Therapy to Prevent Abuse or Therapy as abuse?

By David S. Prescott, LICSW

Our recent blog on conversion therapy prompted lively discussions in social media.  While efforts around the world seek to end practices aimed at changing people’s sexual orientation, therapists working with individuals hoping to prevent further offending often use methods developed to help clients manage their sexual thoughts and urges. As we suggested in our earlier blog, it is important for professionals to consider the aims of the methods they use. Unfortunately, many laypersons only hear of these methods outside of the context in which treatment occurs. Research has long shown that the context of treatment matters. Used in the wrong context, treatment methods can cause harm. A scalpel that saves lives in surgery can become a murder weapon when used in a bar fight. Not all treatment contexts are alike.

The simple facts are: There are many people in the world who feel a sexual attraction to children but do not want to act on that interest. For them, many elements of daily life are challenging, and they often experience shame and self-hatred resulting from attractions they didn’t ask for and sometimes feel they cannot entirely control. Some of these individuals attempt to live as quietly as they can, while others seek out services, support groups, and other types of help. This has all been documented elsewhere and serves as the foundation to what follows. To be clear, however, sexual interest in children is not something that people ask for or a choice they make.  

While some degree of overlap in methods used in helping people manage sexual urges may also be employed in conversion therapy, there are substantial differences between programs that treat people with a sexual interest in children and conversion therapy as the world has come to understand it. One major difference is that behavioral treatments are only one component of a broader, a more comprehensive approach to helping people lead better, more self-determined lives.

The vast majority of programs treating individuals who have abused others regard their behavioral treatments as methods to help people to manage urges or fantasies that would lead to further harm to themselves or others if they acted on them. On the other hand, conversion therapy seems to hold out some kind of promise that the client will become a different person as a result of this treatment, viewing being gay as an accident to be cured, remedied, etc. It’s easy to write those words in a paragraph, but how they play out in the social context of the client and their alliance with the clinician can be quite another matter.

For example, the client who says, “Please can you help me. Even though I have some attraction to people my own age, I also have this strong desire for kids. I do not want to take the chance of hurting anyone. My thoughts about kids often interfere in my relationship with my girlfriend, which is already tenuous enough. I really want to do anything I can to manage these urges. Please can you help me?” In cases like this, where the client is asking freely and independently, there is the possibility that some of those methods may help, at least in the short term. Can we really compare that to the pain and suffering this video of this man who experienced conversion therapy as some kind of torture? And if there are things that might help, should we really put them off-limits? We’ll come back to that point.

Reading about the contexts in which conversion therapy has taken place can be horrifying. There are good reasons why these approaches, too often delivered intrusively and with prejudice and ignorance, are unethical in most places and illegal in many. But it’s not just the actual methods: They are often provided by people whose knowledge of sexuality harken back to a less enlightened era, and the professionals violate all the tenets of the therapeutic alliance. Further, they blithely ignore the principles of informed consent. These treatments are often unethical on their face in the ways that they run roughshod over clients’ autonomy and beneficence (central to the codes of ethics of all the helping professions).

All of this calls to mind some of the things that Thomas Szasz said in 1961: that therapy can only be ethical when the client comes to the therapist for help and is willing to pay out of their own pocket. His point (as someone who had fled then-communist Hungary) was that we should all watch out for the negative consequences that can occur when the state gets involved in providing treatment.  He might have added the family and societal pressures brought to bear on clients as well. We’ve written elsewhere on how these conflicts can be managed.

The techniques for helping clients manage their sexual behaviors are far less important than whether the treatment experiences:

·         are consistent with the client’s goals; goals that are personally meaningful and relevant, held strongly, and arrived at independently.

·         take place in an environment in which the client feels heard, understood and respected.

·         consider whether the client believes that the techniques of treatment are a good fit for him.

·         include informed consent for treatment that is reviewed frequently.

·         occur in context such that clients view the therapist’s role as that of a helping professional and fellow traveler.

One colleague expressed it like this: “I can’t change what people want; I can only help them to change how they behave around what they want.” Likewise, in describing Motivational Interviewing, Miller and Rollnick (2013) have said that, “Treatment is something we do for and with clients, not to and on them.” These two quotes embody the fundamental differences between legitimate treatments offered to individuals who have abused them and the more controversial conversion therapy that appears in the news and social media.

There are still reasons to be vigilant about implementing any kind of treatment under conditions where personal liberties hang in the balance. How consensual is the treatment when the informed consent was signed under the duress of being imprisoned longer? In addition, the therapist believes it’s important to use these methods. At the same time, the client is going along with the process in order to complete treatment even though they don’t want to. On the other hand, millions of us have signed consent for medical procedures that we didn’t want, that caused us pain and anguish, but that added many years to our lives. There are many, many nuances involved.

Ultimately, professionals have an obligation to consider all aspects of treatment that they deliver, including the context in which treatment occurs.

It’s not the cure, but the delivery system that matters: the importance of community

 

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

 

This has been a frustrating week for writing. With respect to developments in our field, it seemed as though the goalposts kept moving; the blog could have been on anything and nothing. As the week started, we were looking at recent reports (The Sun; Complex;  New York Times) about the reality of Pornhub was, despite their protestations, all is not happiness, smiles, sanitized sex, and sexuality; instead, there is a dark side. It wasn’t long before Pornhub took remedial action; we will have to wait to see the results.

Next, the blog was going to examine the unintended impact of new encrypted messaging policies and practices that can put children at risk for grooming and abuse (The Guardian; The Children’s Commissioner for England). This promised much to discuss. However, that debate has been moved down the agenda, in the UK at least, with increased discussions around Brexit and COVID-19. important messages and conversations are getting overshadowed. Stimied again! However, this is a topic that we will return to in the new year, as it highlights the balancing act between risk and safety in child protection with an evolving frame of online protection.

The third and final, blog that we were going to write is about the balancing act between internet filters and prevention messaging after Kieran attended a meeting that discussed whether the cost of implementing such tools was an appropriate and relevant investment. Interestingly, this meeting went round in circles and it was decided that more research and evidence was needed. All of this highlights and focuses the challenge of prevention: do we prevent and try to stop what might happen or do we respond to what is happening? This, in turn, feeds into larger debates and reflects previous blogs on this site, so it felt like retracing old ground.

Another day brought headlines reporting the first people in the UK–first in the world – outside of clinical trials to be vaccinated against COVID-19 with the Pfizer jab, which was great news! Interestingly, the news coverage throughout the day and ensuing discussions about evidence, effectiveness, patient safety, and rollout highlighted the lynchpin that brought all these potential blogs together. The real issue is not necessarily the vaccine itself, but the mechanism through which the vaccine is delivered. The biggest challenge is changing public minds, education, prevention, engagement, inclusion, and community building. All these same challenges confront us in the field of sexual abuse.

Like COVID-19, preventing sexual abuse means understanding and responding to it directly (and does not involve behaving as though it does not exist or will go away on its own). Also, like COVID-19, sexual abuse can be overwhelming, omnipresent, and presents challenges for individuals, communities, and society. This means (again like COVID-19) our response is often divided – even divisive – and results from a spectrum of belief and acceptance. Beneath this are considerations of people’s knowledge, understanding, trust in the system, belief in science, and hopes for the future. In many circumstances, we find ourselves at a stalemate: in recent years, the field of addressing sexual abuse has tried new approaches to tackle the issue, including prevention, reframing messages, groups of people reaching out to the public, and listening systematically to who people who have abused – and those who have been abused – have to say.

Each of these efforts has worked to a greater or lesser degree. We can see the same pattern, the same approaches, and the same frustration in these debates as we do in the rollout of the COVID-19 vaccine. The question then becomes, what now? Do we all need radical overhauls in our approaches? Is the answer to preventing sexual harm in doubling down on our current approaches and seeking out more evidence and opinion? Or is it a return to control and regulation? These are difficult questions with no obvious answers.

The one common element that arises in both the challenges around sexual abuse and COVID-19 – the element that ties together the threads of Pornhub, encryption, and filtering software is the community. Our communities. Sexual abuse is a community issue and therefore communities need to understand it better to respond to it more effectively and prevent its spread. Punishment and restriction do not stop sexual abuse. While such sanctions can help in some cases, awareness and support can do much more.

We are all members of our communities and society beyond, and together we shape the debates and actions that move us forward. Our greatest successes come when we work together, and our greatest failures happen when we resist new information and cooperative efforts. This is true across the board, from child protection to immunization. In many ways, especially in the political arena, our community is more fractured than ever before. While advances in accessing knowledge and resources have brought so much of the world together, they have also happened at the very times that many of us have become increasingly entrenched in our own echo chambers. If services to prevent abuse and rehabilitate those who have abused are the primary issues, then how do we respond? It seems safe to say that we need a new delivery mechanism and new ways to think about moving forward.

The challenge as we move in 2021 is how do we immunize ourselves against sexual abuse, the way that we are immunizing ourselves against COVID-19? And how do we immunize ourselves against both the panic and apathy that violence and the pandemic can bring? How do we get the “cure” out there (in COVID’s case, that means the Pfizer jab, and in sexual abuse, it is the education, knowledge, and understanding we need) in a more effective way? It is a challenge, but as a community, we can work together to solve it!

QAnon and the Hard Work of Preventing Sexual Abuse

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

 According to Wikipedia, “QAnon is a far-right conspiracy theory alleging that a cabal of Satan-worshipping pedophiles is running a global child sex-trafficking ring and plotting against US president Donald Trump, who is fighting the cabal. QAnon also commonly asserts that Trump is planning a day of reckoning known as the "Storm", when thousands of members of the cabal will be arrested. No part of the conspiracy claim is based in fact. QAnon supporters have accused many liberal Hollywood actors, Democratic politicians, and high-ranking government officials of being members of the cabal.”

As scientists, practitioners, and academics, the authors have continued to marvel at the fact that QAnon has gained so much traction. They command an audience in the absence of evidence and when there is so much evidence that they could turn to if their aim really were to prevent child abuse (and we have no evidence of that, either). This raises significant questions about the role and significance of research, evidence, and expert knowledge in the world currently.  Tom Hanks and Hillary Clinton and others may be a lot of things, but calling them pedophiles detracts from the very serious work that at organizations such as ATSA and Stop It Now! (to name only two) are involved in.

In a recent blog post, Marty Klein stated that QAnon is “replacing child protection groups – who should blame themselves.” This comes as a surprise to many organizations committed to preventing abuse, who have mostly read about QAnon in the headlines. To our knowledge neither interest in their work nor their support from charitable foundations and concerned individuals has changed very much. Marty Klein actually only mentions two organizations, Save the Children and the National Center for Missing and Exploited Children (NCMEC), about which he had blogged in 2017. His argument is that, in particular, NCMEC has created the very conditions that allow QAnon to thrive by what he refers to as its scare tactics and “used statistics in a cynical fashion—with concepts like “at risk for exploitation,” “potential victims,” and “children gone missing.” While we are not defending NCMEC (and they can defend themselves), we believe that not every prevention-oriented organization is the same, and that the vast majority do so ethically.

In another blog, Jeremy Malcolm of the Prostasia Foundation offers very different insights, beginning with a description of the evolution of the origins of many of QAnon’s statements and beliefs. Malcolm also takes issue with NCMEC, noting for instance, that “A NCMEC figure that QAnon sources commonly quote is that 800,000 children go missing each year. Less often acknowledged is that in over 99% of those cases the child returns safely, often within hours.” Malcolm’s blog for Prostasia also examines the panic around Satanic cult abuse (which many readers will remember) from the mid-1980s into the 1990s. In the end, when we visited to NCMEC’s website in preparing this blog, we did not turn up any wildly inflated facts, although its aims are clear. We have concluded that there are many points worth noted in these blog posts, and while we may differ in some key areas, we respect the authors’ work very much.

What can we take away from these passionate disagreements? While there is no shortage of overt disinformation in QAnon’s efforts, everyone in these debates appears to agree that the sexual victimization of children should be prevented. That might be a place to start.

 In our view:

·         It’s important to examine the evidence base in deciding what directions we take in any course of action. We need to make sure that people with deep knowledge of the issues are at the table and being listened to. This leads to the question of how we can best “reframe” or “relaunch” expertise in a way that captures the imagination of individuals who are more susceptible to conspiracy theories?

·         Conspiracy theories are not helpful in preventing abuse, especially when so much credible evidence about effective approaches already exist.

·         Accusing people of child abuse has a deep and long-lasting impact; even when the accusation is withdrawn afterward or no proof is being offered, the suggestion will linger for a long time and will remain a stain on someone’s reputation.

·         Groups like QAnon are making the work of preventing abuse more difficult for all of us through their spreading of information for which there is no evidence.

·         Individuals and groups that focus passionately in one specific area are at risk for not taking other perspectives into consideration.

·         Missing from many mainstream and social media accounts is that child abuse is preventable, that many people have developed and tested ways to prevent it, and that knowledge about prevention is there for the taking.

·         A fact that often goes missing in these debates, especially among organizations, is that ordinary individuals can play a powerful role in preventing abuse.

·         Ultimately, all people will be able to prevent abuse most effectively when they are in possession of high-quality knowledge and are willing to speak up and speak out about abuse prevention.

In the end, we need to reaffirm that sexual abuse is an individual, interpersonal, community and a societal level issue; which means that we all need work collectively to prevent sexual abuse and the existent of conspiracy theories undermines this collective working.

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.

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.

"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.

FEAR

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.

REALITY

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.

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.  

         

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? 

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.

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.

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.