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.