Thursday, February 20, 2020

Experiencing and coping with the “sex offender” label: An international challenge - Can we handle what our clients have to say about it?

By Ingeborg Jenssen Sandbukt, David Prescott, LICSW, & Kieran McCartan, PhD.

Please note that this blog is longer than normal but we felt that breaking the blog into two would have been artificial and would have broken up the flow of the piece. Kieran

The first author (Ingeborg) recently completed a thesis that studied the concerns expressed by individuals convicted of sexual offenses. It examined their experiences with stigma, both in prison and post-release, in Norway. The study is based on qualitative interviews with eight adult men, all convicted of at least one sex offense. The eight men interviewed were relatively recently released from prison, and most were still subject to terms and conditions set by the Norwegian Correctional Services. Five had been sentenced to regular prison sentences, two had been sentenced to preventive detention, and one had been given a community sentence in addition to imprisonment.

These men’s experiences in prison involved hearing about and witnessing violence and threats towards other persons convicted of sex offenses. A few of the men had been bullied themselves by other prisoners. Internationally, these experiences are not unusual for people incarcerated for sexual offenses. Some of the men were advised by prison staff to come up with a believable cover story to avoid negative sanctions from other prisoners. In some cases, these men told others that they had been convicted for various petty crimes. In one case, a man had been advised by a prison officer to simply state that he had ben convicted of fraud involving welfare benefits. Not surprisingly, most participants did their best not to be recognized as a “sex offender” in prison, although some could not avoid the label. However, the all the men who took part in the research were all highly aware that they were unwanted and seen as outcasts by the prison community, never mind the general society outside of prison, which reemphasizes the stigma that sexual offending elicits in society.  

The experiences that these men had in prison are relevant to their post-release use of coping strategies. The results highlighted that the strategies used in most cases were a reaction to and a result of others’ perceived attitudes towards people convicted of sex offenses as a group. The strategies were not the result of a proactive desistence strategy.

Informants in this study experienced high levels of stress linked to being recognized as someone who had committed a sexual offense, even after release. In many ways they limited their own life opportunities as a result of trying to cope with the threats they perceived. The reasons for these responses are easy to understand. In prison they learned that their offenses would not be forgiven. They were told to lie to stay safe. After release, their families and friends cut them off. Courtesy stigma and episodes of informal notification by others of their crimes led them to believe that there was no chance of redemption. Finally, through the media, they learned that others with similar histories as themselves were considered monsters. As a result, and as a group, informants in this study withdrew and isolated more, and their self-images were in some cases affected negatively.

This study reflects broader research in the field internationally, with many participants experiencing broken bonds with family and friends and a negative portrayal in the media. Further, they have seen how they are considered to be “monsters” in public discourses, with the associated perception that they are always going to be a threat. This is very relevant to post-release experiences in Norway, as media accounts are widespread, and the country has a comparatively small population and a deep sense of community that binds people together. Therefore, media discourses feed into wider stigma.

These media processes and resulting stigma are especially important because Norway is often seen as exceptional when it comes to post-release reintegration and inclusiveness. These findings challenge this belief. Norway does not have official registration and disclosure policies for people convicted of a sexual offense, but the nature of the offense was enough to create an informal, persistent label that the men could not escape. In light of this, Ingeborg’s research examined participants’ perspectives of the way that they were perceived and labelled focusing on how it impacted their self-image and capacity to desist as well as integrate back into the community. The research found that some participants presented their futures with hope and enthusiasm, while others seemed somewhat hopeless. The men described how their status as a person convicted of sexual offenses did, and could possibly, limit their opportunities to live the life they wanted post release.

The recidivism rates for this group of offenders are low* in Norway, as in the rest of the world. The challenge is that research consistently finds that one of the greatest contributors to desistance is strong social bonds and pro-social networks, but the way that these men are labelled and viewed in society breaks these bonds and, therefore, makes reoffending more likely. What the participants wanted was to be able to be open about their conviction and treated like any other citizen even though they had once committed a sexual offense. Their stories indicate that there is a need to review the idea of the inclusive Norwegian society, concerning this topic.

What is the international relevance of these findings from Norway? These findings add to what has been known from earlier studies (Levenson, Prescott, & Jumper, 2014; McCartan, Harris, & Prescott, 2019). Namely, that understanding the service user perspective is central to public safety as well as successful treatment and integration back into the community. Perhaps the most puzzling aspect of studying the service user’s voice regarding their treatment experience is how little study has taken place. Why? How is it that programs don’t consider feedback? What gets in the way?

First, remember that understanding client experiences and client satisfaction is not the same as monitoring outcomes or checking in on the working alliance. Ensuring that clients are generally happy with services is not the same as ensuring that those services are working, even though the latter is unlikely without the former. It’s important to consider every angle of the experience in order to produce services that effectively build community safety.

Second, the working alliance is about more than just the relationship; this has been found to be important in community supervision efforts as well as treatment. The working alliance involves building agreement on the goals of rehabilitative efforts (which itself can require a wide array of interpersonal skills). It also requires agreement on the tasks of treatment and agreement on who the therapist is in the life of the client. Finally, the alliance involves delivering treatment, supervision and support in a manner that fits with the strong personal and cultural values of the client.

Third, the vast majority of research into the treatment of people convicted of sexual offenses is about the model used and its impact in reducing re-offending, and not about behavior change or harm reduction; both are helpful key performance indicators in treatment.

Fourthly, and perhaps the biggest barrier to honoring the service user’s voice, is the belief of agencies and individual clinicians that they are already doing it. It can be easy for professionals to assume that they understand each client’s internal experience of treatment and to form further assumptions and plans for treatment accordingly. Unfortunately, research from within our field (Beech & Fordham, 1997 ) and outside it (Bertolino & Miller, 2013) finds that therapists typically overestimate their effectiveness. This can become a bitter pill to swallow, especially when so many forms of psychological approaches already come with an implicit assumption that treatment is something we do to our clients rather than with them or on their behalf.

Finally, it is worth noting that if we are truly to help efforts at public safety, it makes perfect sense to study those who experience our interventions the most. As research indicates, they are often the ones most motivated to make treatment work.

* In a Nordic study of recidivism (Graunbøl et al., 2010), 3% of individuals convicted of sexual offenses in Norway recidivated within 2 years after release from prison, none of them into new sex crimes. Longer follow-up periods naturally provide higher recidivism rates, as indicated by a 5-year sexual recidivism rate of 8% in Norway (Grünfeld et al., 1998).


Beech, A. R. & Fordham, A. S. 1997. Therapeutic climate of sexual offender treatment programs. Sexual Abuse:  A Journal of Research and Treatment 9: 219–237.
Bertolino, B. & Miller, S.D. (Eds.) (2013). The ICCE Feedback Informed Treatment Manuals (6 Volumes).  ICCE: Chicago, Illinois.
Graunbøl, H.M., et al. (2010). RETUR En nordisk undersøgelse av recidiv blandt klienter i kriminalforsorgen.

Grünfeld, B., Noreik, K., & Sivertsen, E.A. (1998). Straffedømte sedelighetsovergripere. Hvor stor er tilbakefallsrisikoen? Tidsskrift for Den norske lægeforening, 118(1), 63-66.
Levenson, J.S., Prescott, D.S., & Jumper, S. (2014).  A consumer satisfaction survey of civilly committed sex offenders in Illinois. International Journal of Offender Therapy and Comparative Criminology, 58, 474-495.

McCartan, K.F., Harris, D.A., & Prescott, D.S. (2019). Seen and not heard: The service user’s experience through the justice system of individuals convicted of sexual offenses. International Journal of Offender Therapy and Comparative Criminology, 1-17.  doi: 10.1177/0306624X19851671.

Friday, February 14, 2020

At the crossroads 2.0: Future directions in sex offender treatment and assessment

By Kasia Uzieblo, PhD, Minne De Boeck, PhD, & Kieran McCartan, PhD

NL-ATSA (the chapter of ATSA based in the Netherlands and Belgium), the University Forensic Centre) (UFC) and the University of Antwerp organized the second edition of the conference “At the Crossroads: Future directions in sex offender treatment and assessment” in Antwerp, Belgium. The second edition took place from the 6th – 7thFebruary in Antwerp, following on from two days of pre-conference sessions focused on treatment and risk assessment. The conference was a real mix of research, practice, and policy with approximately 250 participants from the Netherlands, Belgium, Germany, Slovenia, Spain, Iceland, USA, Canada, and UK; in addition Zuhal Demir, Flemish Minister of Justice and Enforcement, opened the conference and attended the first session on the first day. In this blog we are going to take you on a whistle-stop tour of the event.

The conference had 2 pre-conference sessions, which were separate from but connected to the main conference, on Static-Stable-Acute training (Wineke Smid, Minne De Boeck and Kasia Uzieblo) and how to effectively apply Risk-Need-Responsivity principles to treatment (Sandy Jung). The first day of the conference was all keynote sessions, which included, Maia Christopher (ATSA) on working with victims organization to co-create effective public policy;  Erick Janssen (KULeuven) on the relationship between arousal and emotions on decision making in risky sexual behaviors and/or sexual offences; Georgia Winters (Fairleigh Dickson University) on sexual grooming behaviour; Ross Bartels (University of Lincoln) on the sexual fantasies and their role, or not, in sexual offending; and Nicholas Blagden (Nottingham Trent University) in the importance of the rehabilitative climate and how prison can be a place for therapeutic change. The second day the conference had started out with two back to back workshop sessions: There were 5 sessions and they were repeated twice which enabled the attendees to get the most out of the conference. The workshop sessions were more practice-based and focused on online sexual offences (Hannah Merdian, University of Lincoln), risk communication (Daniel Murrie, University of Virginia), case formulation incorporating risk assessment (Leam Craig, Forensic Psychology Practice, LTD), sibling sexual abuse (Peter Yates, Edinburgh Napier University) and professional self-care (Joanna Clarke, Petros People). The second half of the second day focused on keynotes from, Klaus Vanhoutte (Payoke) talking about human trafficking, sexual exploitation and how the “lover boy method” could be used to understand this process;  Eric Beauregard (Simon Frasier University) on research and practice into serial sexual homicide and what that means for practitioners; desistance from online sexual offending (Hannah Merdian, University of Lincoln); and how we move on from the crossroads in terms of using evidence in policymaking (Kieran McCartan, University of the West of England). On the second day, like the first, there were about 10 poster presentations during lunch (21 in total) that highlighted the breadth and depth of research in the Netherland, Belgium, Germany and UK on sexual abuse, including, research on BDSM, Minor Attracted Persons, Stop it Now!, COSA & Circles Europe, and desistance.

The NL-ATSA conference really highlighted the diversity of sexual abuse and how wide, although interconnected, the field is. The multi-day conference connected all the domains from theory to treatment with each other. Current trends and lesser-known phenomena were also cited. For if we don’t understand sex and sexuality in everyday life, how can we tell normal/accepted sexual practices from “deviant”/non-normal ones? How can we understand the way that the public, as well as policymaker, attitudes to sex and sexual abuse are formed, and therefore how they impact real-world responses to sexual abuse? If we do not know the difference between fantasying and doing, or viewing and doing, how can we present first time offending or recidivism? If we do not know how people groom, offend or behave, how can we prevent or respond to sexual abuse? This also means that we must hear the client as the service user and recognize professional experience and knowledge to frame best practice. So that we can build rehabilitative climates that are fit for purpose, help treat people and stop burn out in staff. Therefore, we must recognize that rehabilitation is possible and that desistance can happen. The evidence base in sexual abuse is often varied, but we do know that treatment/interventions are more effective than doing nothing. Do we acknowledge that enough? And how do professionals and researchers convey that to the public and policymakers? This conference highlighted and incorporated all these points. Yes, we are at a crossroads and we have been there for a time, but we need to go forward not back. We go forward together united in a multi-disciplinary, multi-agency way and by connecting all the different subdomains within our field. The conference reinforced the importance of international collaboration, conversation, and research.

Wednesday, February 5, 2020

Moral Injury and Radical Hope: Part 2

By David S. Prescott, LICSW, and Kieran McCartan, PhD

Note: This is part 2 of a 2-part blog, Part 1 can be found here. Kieran

One problem with working individually to combat moral injury is that we very often do it on our own and in isolation. Our field is now rife with discussion about self-care (and we note, to some degree, unfortunately, that our blog on self-care was among the most read and shared blogs of 2019). An aspect of our work that we only rarely discuss is hope and how we keep hope alive.

In 1999, the late Rick Snyder produced an excellent chapter on hope in which he broke it down into two components. The first, “agency thinking” refers to the awareness that a goal is possible. The second is “pathways thinking”, which involves an awareness of how to achieve a goal. It can be enormously helpful to break hope down into these components to see where we, as individuals, may best become more helpful to our clients, colleagues, and selves. In our field, there has been only one article and a book chapter, both well over ten years old, published on the topic of hope in treatment. Nothing has been written on how professionals can remain hopeful about their work.

The case example discussed in part 1 calls to mind that hope at the individual level may not be enough. Even if we practice excellent self-care and keep hope alive for ourselves, how do we best work together as teams to remain engaged in improving the systems that often seem to do their best to spread fear, anxiety, and moral injuries?

Another recent article may begin to yield clues about possible ways forward. Della Mosley and her colleagues recently published on the topic of “radical hope”. Mosley er al's specific focus is in the direction of community-based hope for marginalized groups, but may yield insights into how professionals in our field might also become more effective (as well as more culturally safe, humble, and competent). Mosley and her colleagues introduce radical hope as:

“A culturally relevant psychological framework of radical hope, which includes the components of collective memory as well as faith and agency. Both components require an orientation to one of four directions including individual orientation, collective orientation, past orientation, and future orientation.”

The authors go on to describe how their framework also “consists of pathways individuals can follow to experience radical hope including (a) understanding the history of oppression along with the actions of resistance taken to transform these conditions, (b) embracing ancestral pride, (c) envisioning equitable possibilities, and (d) creating meaning and purpose in life by adopting an orientation to social justice.” These pathways can inform how professionals think about the hope within the work of treating sexual aggression.

We acknowledge that the focus of Mosley’s article is  directed toward marginalized people (in this case, people of color) and not simply those who often work with them. We further acknowledge being the beneficiaries of some forms of privilege, even as our lives have not been without their own significant challenges. Nonetheless, the idea of radical hope provides an approach that may be helpful to us. As a start to how we might consider moving from individual self-care and hope, professionals in our field might wish to ask:

· How can we build mechanisms of best practice that encourages the service-user voice while recognizing the gap between client success and key performance indicators?
·  How well do we understand the systems that so often create barriers to helping people build healthier, risk-reduced lives for themselves?
· How well do we understand the history of thinking that resulted in these systems functioning as they do?
·  How might we better celebrate the work that we do? After all, working with clients who have abused provides an important function in keeping our communities safe. The work we do matters, and as recent meta-analyses have shown, the work we do can be effective, even as we acknowledge that no efforts in any human endeavor are effective all the time.
·  How can we best argue on behalf of equitable outcomes for all of the people who come to our attention? All too often, it seems that there are internecine rivalries between professionals of various beliefs, including those who believe that being empathic with those who have caused harm is somehow disrespectful of those who have been harmed (and despite research showing that those who harm have very often been harmed themselves).
·  How can we best remind the world at large that this work matters and is in the public interest? The simple fact is that this work has great meaning and an important purpose.
· And finally, in terms of moral injury, how do we remind others of the need to practice both autonomously and as members of teams? Getting this balance right can be a true challenge. Nobody ever said collaboration was easy.