers are more likely to be doing research online, at a distance, at home, and, potentially, in isolation. This means that researchers may need to check in with each other more often, talk with them about their research, and quite possibly discuss the impact that it is having on them (and their relationships with family and friends).  For those who are doing research in institutions, they are doing these in COVID-19 conditions with additional precautions around them and, therefore, may feel more on edge and more vulnerable.
  • In regard to participants, either people who have been victimized, people who have committed sexual abuse, and/or the peers and families that surround both groups, we need to make sure that there are appropriate safeguards in place, clear information on where they can go for support and assurances, and that the research will not do more damage than good. The reality is those participants involved in sexual abuse research, especially qualitative research, may be more vulnerable, whether psychologically or physically, because of the lived reality of COVID-19; we need to recognize as well as support them in this. In addition, the participants may be in a shared house, with people potentially causing harm to one another or being an unaware third party in a home in which abuse is occurring or about to occur. This will change the nature of the interview and could present additional risk concerns. 

The reality is that online research presents additional concerns about data protection, anonymity, and privacy. Certainly, in Europe, there have been conversations about the General Data Protection Regulation (GDPR) and online qualitative research.  

Data Collection: Although we are still collecting data, the pandemic has affected means for doing so. This impact has been and will be, different depending on the methodology. The biggest impact will be on lab-based research and qualitative research. During the pandemic, especially in Europe, we have seen labs closed for periods of time, greater restrictions on how labs are being used, and who has access to them. In conversations with lab-based researchers, it’s not uncommon to hear them question how their projects can continue or the data collection altered. In terms of qualitative methodology, the pandemic has resulted in a change to online data collection, with zoom interviews or Microsoft Teams focus groups. Is this the most effective approach? Is doing qualitative research with people who have been sexually abused and people who have committed it effectively when data collection occurs online? The challenge is that we don’t know, especially with the research and methodological fields swinging back and forward; some have stated that it could enable people to participate more while at the same time others believe that online interviews can inhibit conversations. The reality is that moving qualitative research online changes it and presents substantive challenges to the research, the researcher, and the participant. This, in turn, changes the approach to data collection impacts the data that is collected. 

Doing sensitive and challenging research in the new normal means that we need to adapt our approach, that we must look at new methods and add in different considerations. It does not mean that data collection cannot happen, just that it cannot happen in the way that it did before. 



Wednesday, September 30, 2020

“Victim”: Reflections on autonomy, choice, and the power of language

By David S. Prescott, LICSW

You are never more than a stone’s throw from someone who has survived sexual violence.”

-          Alissa Ackerman, Ph.D.

For years, I’ve puzzled over the American Psychological Association’s definition of trauma:

Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives. Psychologists can help these individuals find constructive ways of managing their emotions.

There is a number of ways to read this definition, starting with the idea that trauma is an “emotional response.” This seems strange given that victimization can have devastating effects on how people view themselves and the world around them (for example, cognitive schemas that the world is a dangerous place where one has to see risk everywhere in order to survive). Being victimized is about a lot more than simply emotional responses. This is evident even in the criteria of our diagnostic manuals.

Looking deeper, however, it seems odd that the definition concludes with the idea that “psychologists can help these individuals find constructive ways to manage their emotions.” While the statement is not untrue, there is an implication that psychologists may be more exclusively qualified than others to assist those who have been traumatized. There is an implication that those who have been traumatized likely need professional help. Of course, there is no evidence to support either of those statements and no evidence that the APA intended to imply these things. Nonetheless, I have found myself wondering whether this isn’t where a curious kind of colonization begins. After all, close friends can also be helpful to those who have been victimized. By what right does any profession claim, even implicitly, that they have the best answers?

History has shown that colonization can start with good intentions – actions taken “for your own good.” For professionals, it can begin with implicit beliefs about our clients, often beyond our awareness. For example, “This person clearly needs treatment…” can morph into “… and I am the right person to provide that treatment.” Others may simply imply that they speak for all who have been victimized and that they know what these people need or want. Meanwhile, anyone who has worked with people who have survived sexual abuse knows that no two people have the same experiences as they re-build their lives. The fundamental question becomes how we know that we speak for others without first confirming with them that we’ve heard and respected their voices? It may seem petty, but if we are not allowing them to frame their own experiences, how can we know that we are not causing further harm by, in essence, colonizing their experiences to meet our own agendas?

How we frame these issues matters. Over many years of practice, I’ve spoken to a number of practitioners. One interaction has haunted me. This practitioner described how “victims” often believe that they are “damaged goods” and therefore need long-term treatment to learn that they are not. This person then went on to describe clients returning to treatment decades later after re-traumatizing experiences. On the one hand, these situations are not unusual. On the other hand, this practitioner appeared to derive a sense of professional identity and intrinsic gratification at being the one to whom these people would turn. It was as though she needed her clients to desire her continuing care more than they need to be back in treatment. Most professionals in our field are proud to be helpful to others, myself included. Where we cross the line into the beginnings of colonization can be difficult to discern, however.

While the broader discussions could fill a book or multi-day conference, this post focuses primarily on words. I’ve come to wonder whether phrases such as “damaged goods” (as in “You may feel like you are damaged goods. Rest assured that you are not, and many other people have felt this way”) may actually cause harm to those that don’t feel that way but start to wonder if they should. Why put our linguistic focus on “damaged goods” first when we can just as easily say truthfully that many survivors go on to reclaim their bodies or their lives despite sometimes wondering if they would ever get over the harm they’ve experienced. Post-traumatic growth receives far less attention than post-traumatic stress disorder in our education and research. While no one can realistically argue that the harm caused by abuse can last a lifetime, studies continue to find that life-long harm is far from inevitable. As Kieran McCartan and I have argued, it should not be left up to others how someone survives.

Where does this leave us? One place to start is in reconsidering the word “victim”. Many who have victimized have been quite vocal that they don’t want to be defined by the worst thing that has happened to them. Many prefer the term “survivor,” although having worked with a number of extremely violent men, I’ve learned all too well that not all who are abused actually survive. Three years ago, ATSA issued a statement regarding person-first language. Perhaps it is time to extend the same courtesy to those who have experienced victimization. Of course, just as important is that we explore with clients how they want to define themselves – for the moment and in the future.

Ultimately, it can be easy to forget that language is sometimes intervention in itself, and not just one part of treatment. The words we use can have a profound impact on others as well as ourselves. Given how often mental health practitioners worry that stigma interferes with people seeking our services, it makes sense that we do what we can to abandon stigmatizing language. It may also be the case that thinking in person-first terms (for example, “person who has been victimized” rather than “victim”) will help all professionals to better understand that people who abuse are themselves often people who have also been victimized.

In the end, Judith Herman may have captured it best in the early 1990s when she said that no intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it may appear to be in her own best interest. One place we can start is with our assumptions about who we are in others’ lives and how our language (as well as our actions) can bring about assistance or cause further harm.

The author is grateful to Kasia Uzieblo, Jill Levenson, Alissa Ackerman, Danielle Harris, and Kieran McCartan for their review of an earlier draft of this post.

Friday, September 25, 2020

The evolution of the ATSA 2020 Conference: ATSA from home

By Kieran McCartan, Ph.D.

This year has been difficult and challenging in many ways, with all of us having to change our lifestyle and working practices. Currently, large amounts of us are working from home and only thinking of our next trip to the food shop, never mind moving further afield. This means that trips and experiences that would be a normal, regular part of our professional and personal calendar either are not happening or have significantly changed. One example of this is conference attendance. We are often told, especially in academia, that conferences are a luxury and that we should take the hit this year with everything else that is going on. I would counter that argument as the core root of evidence-based practice is research and the function of a conference is to create an environment that enables free, frank, and critical engagement with colleagues on research and practice. Conferences, therefore, are an important part of the lifeblood of our field, they are where we hear cutting edge research, network with colleagues, and generate new ideas. The Covid-19 pandemic has impacted the viability of the conference circuit with some organizations suspending their conference to 2021 (IATSO, NOTA), putting on a reduced conference program in the form of webinars (NOTA), however, ATSA has decided to continue with their conference albeit in a different way. 

ATSA has had an annual conference each year for 38 years and 2020 will have an ATSA conference as well, but this year rather than it being in person (it was supposed to be in San Antonio) it will be online and “from home”. ATSA has embraced the recently necessitated technological and online move predicated by Covid-19 and moved the conference to be completely online. The conference will run from October 21-23, 2020, with the first day being a series of pre-conference training and the next two days being traditional conference presentations and workshops. 

The 2020 conference theme – Blending Voices. Strengthening Lives. – is particularly meaningful at a time when so many people feel isolated and vulnerable due to the ongoing pandemic. As I have noted in this blog and we have seen in many media reports, there is an increased risk of sexual abuse when individuals are isolated without the normal access to support structures that can help prevent and address that abuse.

The 2020 ATSA from home the conference has a strong line up with plenaries from Shannon Moroney and Michael Seto, with more than 40 educational sessions (all with CEUs at no additional cost), 30 poster sessions, several chat rooms, and many other opportunities to hear from and interact with experts in the field of sexual abuse prevention. Speakers and attendees, at this year’s event, will be international in nature and the research and practice discussed will be of the same standard as previous conferences.

While ATSA from home will be different format, layout, and approach to the traditional in-person conference it does allow us to meet, talking, and learn from each other. In person, conferences seem like a long way off and quite alien at the minute. Has Covid-19 changed the nature of conference attendance, especially international conference attendance, permanently, or is this only a bump on the road? Who knows! To me, it shows that ATSA is moving with the times to support researchers and practitioners to prevent sexual abuse.

Thursday, September 17, 2020

Not so cute after all? The controversy over “Cuties”

 By Kasia Uzieblo, Ph.D., David S. Prescott, LICSW, and Kieran McCartan, Ph.D.

In recent days, a controversy arose over a Netflix-produced movie titled, “Cuties”. Its marketing campaign featured young girls dressed provocatively. It drew instant criticism in social media with some claiming it is a movie for pedophiles; others even stated it will elicit pedophilia. The topic has also become politicized, with politicians apparently fueling the idea that the movie is evidence of an underage child sex trafficking cabal in Hollywood. The furor over risqué art is nothing new, but the speed with which Netflix was chastened and responded was impressive: Netflix apologized, canceled the marketing campaign and in some countries has seemingly removed the award-winning movie from its platform. Ironically, most agree that the marketing campaign did not reflect the actual content of the movie effectively. The film was about a girl caught between the cultures of her French schoolmates and her Senegalese Muslim family and reflected the director’s story. Still, opinions of the content have been sharply divided within our field.


So, did we judge too soon? Most probably. Many judged the metaphorical book by its cover, without having seen the actual movie. The experience shows us the many perils of social media. Although social media has its merits, it tends to ignite polarized discussions with little room for nuance and reflection. Social media encourages the rapid browsing of headlines and elevates provocative items. Users are rewarded for (re)posting provocative, splashy items by giving them more followers and retweets, even if the story is untrue. Hence, social media focuses our attention on the number of likes and distracts people from accuracy. This is a dangerous evolution that is increasingly misused and abused by certain people and groups in society to mislead people on political, economic, health, and climate issues, to name a few. All of this is important for those us who spend much of our careers attempting to dispel inaccurate, seemingly mythical information about sexual abuse.


Will people change their judgment on the movie? Some might, and many will not, even when they hear what the story is really about. Information that is initially accepted but later corrected, is found to have a persistent influence on people’s memory and reasoning. New information will always be weighted and interpreted in light of information already received (Ecker, Lewandowsky, Pin Chang, & Pillai, 2014). In addition, people are more likely to accept (mis)information when it is consistent with their believes and attitudes (see for a review, Lewandowsky, Ecker, Seifert, Schwarz, & Cook, 2012). Thus, the danger in this story also lies in the fact that this controversy will fuel wrong conceptions on pedophilia and facilitate child trafficking conspiracy theories.


Will the movie ‘elicit’ pedophilia, as some have argued? There are two possible questions within this idea. With media willing to sexualize children in high supply everywhere in western society, perhaps we should be engaged in a broader discussion about this topic. On the other hand, questions regarding whether this film will create pedophilia where none existed before might best be answered with the question of whether watching films about gay people have ever changed anyone’s sexuality at a fundamental level. While there is always the possibility that any media will move people into some kind of action, people’s fundamental sexuality is simply not that subject to change.


Further, while there are provocative images and content within Cuties that some will view as confirming their existing offense-related attitudes and beliefs, the film is best understood in context. The ongoing debate reinforces the point that problematic content is always available and easy to access for our clients. This means we need to respond to this with our clients. It is not that different from the times before the Internet, when our clients would commonly use non-pornographic child sexual abuse imagery. Those who are interested in children will always find this content, with the difference here being that it was given directly to them. 


The main issue remains that these headlines and social media attacks divert from the important discussion that the director intended to have with the audience. She wanted to ignite a discussion on the sexualization of children. As the directors stated, “I wanted to open people’s eyes to what’s truly happening in schools and on social media, forcing them to confront images of young girls made up, dressed up and dancing suggestively to imitate their favorite pop icon.” This is the discussion that should get our attention. When I (Kasia) bring this topic up in my classes – which I have been doing over almost the last 10 years - many students argue that I’m not a feminist. Girls and women have the right to dress how they want; an argument that many pop icons promote as well. But isn’t the pressure that these girls feel to dress provocatively so that they can be part of the current pop culture not also a sign of oppression? And isn’t this form of oppression also worthy of close examination? Perhaps our rush to judgment precludes other, more important discussions, including those regarding where oppression begins and ends?

Thursday, September 10, 2020

“But they must have known”: Am I getting this wrong?

 This blog was written by an individual from the UK who wanted their story heard but wishes to remain anonymous.

This is a blog in a continuing series about the impact of the arrest & prosecution of individuals convicted of having Indecent Images of Children on their families (please see a previous blog by a professional and a family member). The author of this blog has wished to remain nameless, but please be aware that the individuals who contribute to these blogs, while anonymous, are different individuals. Kieran

The “But, they must have known!” blog presented the story of an ex-partner of an IIOC and her experience and emotions in the five years since ‘the knock’. My situation is almost identical, just five years on, and I wanted to highlight how the focus on the event and the immediate aftermath is not enough, and how the situation continues to evolve, and even heighten, as the year's progress. I am an ex-partner of a man arrested for IIOC offences 10 years ago. He received a community sentence and 5 years on the SOR. My children do not know. 

On the night that my ex-husband was arrested, my 2 sons (3 and 6) were playing in the living room. We had a great family, the kids loved their dad, and contrary to what people may imagine, there were no signs, we were very happy, and for the children, that meant an unexpected decimation of the family. Ten years on they still don’t know about their Dad, but this is what I imagine THEY FEEL.


Every day after the knock my eldest asked me: “What did Dad do wrong?” Every day I distracted him with: “Look what your brother just did”. One day, about a year after the arrest, he asked me: “Did Dad kill someone?” and I vowed that the next time he asked I would tell him the truth. He never asked again! I struggle to imagine another situation where what appears to be a happy and stable family unit would be terminated without the permission to grieve or to talk about the trauma. I told my children (and friends and family) that we decided to separate because we weren’t making each other happy. When people say: “The children will be better not hearing the arguments, or living with the tension”, I envy those families because my children were not better without the arguments or tension because there were no arguments and there was no tension. Is it akin to the death of a parent? I imagine in that situation there is permission to talk about Dad and how great he was. The children don’t have to see their Dad unemployed and broken, but silent as to why this has happened. It’s a world based on lies, deception and, ultimately, a disengagement, because the topic cannot be discussed. I hope that they are too young to dwell on the inaccuracies and the contradictions, but I fear that may be false hope.


I think my children feel scared. When your world falls apart in an instant, one of the outcomes is hyper-vigilance. Within a day their mum turned from a laid back, happy person to someone who panics at the sound of the phone or knock at the door, who over-reacts when school phone to tell her you have done something wrong, and who often breaks down at things she never did before – without explaining why. While mum used to have lots of friends, enjoy a glass of wine and relish the chance to mix with other adults, she makes excuses to avoid seeing people, she rarely goes out and she doesn’t talk much anymore. For the (ex)partners of IIOC offenders, the crime has a life sentence – the lies, the deceit, the fear,  it consumes you to a point where the safest option is to retreat, and for my children, that overnight transformation must be terrifying.

Do they know?

I think that one of the hardest parts of being the remaining safeguarding parent is projecting every emotion you feel onto how your children might feel. Are they scared or is that my emotion? Are they confused, or does this all wash over them? And feeling the intense and unrelenting desire to tell them why their life changed so dramatically, but all the time knowing that, once said, that cannot be unsaid. These are thoughts, emotions, and behaviours that are not recognised or supported by agencies set up to deal with offenders, victims, or children of prisoners (the overwhelming majority of IIOC offenders receive a community sentence). For my children, and for me trying to parent them, there is no guidance or support, and the overwhelming feeling I have is: “Am I getting this wrong”.