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.