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”.

Thursday, September 3, 2020

Community Violence and Individual Anguish

 By David S. Prescott, LICSW

The news across cities in the US has once again been horrifying. We, professionals, have found ourselves at our wits’ end trying to figure out what we might do. Watching the news is a harrowing experience. Ignoring it is irresponsible. While some details of each incident may be debatable, the overall trends couldn’t possibly be clearer. People of color have died under circumstances that are questionable at best (and this is an attempt to express it diplomatically). All of this comes against a backdrop since the start of the summer of documented, nationwide increases in anxiety, depression, substance use, and suicidal ideation. Why mention this topic in a blog that typically focuses on issues relevant to sexual violence prevention?

First, most of this blog’s readers have in one way or another made life as well as a living in trying to help build healthy lives and safer communities. For the most part, we all have skin in this game. Yet for all of our specialized efforts anxiety, depression, illness of all sorts, and overt violence – including overt racialized violence – are on the rise. We still don’t have a clear picture of what has been happening with family violence behind closed doors. Where will we want to focus our next efforts? With what resources?

I was recently on a call with colleagues discussing work with at-risk children and adolescents. The question arose about whether any kids in the current era are not at risk, given their exposure to so many horrific events. While, on average, kids from minority backgrounds and marginalized communities are at much higher risk for every kind of bad outcome, it is an interesting question. The challenge of how best to form connections with kids who have been abused was once front and center in our minds, but it may be more realistic now to ask whether we can possibly understand their current realities and emerging world view. How should we change our assessments and treatment in response to the gruesome realities of daily life in 2020?

It’s sad, but not unsurprising, that here at the end of the summer social media for professionals has been quiet on these issues. An earlier draft of this blog post shared with listservs for clinicians of various backgrounds prompted almost no response in some quarters, despite it specifically asking what readers were doing in response to these events. Certainly, there are questions about the boundaries of listserv discussions when the pandemic and our current community violence is so intertwined with politics, economics, and other topics that have been historically off-limits, often for good reason. On one listserv for solution-focused practitioners around the world, there was no response at all. On a US-based listserv for over 2,000 psychotherapists, there was only one response -- a reminder to vote in November.

Nonetheless, there is no way that this same silence goes unnoticed when those of us providing treatment don’t acknowledge the deep, life-altering anguish surrounding us in discussions with clients and co-workers. In just one example, a colleague related how an academic dean sent around an email in sympathy for those affected by Hurricane Laura and the wildfires but never mentioned the numerous instances of civil unrest or their tragic causes. Some professionals feel that it’s important to get the conditions just right before having discussions about race. Meanwhile, professionals of color observe that they have been waiting for centuries for those conditions to become “right.” Some professionals have correctly noted that participating in social media can present a high risk of being misunderstood. On the other hand, practitioners frequently participate in uncomfortable discussions about everything from the sensitive details of victimization to the nuances of sexuality; perhaps it’s time to work on our communication skills?

Further, it seems that all too often our discussions of trauma-informed care are easier when the trauma is clearly of someone else’s doing rather than our own. It’s easier to look at overt violence at an individual level than to look at cultural trauma boiling over -- a trauma that we may well have contributed to, whether actively or passively. Every now and then we discuss clinical approaches to clarification, reconciliation, and reunification for individuals on this list, and yet we’ve been absent from any discussions about how we might apply these ideas to ourselves in a larger social context.

What can we do?

Perhaps the most effective response we’ve heard in recent weeks was from programs in the Southeastern US, where the director asked for data to be reviewed. This involved data about the length of treatment, number of sessions, treatment outcomes, etc. To quote the director, “Across the board, we found that we were not practicing in an equitable way. Our clients of color were less successful, (had) longer lengths of treatment, (had) more disruptions in treatment . . . It initiated a process that we are in the middle of to make changes, with consultation from some folks that are much more astute about equitable systems, in creating a more equitable and culturally responsive practice.” In a subsequent private email exchange, this person emphasized that it was the staff members who had done the heavy lifting to make these changes possible.

In another case, the editorial board of a journal outside of our field engaged in a lengthy self-assessment process in order to completely revamp their procedures. Yet another set of circumstances prompted a lawyer involved in the field of therapeutic jurisprudence to describe how so much of her work had focused on justice with individual cases that she had to re-think how she views community responses to violence. Still, another described, with some grief, how she had changed her legal practice because she could no longer justify her practice in family law to herself.

At the front lines of our work, however, direct questions remain. For example, a young black man is arrested after a brief chase. In his assessment interview, he states that he does not trust people in authority. When asked for clarification, he says, “Just look at the news!” Where are the bounds of our judgment in describing his attitudes and/or behavior as “antisocial?” Where do objectivity and subjectivity begin and end under these circumstances? To what extent do we say that circumstances are “different in the current era” when the primary difference is the ease of access to a video recording? After all, the statistics and concerns have not actually changed much over the years, although the possibility of documenting violence has.

Clearly, addressing issues around race; the backdrop of violence, anxiety, fear; and in some cases suicidal ideation will require efforts at the individual and community levels (and by the community, we mean the full range that the word implies, from professional organizations such as ATSA to our society beyond). This will have to include deep soul-searching and difficult conversations as well as educational approaches, policy reviews, and the like.

As Martin Luther King, Jr., famously asked: “Where do we go from here? Chaos or community”?

Note: The individual communications noted in this blog are shared with the permission of those who communicated them.