Thursday, September 16, 2021

Child Sexual Abuse in religious organisations: A moral juxtaposition that needs addressing!

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

Recently in the UK the Independent Inquiry into Child Sexual Abuse (IICSA) published a report, as part of its mandate, on the extent and impact of Child Sexual Abuse (CSA) within religious organizations. Unfortunately, the report indicated that child sexual abuse was often commonplace, underreported, and that the organizations defended (or at least did not condemn or remove) the person committing the abuse. Further, they found that these organisations did not support those who had been victimized. While this is very troubling, it is not uncommon either in terms of abuse within religious organizations or organisations per se; we have seen this internationally (with a similar story being published in Belgium this week and in the Netherlands last year). These revelations raise the question: why we have not moved further forward in responding to and preventing sexual abuse in organisations?

When thinking about writing this blog, the authors toyed with what was the most significant thing to focus on. As we’ve noted, religious organisations failing those have been sexually victimized is not news. This in turn leads to further questions about safeguarding, disclosures, prosecutions, treatment, and reintegration. Even then, it feels as though we are rewriting previous blogs!! Then, the authors came across a quote from Professor Alexis Jay, chair of the inquiry:


"Religious organisations are defined by their moral purpose of teaching right from wrong and protection of the innocent and the vulnerable. However, when we heard about shocking failures to prevent and respond to child sexual abuse across almost all major religions, it became clear many are operating in direct conflict with this mission. Blaming the victims, fears of reputational damage and discouraging external reporting are some of the barriers victims and survivors face, as well as clear indicators of religious organisations prioritising their own reputations above all else. For many, these barriers have been too difficult to overcome."


Indeed, a recent Dutch study into child sexual abuse within the community of Jehovah’s witnesses emphasizes Prof. Jay’s statement. In 2019, 751 people reported to an anonymous hotline set up by Dutch researchers for (alleged) victims or people who have knowledge of abuse within this community. Three quarters of the victims find the handling of their report within the community by the Jehovah’s community inadequate. Many of these alleged victims stated that the Jehovah’s Witnesses are mainly guided by the biblical principle that they should not take a brother to court. And this is not only a dynamic that we observe in their community; despite all high-profile cases of child sexual abuse in the church of the past few years, it is still far too common to sweep these issues under the rug.

This is significant and important to unpack, as CSA (and any abuse for that matter) is anathema to the role, function, and mission of religious organizations. Without getting too philosophical about the role and function of religion in modern society, the mandate of all – especially mainstream religions – is to provide a sense of moral direction within a shared community where followers are respected, supported, and able to live their lives with a sense of common purpose and compassion.

All major religions have compassion at their centre. This includes understanding and working together to support the most vulnerable in society. The roots of community and religion are often intertwined. This makes sexual abuse within religious communities (especially within religious communities that work to downplay it or dismiss it) even more worrying, since in turning a blind eye to abuse they are going against these core values and shared ideals. Saying that religious organizations are flawed when it comes to child sexual abuse is significant: the message is that it’s not just the organisation and processes that are flawed, but that the underlying belief system is as well. Therefore, these organizations are on the horns of a dilemma: They wish to appear compassionate, and they wish to protect their reputation and often that of the accused. It seems that with each passing day, it becomes less tenable to try to do both, and those who have been harmed are not letting them off the hook.

The challenge for religious organisations is how to acknowledge and respond to claims of CSA, as the “blame it on a few bad apples” approach no longer holds water given the volume, nature, and scope of CSA within religious organizations and they’re at-best lacklustre response to it. The moral paradox of CSA for religion is that they should be supporting the least valued and vulnerable in society and not the people harming them. They should be welcoming and supportive of victims of CSA and not of the people committing CSA. While religious organizations should promote forgiveness and redemption this should only take place after acknowledgement, acceptance, and accountability have taken place. Restoration should be a cornerstone of responding to CSA but only after recognition. Until then, those who have been harmed can neither forgive nor forget.

Religious organizations need to consider their responses to CSA not only from process and policy perspectives, but also from a moral and philosophical level. How does CSA resonate with their spiritual and beliefs, and how does that translate into their social norms and behaviors? Although we’ve blogged about so many of these issues before, it behooves all of us to keep the discussion and information flowing if no fundamental changes are being observed.

Friday, September 10, 2021

Putting New Practices into Place: What Gets in Our Way?

By David S. Prescott, LICSW

A woman who attended a workshop I gave in the mid-2000s contacted me this summer looking for more information. I was astonished not so much by the number of years that I had passed, but by the circumstances. The training was part of efforts to implement motivational interviewing (MI) in the institution where I worked. After leaving my position, one of the staff apparently asked that they be allowed to revert to their erstwhile and less-motivational approaches now that I was gone. Following my departure, another administrator’s campaign to have all staff focus on becoming kinder towards the clients was also reportedly controversial. Several years later, approaches focusing on strengths and motivation had become the norm in this and most other institutions of its kind.

As much as I would love to say that I was ahead of my time and ahead of the curve, I wasn’t. By this time, MI had been the subject of hundreds of randomized controlled trials and several meta-analyses. The truth is that implementing any best practice takes time and teamwork. As just one example, Dean Fixsen and his colleagues have emphasized that implementing any human-service practice can take years. More recently, in a study of Feedback-Informed Treatment (FIT) by Heidi Brattland and her colleagues in Norway found that implementation efforts took two years to bear fruit.

From the author’s perspective, several things are important to keep in mind. First, we often hold onto the myth of the guru. In this myth, there is a guru whose training one must have in order to be considered an expert (sometimes referred to as “one and done” training). While having an expert come in to train is always a good idea, programs and practitioners often seem to neglect the importance of having ongoing consultation to ensure that what was taught is actually being implemented and practiced. As a part of this, it’s easy to overlook the importance of building up the internal “champions” who will carry the implementation efforts forward within each agency after the guru goes home. As an ATSA member once quipped, “An expert is an out-of-towner with slides.”

Why is this so important? In the author’s opinion, it’s not just about the mechanics of implementing best practices, but about the mentality. When implementing any model, method, or approach, agencies have an opportunity to build up the professionals in their employ. This attention to local ownership of models and methods can help build professional longevity and reduce turnover as well as improving services, and yet it is easy to miss. Even more important is to keep in mind that putting new practices into place simply takes time and work. For this reason, it’s vital to build in some self-compassion along the way. Implementing new approaches often not only upsets the apple cart of historical treatment methods employed but can cause personal and interpersonal challenges as well. For example, the person who has always been in a position of implicit power within an agency may find their influence diminished with agency-wide attempts to master new approaches.

In recent discussions with colleagues, three less obvious barriers to implementation have also become apparent. They are worth mentioning so that those seeking to innovate might be better prepared for pushback:

The first is the belief that “We already do this.” Many people who receive introductory information about new approaches form premature judgments about it. In particular, they may take note of the elements that seem most familiar (for example, that many skills in MI, FIT, or the good lives model [GLM] can be found elsewhere) and arrive at the conclusion that they are already proficient at implementing the method. Sadly, it is sometimes difficult for people to dissuade themselves of this notion. It can come in the form of, “I’ve already gotten training on this kind of thing.” By this time, extra work can be required for the person to learn what is new, different, or unfamiliar about the approach.

The next is the belief that “This is easy.” It is indeed easy to read a paper or even a book and assume one can quickly develop expertise in a given method, model, or approach. In order to prevent this, training is most effective with the trainer reminds trainees to suspend their beliefs or disbeliefs until they understand the entire model and how its components interrelate. Further, the most effective way to learn a new approach is with guidance, supervision, and coaching. Receiving feedback on one’s practice is one of the most effective ways to improve one’s performance.

Finally, there is the response that, “We’ve seen these new models come and go.” This can also take the form of, “We tried that and it didn’t work.” Again, this is where the truth became inconvenient: it takes time and effort to implement new practices. Very often, the best antidote is for the person who is learning the new approach to either experience it for themselves (for example, to engage in a motivational dialog with a skilled practitioner) or to apply it within their own life (for example, understanding how the GLM might apply to their own behaviors).

Fixsen’s work reminds us that for every approach one tries to implement it’s important to let go of two other approaches that are no longer serving the program or practitioner. Ultimately, however, we can all be at our best when we let go of everything else and simply seek to become the most effective practitioner we can be; one skill at a time and one client at a time.

Note: The author is grateful to many colleagues who contributed ideas to this blog post, including Gwenda Willis, Christine Friestad, and Ingeborg Sandbukt Jenssen.




Friday, September 3, 2021

Under attack on Twitter: How gruesome tweets can highlight the importance of our language

By Kasia Uzieblo, Ph.D.

I have an ambivalent attitude toward Twitter. I find it primarily a platform for individuals who have an opinion on really anything and feel it necessary for everyone to know about it, as well as for individuals who find even just about every thought that passes through their brain cells of such value that it must be shared with the world. And then you have those with both opinions and thoughts. At the same time, I can also lose myself in Twitter. I like to scroll through it just to have a chuckle with or to willingly get all stressed out by all those stories, opinions, and thoughts of others. But usually, it all just goes too fast for me – I’m getting older after all – and therefore I try to limit my Twitter use by mainly reading or posting work-related things. What I am also sometimes guilty of is shameless self-promotion by, for example, announcing my upcoming presentations on Twitter, hoping that someone might be interested, whilst ignoring the sobering number of likes and retweets of the past. But last Friday it finally happened. I couldn’t believe my eyes; I have never seen such a high number flashing red on my Twitter-icon. A few seconds later, I regretted that my narcissistically driven curiosity had urged me to open the Twitter app.

My tweet on our IATSO session on help-seeking behaviour in minor-attracted persons was indeed a hit, but not in the way I hoped for. My tweet was under attack, I myself was under attack. I want to spare you the worst ones, but this tweet kind of sums it all up. A Machinegun for Every Child[1] tweeted: “I’m perfectly willing to accept that pedophiles have no control over what they are attracted to and thus need help. But referring to pedos as ‘minor-attracted persons’ is a good way to ensure pedophilia is normalized and anyone using the phrase should be regarded as a threat.” [2] Many wanted to kill all “pedos”, some wanted to kill me. A few even found the missing link between me, “pedos” and the Taliban. It didn’t stop for days; it was pouring shocking reactions and retweets until I finally found that ‘block’ button.

At first, I reacted indignantly and almost smugly. What do these people know? How short-sided are they? But when the initial emotions subsided, I took a moment to reflect on this. What does this all mean? Most of the tweets strongly questioned the term “Minor-Attracted Person (MAP)” and wanted me to call these people “pedophiles” or other variations of this spelling. Some even wanted to “help” me out with spelling. “The word you’re looking for is “pedophile”. I’m glad to be of help”, one tweeted. So, it made me wonder, why are so many struggling with the term MAP? Why does it evoke so much resistance even when it refers to a similar concept? Shouldn’t it be applauded that we have succeeded in finding 1 term for this heterogeneous group of people with sexual interests in minors? The tweeters, some of them also refer to their own victimhood, made it clear: The term MAP doesn’t feel negative enough, it doesn’t feel accusatory enough, “Minor-attracted persons” is a far too fancy word for “these people” … I wasn’t really shocked by the assessment that pedophilia was equated with child sexual abuse. But the great need in so many to use “pedophilia” for people with sexual interests did take me back, emphasizing the importance of the language we use.

In recent years, we – both researchers and professionals in the field – have paid a great deal of attention to the language we use for our patients and clients. First-person language for example, has become more and more ingrained in our speaking and writing about persons who have committed sexual offenses as well as for those who exhibit sexual interests in minors. We changed our language to diminish the negative effects of our language on those who have committed horrific crimes, to ensure they feel acknowledged as a human being. Maybe our use of first-person language is also a way for us to cope with all the horrific stories we are confronted with; it enables us to see the human being beyond their deviant interests, beyond their crimes. But the public is clearly struggling with our language. Maybe their language should also be considered to cope with sexual offenses and their fear for possible future offences by people exhibiting such interests. Changing terminology, changing perspectives clearly takes time. It took decades to change our language within psychiatry: we have moved from “this is an autistic man” to “this a man with autistic characteristics”. And even in that context, many continue to use labeling terms.

This experience also emphasizes how difficult it must be to seek help when you are indeed struggling with your sexual interests and/or with your behaviours. Coming out could mean losing everything and everyone; for some it could even mean a death sentence, as was graphically illustrated in several tweets. When trying to promote preventive measures for people who have committed (sexual) violence in Belgium, there is always someone in the audience (often professionals and students) who states: “Yes, but sexual predators do not feel the need to seek help.” Or “Pedophiles enjoy it and do not want to be helped.” The coordinator of a Belgian anonymous helpline for the prevention of violence that targets victims, bystanders and those committing violent acts, recently told me he was very surprised that they barely receive phone calls from the latter group. But is it really that surprising that their request for help remains so under the radar, if we, including professionals, media, and policymakers, use terms like “perpetrator”, “offender”, “predator”, “pedo”...?

Change takes time. Will we ever succeed in finding terminology that will appease all? Probably not. But we should keep on explaining to our colleagues, to media, and policymakers how crucial our language is, if we want to reach people exhibiting such interests and/or behaviours. In any case, these confronting encounters on social media should not stop us from moving the field onward. It will not stop me. I’m looking forward to posting my tweet on our ATSA-session on help-seeking behavior, especially now I know that there is a block button.

[1] I’m not making this up.

[2] Writing errors were deliberately not corrected. 

Wednesday, August 25, 2021

Digital Godsend or Curse? Apple’s New CSEM Measures and the latest chapter in Privacy/Protection Debate.

By Alex Rodrigues, PsyD

Recently, the tech juggernaut Apple garnered considerable attention after announcing new steps to combat child sexual exploitation material (CSEM) or child pornography.  The company declared it would take more decisive actions to counter the proliferation and sharing of child sexual abuse content.  More specifically, the company plans to launch protections with the Messages and iCloud Photo apps as part of routine software updates scheduled later this year.

For many, Apple’s announcement was long overdue.  In 2020, the National Center for Missing and Exploited Children (NCMEC) received over 21.7 million reports of suspected online child pornography in the U.S. (This process will be detailed more below). Compared to other companies like Google and Facebook, Apple has initiated far fewer NCMEC CyberTips or referrals for suspected CSEM.  However, Apple’s announcement was also met with concern from privacy advocates. While no one was championing the rights of CSEM producers, privacy experts were alarmed about the unprecedented steps the company was taking, the threat such measures posed to personal privacy, and how these new tools could cause more harm than good.

Before diving into the privacy/protection debate currently encompassing Apple, one needs to understand how most Internet CSEM is identified and NCMEC's role.  NCMEC is responsible for much of the initial work in a child pornography investigation.  The organization serves as a clearinghouse for child pornography investigations. It has a massive database of known CSEM images and videos.  Typically, the investigation process starts when a tech company or electronic service provider (ESP) identifies CSEM on its platform and refers the case to NCMEC.  For instance, someone may attach CSEM to a Google email or upload child abuse content to his Dropbox account. Tech platforms identify such content as part of routine monitoring.  They then refer the matter to NCMEC with a CyberTip, containing information about the suspected offender, including email and internet protocol (IP) address.

Next, NCMEC reviews the media in question.  CSEM content is identified, like all digital media, by its hash value, a string of numbers specific to that image or video. The hash value serves as a digital fingerprint.  Technically, the database is ignorant of the actual image depicted and is only looking for a pre-identified number series.  NCMEC checks the image’s hash value against its database of recognized CSEM and associated hash values. With the assistance of geolocation technology, NCMEC can help identify where the content was uploaded and notify local law enforcement, which then assumes control of the investigation.

While the technology and referral process outlined above has been around for some time, Apple’s new approach differs. The search for CSEM will occur at the individual phone user’s level.  Supporters argue this approach will combat CSEM earlier, or “upstream.” The company recently reported, “Instead of scanning images in the cloud, the system performs on-device matching using a database of known CSAM image hashes provided by NCMEC and other child safety organizations” (, 2021).  A hit, or match for CSAM hashes, will result in a “safety voucher” being produced.  Safety vouchers condense and encode information of the suspected CSEM.  If the specified number of safety vouchers is met, the information will be decoded and reviewed by an actual person.  

At this point, I suspect most tech neophytes are feeling overwhelmed by all the heavy jargon use.  So, let’s use the traditional mail system, or “snail-mail,” to understand the process better.  Imagine that your mailbox represents Apple and individual mail envelopes represent suspected CSEM.  Whenever an image with known-CSEM hashes is found, it is packed into an envelope and placed into your mailbox. Now, obviously, you can't physically see into the sealed envelope and identify its contents, similar to how someone cannot initially see the encoded contents of an Apple safety voucher.  Also, you're not permitted to open that envelope of possible child pornography until your mailbox is packed with similar envelopes of suspected CSEM.  Once the threshold is reached, in Apple’s case, the number is 30 safety vouches; you are then allowed to unseal all those stockpiled envelopes and investigate their content.  For Apple, the encoded information in a safety voucher cannot be decrypted and read until enough other safety vouchers are collected.  This threshold limit minimizes the risk of false positives.

Only those photos uploaded to iCloud will be subject to review. Apple users can opt-out of this process by disabling iCloud Photos, and the system does not search for non-marked images involving children.  For instance, a parent who takes a picture of her child bathing will not be flagged for CSEM.  That personal family photo's hash value will not match those already identified by NCMEC as CSEM. 

Many see such technology as a welcomed tool in the fight against child sexual exploitation. However, privacy advocates worry that nefarious actors may use the technology for ill intent.  Hypothetical examples include governments utilizing the tool to identify images other than CSEM.  Imagine if a regime hostile to homosexuals decided to create a database of supposed gay-related pictures to identify LGBTQ individuals.  Again, the software is indifferent to the actual content depicted and only focuses on identifying specific hash values.  Nothing stops a country from developing a database like NCMEC’s compiled of only “gay” images.  Another example includes the Chinese government employing such technology to identify Muslim Uighurs.  Presently, the only thing preventing countries from using Apple's technology in such manners is the company's promise to prohibit such uses.  However, critics question whether Apple can maintain prohibitions in the face of economic pressure and the threat of being ousted from a country for noncompliance.

The debate surrounding Apple's new child safety protocols highlights the delicate balance between protecting children and safeguarding privacy.  It's also a precursor for what will likely be many future complex discussions involving these noble, but sometimes competing, interests.  Various sources have done excellent work covering this evolving situation. Popular websites like Tech Crunch and Technology Review.  Additionally, the details outlining the new technology are listed on Apple’s website.

Friday, August 20, 2021

Community, no unity? How do we build it!

By Kieran McCartan, PhD, Kasia Uzieblo, PhD, & David Prescott, LICSW

The last week has been a challenging week on the local (a shooting in Plymouth England by someone identified to have incel beliefs) and on the global stage (the return of the Taliban in Afghanistan) with sex and sexuality at the centre of both stories. You may wonder what links these two stories, both from opposite ends of research and practice in our field? The incel story is a conversation about mental health and risk management. It is a conversation about whether being an incel is a cognitive bias, a mental illness or simply a series of problematic attitudes and beliefs. It is a conversation about attitudes towards women and girls from a select subgroup of individuals in our society and what we can do to prevent violence and promote a proper understanding of and commitment to healthy and equal men-women relationships. But interestingly the Taliban story is the same story but from a meta perspective; it is a story of how a larger and more defined, and co-ordinated, group of people have problematic and antisocial attitudes to women and girls that promotes intolerance, bias, and violence. In both cases, the incel and Taliban story, the underlying current is that females are the problem and that violence and anti-social behaviour towards them is acceptable and justifiable. Both these stories remind us that the context in which we live matters, whether it’s the sub-group that we are part of, the country where we live, or our broader human values – the idea that violence towards women and girls is acceptable although? It is fundamentally wrong but seems to exist globally.

As a global community we have developed policies and laws that aim to reflect our attitudes and beliefs. Attitudes and beliefs that were developed in westernised, northern hemisphere countries and then challenged and adapted by the rest of the world. These laws, policies, and guidelines reflect the need for justice, equality, equity, and standards of living across the world. The recognition that all these shared values and beliefs are not balanced internationally with some countries adhering to some and not to others resulted in the creation of the “Sustainable Development Goals” (SDG’s) by the UN. The expectation is that to be recognised by the UN, and to play an active role within it, you must adhere to these 17 development goals, The SDG’s impact countries and people directly as well as indirectly, through international sanctions and trade agreements through to altering national laws so that they reflect them. Some of the SDG’s talk directly to the field of sexual abuse than others, these are:

-              Good health and wellbeing

-              Equal access to quality education

-              Gender equality

-              Reduced inequalities

-              Peace, justice, and strong institutions

These SDG’s reinforce the need for access to health, wellbeing, and mental health services as preventive as well as responsive requirement in dealing with sexual abuse for both victims and people convicted of a sexual offence. These SDG’s also talk about the importance of balanced, informed, and evidence-based education for all regardless of geographic location or gender. Access to education can change attitudes and challenge anti-social and problematic behaviour. In addition, access to education can increase the prevention of sexual abuse by increased awareness and help in the integration of people impacted by sexual abuse through greater understanding of the aetiology as well as impact. Also, increased access to justice means that societies become more trusting of the state and that people are more likely to report sexual abuse, and ultimately more likely to get the help and support they need.

However, it would be naive to think that these changes will happen overnight. On the contrary, our (recent) history shows that it is more like a process of Echternach where you take two steps forward and then one step back. Take for instance the situation in Poland: Although Polish women have gained many rights over the past decades, the current ruling party has managed to trample women’s rights in the past few months without too much resistance from the UN or Europe, except for some critical tweets and threatening language from political leaders. This shows that the SDG’s cannot be taken for granted, even not in the westernized part of the world. The questions it also evokes is whether we are sufficiently prepared to fight for this? Are we prepared to take on this seemingly never-ending struggle? Do we remain vigilant, or do we let it take its course and turn our heads the other way? Will we only call out our concerns on social media and change our Facebook profiles in support of disadvantaged groups in our society or do we take actual and effective actions?

The two stories highlighted in this blog really reinforce that across the socio-ecological model (i.e., the incel story is particularly reflective of the individual and interrelationship stages and the Taliban story more reflective of the community and societal stages) more work needs to be done to strengthen our shared global values (the SDG’s) and that no part of society or corner of the world is immune from distorted attitudes and beliefs towards women. We need an individual and global assertive response and perseverance.

Friday, August 6, 2021

ATSA’s Commitment to Addressing Race, Power and Privilege (RPP) – Where are We Now?

By Judith Zatkin and Joan Tabachnick 

In 2018, the Board of Directors of ATSA made a deep commitment to addressing the issue of race, power, and privilege.  In their public statement, the board formally “recognized that race and privilege impact ATSA’s work and the work of ATSA members.  Furthermore, the board voted to ensure that ATSA commits to incorporate privilege and race issues into all of its strategic goals.”  

This statement came through the work of ATSA’s Prevention Committee and followed a survey which found that:

- 87% of respondents agreed that issues of RPP had an impact on perpetration, survivor’s healing process, and prevention.  

- just over three quarters (76%) agreed that ATSA should address RPP.  

Since this initial statement, each of ATSA’s committees also made a commitment to look at how RPP affect their mission and its’ implementation.    

Over the last two+ years, the Prevention Committee workgroup met weekly and through our work, conducted more than one survey, developed a series of infographics based on what we heard to be disseminated through social media, hosted a conversation at last year’s ATSA conference, and most recently, hosted a series of six meetings with board members/representatives from each of ATSA’s committees to ensure that each committee has begun to incorporate these issues (race, power, and privilege) into all of their committee work.  

The six sessions developed by ATSA’s Prevention workgroup on RPP and attended by the representation of ATSA’s broad array of Committees provided a strong foundation for incorporating RPP throughout ATSA.  We were happily surprised that most of ATSA’s committees had followed the board’s stated commitment and hosted a number of serious conversations about the impact of RPP on their particular area of expertise.   Much of the conversation was captured through an artist’s rendering of the discussion.  It was helpful to vividly see the challenges and the opportunities organized and laid out for us as we walked through the discussions.  It highlighted how we have to step up to the challenge of what language we want to use, how to address the concerns that we have heard from some members about this new direction, and we began to consider how our organization could be more inclusive and encourage a broader range of representation.  Some key concepts for organizational change were also discussed, bringing in concepts of how to overcome barriers to uncomfortable conversations and rather than talking about “safe spaces” to use the concept of “brave spaces.”  For us on the Prevention Committee, it was also exciting to think about how over ten years ago, the ATSA board made a commitment to integrate prevention into all of ATSA and we have done just that around prevention.  The board is now poised to do a similar initiative and commitment around ATSA’s response to the issues of race, power, and privilege.  

These six sessions began that deeper commitment.  Through these six sessions, the Committees shared a deep commitment to this organizational change and offered many ideas and suggestions for ATSA’s next steps, and voiced a strong consensus that the ATSA Board of Directors needs to take a role in this process in a sustainable, specific, and permanent way.  A proposal will be presented to the ATSA Board of Directors meeting in August with the specific request of creating a limited time, board led the working group that will: 

- Develop Pillars/Guidelines of RPP for ATSA.  These Pillars/Guidelines will establish a clear direction for ATSA and ATSA committees as we integrate RPP into the work we do.  

- Identify and bring forward the language and clear definitions that will be used.

- Offer specific recommendations for the next steps based upon the ideas shared to date.   

- Offer specific recommendations for the ideal structure moving this integration of RPP into ATSA.

- Ensure diverse representation (including international voices) on the final BOD Working Group

We hope that from this next ATSA board meeting, we will create a time-limited working group to address this list of tasks.  We are so thankful for the commitment of ATSA to addressing these issues in our work.  We would like to acknowledge the ATSA members who have been meeting weekly for the last few years to make this happen.  In addition to the authors of this article, we want to acknowledge a fantastic group of individuals including Charles Flinton, Tyffani Dent, Ariel Berman, Jannine Hebert, Joan Tabachnick, Maia Christopher, and Aniss Benelmouffok.  

For more information about the infographics and what ATSA has done to date, go to  

Wednesday, July 28, 2021

Risk of what?

By David S. Prescott, LICSW, and Kieran McCartan, Ph.D.

In a recent discussion of assessment measures, an ATSA member referred to an instrument saying in essence, “Don’t forget that it is not a risk assessment instrument; it assesses areas of risk.” Among professionals who conduct risk assessments across diverse settings, this sentence actually makes perfect sense. Translation: While the instrument helps assess risk factors as part of a broader assessment process, it does not provide a total picture of the specific risk for a specific risk outcome (for example, “individuals with Mr. X’s score have been found to re-offend at a rate of Y over Z number of years”). It is not simply an academic discussion; different assessment instruments are designed for very different purposes, ranging from estimations of the likelihood for re-offense to case formulation and planning. Static-99r is an excellent choice for the former but might not be as helpful in many aspects of case formulation. On the other hand, some measures can aid case planning but lack the empirical support of Static-99r for arriving at a baseline.

Assessing risk has eternally been an area of great importance in our field, and rightfully so: How can we design empirically grounded programs without some idea of what kinds of risk, a person poses and what level of intervention they require? On the other hand, we often benefit from taking a step back and reflecting on how we conceptualize “risk.”

 A quick Google search on “definition of risk” yields a top result of “expose (someone or something valued) to danger, harm, or loss” as in, "He risked his life to save his dog." Right away, there is a question within “risk assessment” of whether we are trying to understand the danger, the exposure to danger, or the likelihood of the worst outcome. One could argue we each conduct a risk assessment each time we cross a busy street.

These questions, in turn, provide more opportunities for reflection. It is not uncommon to hear the expression “risk prediction” which begs the question of whether the professional is assessing, predicting, or some combination. Assessment and prediction are not the same things. If they are predicting, are they trying to predict re-offense itself or simply the exposure to danger or harm described above. Are we trying to predict what circumstances will be in place in the future? Or are we saying “prediction” when we are actually examining historical risk factors that might become present in the future? When we say “risk assessment” do we mean assessing risk itself or the circumstances under which risk would become unmanageable? Should we clarify this in our reports?

In the context of civil commitment “risk” is defined in the statutes that give rise to the assessment itself. In other circumstances, risk assessment may be a broader term covering many areas, which professionals use because it is so common. For example, “risk assessment” in the juvenile world often indicates a more comprehensive process that encompasses the identification of treatment needs and strategies for producing the best outcomes.

Further questions remain, such as the risk for what? Often, risk assessments consider some areas but not others. Assessors sometimes focus on specific areas, such as the risk for violence and general criminality, as well as for sexual re-offending. All too often, the same reports are silent on the possible risks of self-harm, suicide, or simply not living up to one’s full potential (which is often the highest risk of all). While we often talk about victim access in general, we seldom reflect on what risks might exist for those who have been harmed. Unfortunately, this area can be far less clearly defined in our referral questions.

Strikingly absent in many discussions of risk assessment are considerations regarding risks to the health and welfare of those who have been abused.  Few of our processes (and the actions of the criminal justice systems beyond) were designed to calculate how assessment or treatment can aid those who have been harmed, including by involving them or leaving them alone. Mistakes in this domain of our work only seem to create new risks of harm to others.

It also behooves us to consider the fundamental purpose of understanding risk. Clearly, it should enable rehabilitation and safe community integration. It’s also about management and incapacitating truly high-risk cases. One challenge in risk assessment is the perennial question of who manages the different risks? Is it the professional’s job to manage and be responsible for the individual’s risks? Or specific risks? Or is it the client’s responsibility to manage their own risk? Or specific risks? Or is it somewhere between the two?

These can be difficult conversations, as risk changes depending on the context and the place that the person is at in their rehabilitation. Central to the process can be helping the client to identify and manage risk(s). Of course, not every client is ready, willing, or able to do that. Ultimately, risk assessment creates a space in time to understand the context of that individual, which is why it’s an ongoing process, frequently redone and refined.  No one can fully predict future offending. We can only make our best judgments based upon the existing data and using the most appropriate research.

While some of these reflections may mystify some and be crystal clear to others (and there are many more considerations that we can’t discuss within the space limitations of a blog post), we have to acknowledge that with the explosive growth in our understanding of risk and risk assessment across the past thirty-plus years, our answers continue to pose new questions. For our communications, however, the very idea of risk itself may be in danger of being clearer in our minds than in our reports.

Friday, July 16, 2021

Do high risk offenders remain high risk forever, or do we just want them to be?

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

NOTE: It is important to state that the authors have no more information on the risk posed by Colin Pitchfork than has been released into the public domain. The aim of this blog is not to challenge or validate any decisions that have been made, rather to debate the question of change and, ultimately desistence, in high-risk individuals – Kieran

Earlier this week it was announced that Colin Pitchfork, one of the UK’s most notorious child killers would be released from prison back into the community after the parole board stated that it was safe to return him to the community. As well as killing his victims, Pitchfork also sexually assaulted and raped them. At the time of his offence and conviction his case made national headlines, which has not abated during his time in the prison system and all his parole hearings as well as appeals. The Pitchfork case presents a challenge between evidence, practices, public opinion, and “politics” and in doing so reminds us of the mantra, and challenge laid down by Karl Hanson that not all high-risk offenders will always remain high risk.

The balancing act in the pitchfork case is multi-layered and complicated, involving the nature of his offence, the public and political reaction, media commentary, trust in the state to manage people after their release and a fundamental question of whether we believe that people can change. To start to understand the complexity we need to pick apart the social, political, and cultural dimensions that surround the case.

The offence: Colin Pitchfork raped and murdered two schoolgirls in the 1980s in Leicester England. They where Lynda Mann and Dawn Ashworth, both 15, in 1983 and 1986 respectively. The offences while harrowing, are particularly salient given the nature of the crimes and victims. These events have provoked public and political reactions, creating, and reinforcing stereotypes and misperceptions about the reality of these offences as well as the people who perpetrate them. One reason that this case made national headlines was that Pitchfork was the first person in the UK to be convicted, in 1988, by use of DNA evidence. At the time of conviction, he was sentenced to two life sentences, 30 years in the UK, to be executed simultaneously, which meant that it was initially due for release in 2018.

Public and political reaction: Given the nature of the crime and the conditions of the conviction, and international media coverage at the time, Pitchfork’s case was in the public and political interest. This resulted in many consecutive Secretaries of State becoming involved, right up to and including the current one. Currently, the Ministry of Justice and Robert Buckland, MP, has come out and said that they are disappointed by Pitchfork’s release and are considering a root and branch review of the parole board and their decision-making processes. This adds complexity to the case; it reinforces public concerns (that can often be laden with misconceptions) and calls into question professional standards and decision-making processes. It begs the question of whether high profile offenders should, could, and are being treated differently than other offenders because of the reaction that their release creates. 

Media commentary: The media’s close attention to the case often highlighted the salacious nature of Pitchfork’s offending behaviour, especially at key points in the trial, sentencing, and previous attempts at release. The media have often reinforced the public and political view that pitchfork is a constant and unrelenting threat, and therefore he should not be released. No counterpoint has examined the legitimacy of the potential risk management plans, the risk assessment, or the expertise of the professionals responsible for these decisions. The media often state that they are following and discussing the story because it’s in the public interest. The real question, however, is whether they are framing the story in a way that is in the public interest.

Practice and evidence base: The extant research and practice evidence bases highlight that people can and do change, especially over the course of many decades and as they age. They very often desist from further crime and community as well as social support often help in this. This knowledge base includes not only people who have committed sexual offences and murders but also other people who have committed serious offences that have resulted in life sentences. The reality is that Pitchfork was given a life sentence (i.e., 30 years) and not a whole life tariff (i.e., that he would die in prison). Therefore, there has always been the expectation that he would be moving towards release and community integration at some point. We can see through his time in prison that this was the objective, especially given the treatment and rehabilitation programs that he attended as well as the fact that was moved to an open prison towards the end of his sentence. Additionally, Pitchfork has had an extensive and restrictive risk management plan developed as part of his release, highlighting the centrality of community safeguarding and public protection in his release from prison. All of this raises the question of whether the real issue is whether the sentence, tariff, and process are not what the public, media, and politicians wanted. After all, the prison service and parole board’s methods are obliged to be in line with the evidence base.

The Colin Pitchfork case creates more questions than it answers. It begs the question of whether the public, political, and media reactions are based on the nature of the crime and the perceived nature of punishment required. Looking at the evidence base, HMPPS and the parole board have delivered what they were meant to and that they have worked towards. If society at large is not happy with that, then the question needs to be asked if it is more that they are not happy with the sentence, tariff, or processes involved rather than what has currently been delivered. Therefore, we need to reflect upon the public and political perceptions of punishment, rehabilitation, risk assessment, and risk management versus the evidence-based reality of practice in this area. How do we bring perception and reality closer together? How do we create an informed, evidenced understanding of the challenges and processes involved in successful (risk) management of high-profile cases?  



Friday, July 9, 2021

An Update on ATSA’s Efforts with Sexual Misconduct on Campuses

 By Judith Zatkin & Joan Tabachnick

Recently, the White House requested comments and feedback on new Title IX regulations released in August of last year, regarding campus sexual harassment and assault.  With the previous administration, there were a number of changes that many colleges and individuals strongly objected to.  In fact, there were over 130,000 comments submitted, mostly voicing their concerns and objections during the comment period.  Without going into all of those changes and the seismic changes that these caused on our campuses, one change significant for ATSA was to encourage equitable respondent services alongside of similar services for survivors.  Equitable was not defined, but it opens the question about what are equitable services for complainant (those who were harmed) and respondents (those who have been accused or found responsible for that harm).  We believe that it is possible to both protect survivors, and match respondents with adequate services to promote healing and prevent further aggressive behaviors.

In 2020, Jenny Coleman and Becky Palmer put together some commentary, with our concerns about the initial changes.  For the current comment period, these comments were edited and updated by Joan Tabachnick with input from members of the campus sexual assault sub-committee.  This group is made up of members from the Prevention and Public Policy Committees. 

This update repeated our request for broader definitions for sexual harassment and assault, which would allow for those with lower-level harassment behaviors to access services that can prevent future misconduct.  With the narrow definition, colleges and universities lose the opportunity to address behaviors before they escalate to sex crimes and establish a social norm of respect and accountability. 

We requested a clearer definition of “equitable” services.  Anecdotally, we have heard that some campuses are ending their Memorandum of Understanding with local rape crisis centers because there is not equivalent service for students who have been accused of sexual misconduct.  Our statement noted that equitable is not necessarily equal, noting that those accused of sexual misconduct need very different services than survivors.  This also offered us an opportunity to describe some of the research from ATSA members which clearly note that services for those found responsible for sexual misconduct must be individualized. This individualized approach, a relatively new concept for many in the campus world, allows institutions of higher education to develop services that are best matched for the needs of their campus community.  Prevention works best when it is tailored to the needs of individuals and the systems in which they reside.

We also commented on the problematic shift in these new Title IX regulations from the use of interim measures, which could be required such as changing class schedules, room assignments, etc. to the use of supportive measures, which are purely voluntary.  Institutions need the ability to ensure safety for everyone, those who are harmed and those who are accused of causing the harm.   They also need the ability to respond to a situation once a complaint has been filed.  Under the new regulations, all of these measures must be voluntary by the party involved.  The only avenue now open to institutions is to conduct a detailed threat assessment to determine if the student is a significant threat to a student or the campus.  If that is founded, then a student can be removed from campus – the campus still cannot address behaviors that are significant, but do not reach the level of a threat to the campus. Again, the campus is losing the ability to respond to a situation when it is reported and begin a more robust conversation with everyone involved.  

We are thankful to ATSA members Tay Bosley, Katie Gotch, Keith Kaufman, Ray Knight, and Seth Wescott provided ideas about this update, which were essential to this work.  The ATSA Statement is now on our website at: If you want to learn more about the public comment period, here is that link (  We would be happy to hear any additional feedback surrounding ATSA’s involvement in the prevention of campus sexual misconduct.


Judith Zatkin, PhD

Co-Chair of the Prevention Committee

Member of Campus Sexual Misconduct Sub-Committee


Joan Tabachnick, MBA

Co-Chair of the Campus Sexual Misconduct Sub-Committee



Thursday, July 1, 2021

Let’s talk about healthy sex – the importance of sexual health care.

By Marije Keulen-de Vos, Kasia Uzieblo & Minne De Boeck (Dutch affiliation of ATSA, NL-ATSA)

According to the World Health Organisation, sexual health refers to a state of physical, emotional, mental and social well-being in relation to sexuality. It encompasses not only certain aspects of reproductive health but also the possibility of having pleasurable and safe sexual experiences. This part of life is often neglected in working with persons with sexual offence histories. Treatment is typically aimed at inhibition, control and suppression of sexual feelings and behavior opposed to identifying healthy sexual behavior and promoting sexual health. Those in the field of providing therapy and education for persons with sexual offence histories are somewhat puzzled by the question of what constitutes healthy sexuality for these individuals. In persons with sexual offence histories, sexual health is not simply a synonym for absence of sexual violence. Instead, it relates to the absence of sexual dysfunction and the presence of sexual pleasure without suffering, without bringing harm to others and having sexual pleasure with mutual consent.

On June 1st NL-ATSA, the Dutch affiliation of ATSA organized an online symposium on the importance of talking about and facilitating sexual health in persons with sexual offence histories. The symposium started with three plenary sessions which were followed by three parallel sessions. 

The first presenter, Prof. Marieke Dewitte (Maastricht University, the Netherlands), focused on a biopsychosocial model towards sex. Sexuality is complex; it involves our brain system, neuroendocrinological system, and anatomy. For example, a sexual trigger may lead to positive appraisal, subjective arousal, genital arousal, sexual motivation and, ultimately, sexual behavior. Psychological mechanisms such as sexual rewards, thoughts and emotions, and attachment, all linked to the societal and relational context, define our sexual behavior. Hence, psychological theories on these mechanisms help us understand sexual behaviour. For instance, the attachment theory provides an important framework for understanding the dynamics of (sexual) interactions in romantic relationships across the lifespan. Because the attachment system primarily serves an emotion-regulation purpose, the attachment theory can help us explain how individuals cope with stressful or threatening situations within the context of their sexual relationship. For example, feelings of intimacy are a likely result of this sense of security. On the other hand, intimacy might also act as a buffer to prevent the activation of the attachment system when facing relational or sexual challenges. Marieke Dewitte concluded that 10% to 23% of the persons with sexual offence histories experience various problems with sexuality and intimacy. Some exhibit a negative self-image, fear of failure, and problems with intimacy and commitment – often triggered by insecure attachment styles, whereas others have erectile dysfunctions, experience orgasm problems, or an increased sexual drive. However, many treatment providers who work with persons with sexual offence histories lack the knowledge and skills to make informed decisions about improving sexual health care in their forensic clients. Marieke Dewitte thus emphasized the importance of including sexuological insights and methodologies in the treatment of clients who have committed sexual offences.  

The second presenter, Jantien Seeuws (forensic psychologist, Fides Beernem, Belgium) focused on policy in forensic centers regarding stimulating healthy sexual expression in persons with sexual offence histories. Despite the liberal view of sexual freedom in Western Europe, expression of sexuality in individuals in mandated care seems to cause fear and division among forensic health care providers. What complicates matters is the fact that – in these individuals – sexuality is intertwined with sexual violence and all kinds of sexual problems, such as a disrupted psychosexual development, deviant sexual scripts, limited sexual regulation and sexual disfunctions. Therefore, a multidisciplinary approach is important when addressing healthy sexual behaviours. The Good Lives Model suggests that treatment for persons with sexual offence histories must regard participants as whole beings in need of focus in many principal life areas, such as family, employment, leisure, community, and well-being including sexual health. Risk and good lives models are complementary models in forensic care, and by emphasizing the merits of each, management and well-being of patients can be maximized while community safety is increased. Furthermore, sexuality is a basic human right. Professionals should commit to this universal right when supporting sexual health of their patients. Forensic settings that offer long-term mandated care should have a clear policy, consistent with local law, aimed at accepting patients’ sexual needs and helping them to securely manage their privacy, sexuality and relationships. Yet, forensic hospitals or units rarely develop such a policy. Jantien Seeuws argued that there are several challenges in developing a sexuality policy in treatment wards for persons with sexual offence histories. First, perpetrators of sexual violence pose a heterogeneous group; there are distinct differences in psychosexual development, the nature of sexual violent behaviors and sexual deviances, criminal history, and other relevant characteristics among those who have offended. These individual differences call for tailoring treatment to the individual. Second, patients and staff may have different views on healthy relationships and sexuality preventing a unified vision. Also, public opinion typically emphasizes repression and punishment. This may induce the tacit acceptance in professionals that punishment is also justified with regard to intimacy and sexuality.  Finally, the interconnectedness of sexuality and violence means that themes such as masturbation, phantasies and pornography are approached very carefully and evokes various important questions. For example, an interest in playing with power dynamics is common and healthy for consenting adults, but is it healthy for someone convicted for sexual assault? Do these (sexual) behaviors all raise the risk for recidivism? Jantien Seeuws concluded that current policies on sexuality in forensic settings are long overdue. It is important to thoroughly map and discuss sexuality in persons with sexual offence histories as sexuality also influences their physical and psychological health. Treatment providers should also take initiative in providing non-judgmental language with regard to sexuality and sexual dysfunctions in their clients.   

In the final plenary presentations, Bas Frelier (psychiatrist, the Forensic Care Specialistis, the Netherlands) discussed the implementation of a Sexual Health Project in a forensic setting. In forensic settings, sex is often approached in a negative way. Also, even in patients for whom sexuality is not related to risk, treatment providers are cautious about the subject. In 2019, the Forensic Care Specialists instated a department of sexology with the goal to integrate sexology within their treatment program for their forensic patients. The department’s vision on sexuality is that a healthy sex life and healthy relationships are protective factors for all forensic patients, and that everyone has the right to sexual health. To achieve their goal, the department initiated the Sexual Health Project, which started with sexuological education for practitioners as treatment providers regularly feel shy about talking about sexual behavior and interests, and providing sexuological treatment. The sexology department is collaborating with two other forensic hospitals to develop a guideline for integrating sexuality as a vital component of forensic treatment programs. The guideline is anticipated by the end of 2022.

The symposium closed off with three workshops. The first workshop focused on providing sexual services to people with intellectual disabilities. The presenter of this workshop Miek Scheepers (vzw Aditi) explained and demonstrated with case studies that, in addition to supporting their social network, sexual services can offer these clients opportunities for learning and experiencing sexual interactions in which consent, equality and voluntariness are the common thread. The second workshop provided by Tom Platteau and Corinne Herrijgers (Institute of Tropical Medicine Antwerp) focused on drug use in combination with sex (“chem-sex”). A recent study on the needs of 20 chem-sex users led to the development of a health-app (“budd”). This app aims to sensitize and support chemsex users in safe sex participation, as well as to increase awareness and insight into their own (risky) behaviors. The third workshop provided by Zohra Lkasbi (ZNA, UKJA) and Jeroen Dewinter (GGzE, Tranzo & Tilburg University) focused on sexuality in adolescents who displayed sexual violent behaviour. They provided several methods to maintain and discuss healthy sex and relationships in forensic youth care and therefore pointed out the necessity of a good therapeutic relationship. These experts also emphasized the importance of paying attention to and cooperating with parents, counsellors and the social environment in order to enhance healthy sexual behavior.

The fact that this symposium was attended by over 250 practitioners (psychologists, psychiatrists, probation officers to name a few) from the Netherlands and Belgium, as well as the grateful feedback during and after the event, illustrates that many practitioners are struggling with how to deal with sexual health in persons with sexual offense histories, but are also acknowledging the importance of including this necessary topic in their work. Opportunities to share best practices to obtain an in-depth understanding of sexual wellbeing in forensic patients are clearly highly needed. 

Thursday, June 17, 2021

Embracing Restorative Approaches to Address Sexual Harm.

By Alissa R. Ackerman, PhD, Alexa Sardina, PhD, & Kevin Lynch 

In June 2018, four rape survivors of rape sat in an accountability circle for a man who had committed a rape 40 years prior.  We, the authors of this piece, are two of those women, and the man who committed the rape.  For over three hours, we grappled with topics related to our individual experiences with sexual harm. We did not know it at the time, but this accountability circle was the start of a journey that the three of us would take together.

For several years, Alissa has been participating in, facilitating, and writing about restorative justice as it relates to sexual harm. While restorative justice has gained popularity in general, few people advocate for its use in instances of sexual harm, despite evidence that it can be effective in helping survivors to heal and holding those who have harmed accountable.  In 2016, Kevin had written a blog in the Huffington Post in which he admitted committing rape in his early 20s.  Kevin had subsequently learned about the work Alissa was doing and asked her to organize a vicarious accountability circle for him.  Alexa was one of the survivors who also participated. For Kevin and Alexa, the experience of that circle was enough to convince them that others should be made aware of the healing power of restorative justice and should be able to participate in restorative processes if they so choose.

Current criminal justice interventions do not prevent or decrease rates of sexual harm, nor do they address the needs of survivors.  As such, the criminal legal process should not be the only avenue available to address sexual harm. Restorative justice offers a trauma-informed, humane approach to holding people accountable and providing opportunities for healing for all parties.

Restorative justice is a human-centered approach to repairing and preventing harm. It requires honesty and often difficult conversations between people who have experienced harm and those who have caused it.  Restorative processes can take many forms, including one-on-one facilitated conversations and circle processes that provide everyone involved (and their support people) the opportunity to be seen and heard. Restorative justice allows people who have experienced harm to speak their truth and ask for their specific needs to be met.  It requires people who have caused harm to fully acknowledge the harm they’ve caused by naming it, discussing their understanding of the impact of their actions, actively listening to the person, they harmed (or a proxy), and then making amends for that harm.

Some of the most common needs expressed by survivors of sexual harm include telling their story in their own way, understanding why the harm was perpetrated against them, having their harm and their pain acknowledged and hearing how future harmful behavior by the person who harmed them will be prevented.  A restorative justice response encourages collaboration and reintegration of all parties, neither further coercing nor isolating either party, as our current criminal legal responses tend to do.

Not all survivors are willing to meet with the person who harmed them. Conversely, individuals who have been convicted of sexual offenses may not be allowed to meet the person they harmed.  Vicarious restorative justice is an alternative model that brings people who have been harmed together with those who have harmed. However, these individuals are not parties to the same acts of sexual harm. The accountability circle in which we engaged is a prime example of vicarious restorative justice.

Much of the work Alissa has done using the vicarious restorative justice model has been done in treatment groups with people who have committed acts of sexual harm.  Based on this work with over 500 individuals, she has come to understand the value of this process for use in clinical practice. As such, ATSA members may be interested in learning more about this process.

Since the accountability circle, we participated in three years ago, together we have learned a lot about the value of restorative justice. For Alexa, the most important lesson was that people who experience sexual harm and those who perpetrate it have more in common than most people would believe. There is more that unites us than separates us. For Kevin, it was the realization both of the lasting harm he likely had caused, and of the power of accountability as a means of healing for survivors.  For Alissa, it was the recognition that all people impacted by sexual harm could experience healing through restorative processes. Together, we have found that most people do not fully understand what restorative justice is, what it requires of people, or how they can participate in restorative processes if interested.

…. And we believe the time has come to take concrete steps to restore the world from sexual harm by making restorative justice inclusive of and accessible to more and more people and communities who are affected by it.  Such steps might include developing a model for how to use it, training facilitators and practitioners to use it, helping communities, organizations, and institutions develop restorative processes, advocating for restorative justice, and taking steps to engage more people who have been harmed, as well as people who have been harmed.

Current criminal legal processes have failed to prevent sexual violence, to help survivors to heal, or to truly hold people accountable for the sexual harms they cause. The time has come to embrace restorative approaches to address all forms of sexual harm. This requires that we accept the complex dualities and contradictions that must be understood and mastered to restore the world from sexual harm. We believe that ending sexual harm requires that everyone be at the table.


*Alissa R. Ackerman, PhD is a criminal justice professor at California State University, Fullerton. Alexa Sardina, PhD is a criminal justice professor at California State University, Sacramento. Kevin Lynch is a consultant and writer in the nonprofit and social enterprise fields.  Together they are co-founders of Ampersands Restorative Justice, an organization designed to brining restorative justice for sexual harm to scale.

Friday, June 11, 2021

The New World of Telehealth: The Challenges and Benefits.

By Janet DiGiorgio-Miller, Ph.D.

Whether you have decided to take a hybrid approach or do all virtual therapy sessions you have come to find that there are challenges as well as benefits to telehealth. I moved out of my office on July 31st, 2020 after 18 years. It was a three-room, third-floor office space in a 1929 building with beautiful big windows in a bustling little town in New Jersey. It felt like a safe and secure place for my clients and for myself.

While I missed that office, I soon came to appreciate my home office with my furniture and my paintings and all the benefits that come with staying at home during the day. As my practice became totally virtual, I thought that I would begin to write down what worked and did not work. I also asked my clients. The following are the challenges and benefits of virtual therapy. Please feel free to continue this blog by posting your thoughts.


Telehealth presents challenges for both the provider and the client. Probably the most challenging issue is working with young children. It is difficult to keep their attention by just talking. Usually, when you are working with a child you have some play materials to assist in the conversation. This is a task that is exceedingly difficult to replicate virtually. In addition, teenagers may be viewing more than one screen at a time or multitasking. When this issue presents itself, it is good to address it and ask the client if they are attending the session. Another issue that I found is that you cannot see the whole person’s body and sometimes cannot tell if they gained weight/ lost weight or are fidgeting and or distracted.

The biggest challenge for some clients is to have a private conversation and worry if they are being overheard. This concern has led some to clients doing sessions in their car.

Another challenge is that parole officers will not allow a client to use the Internet to have a virtual appointment. Some clients have had their attorney lobby for this privilege and other clients must use the telephone to have appointments.

As we all know, you can have technology/internet issues. It is helpful to watch YouTube videos of the technical issues and find tips there. It is also helpful to remind ourselves that we as well as our clients are learning more and more about technology. So, I tell myself to be patient (with myself and others) which is one attitudinal foundation of mindfulness.


The biggest benefit by far is the convenience for clients. Therapy is now available for any client who has 45 minutes to take out of their day. Previously a client would have to find a therapist in their area, drive to the therapist's office, park and/or pay, find the office or suite, and then drive back to home or to work. Instead of taking 45 minutes to find a private place to talk clients have to take at least two hours out of their day to have a therapy appointment. It is easier for clients who work a regular job or work overnight to find 45 minutes. It is also easier get approval from their supervisor to leave for 45 minutes as opposed to two or more hours. They also save money on gas and parking. In addition, if a client forgets their appointment, I can text them and remind them and we can have a session instead of missing an appointment. I can also text clients to remind them of their appointments. Or if the client cancels an appointment at the last minute, I can fill the slot with someone who is waiting for an appointment. Another benefit is that client does not have to find childcare to attend their appointment. I had one client turn the camera away and breastfeed a baby while she was speaking in therapy.  

Teens and millennials are extremely comfortable using the computer as a forum to talk. Many times, I see adolescents and young adults in their hoodies, on their beds with a cup of tea talking. In fact, some people eat their breakfast and lunch because they are in a hurry to get to work or to get back to work. I have noticed that you can see a person’s personality when they are talking from different parts of their home. You can ask them about their surroundings to get to know them better. It is also a perfect forum for clients who have been in your care and then go off to college in a different state. They have continuity of care since telehealth. You can also invite other family members to join a session.

Another benefit is you can see different people throughout your entire state/territory as opposed to having geographical limitations regarding clients coming to your office. That means the expertise is spread throughout the state or territory. This is extremely helpful since therapists with expertise in treating sexual abusers are few and far between. Another benefit is that you can evaluate and treat clients in a safe place.

Telehealth is ideal for anxious clients. Clients who have anxiety are worried about getting to the office, finding parking, being on time, and then having to settle down to discuss their anxiety in therapy.

You can still use certain tools such as reading cards, sharing screens to test clients, and showing books to suggest that they read. You can also meditate virtually. You can do your progress notes while talking to a client in a discreet manner. You can also refer to the last session notes to have a point of discussion if needed.

One unexpected benefit is that the US government is supporting telehealth by waiving copays for mental health for most insurance companies

Clients Perspective

Some clients find telehealth extremely convenient and useful however some clients indicated that they like in person sessions because it is a space for them to feel safe talking about their issues. One client told me that on one hand “It is a designated safe space to have a conversation however due not having it, it allowed me to work on several safe spaces (in and around) my home to talk.”

My/Therapist Perspective:  

It is nice to be able to eat healthy food and have no commute. It also a pleasure that my husband is home more often. I can come down to my office at any time to do my work instead of having to drive anywhere. All my documents are in one place. I have more time to balance my work and self-care.

To summarize, I have found that telehealth primarily benefits clients. I do not see a difference in live or virtual therapy regarding rapport with clients or having them open up to discuss their issues. In fact, they seem more comfortable in their own home discussing personal issues. In addition, they do not have to worry or stress about getting to an office. Regardless of the shift of their work they can find 45 minutes a week to be available for a therapy session as opposed to over 2 hours if they would have to leave their home and go to the office.

I have chosen to continue doing telehealth as it is the best option for clients and has the added bonus of being home. Another major advantage of staying home is saving money by having no rent or additional expenses related to having an office, and less wear and tear on my car.

The lack of commute is a definite bonus.   

I think telehealth is convenient, benefits clients, and is here to stay. So, embrace the change, notice the benefits, and enjoy.