Wednesday, June 29, 2022

We need to START enacting effective practices to prevent and report sexual abuse within institutions

 

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

Sexual abuse within institutions, whether big or small, is not a new phenomenon. It’s something that we have discussed on this blog before. Therefore, we are not going to re-tread old ground. In recent weeks both the Baptist Church and Hockey Canada have been hit with allegations and been levelled with criticism that they have not responded appropriately. This is agonizing for the community at large, but especially for professionals who want to help. These are the same professionals who ask for a seat at the table to inform policy, too often get rejected, and eventually see the same thing happen time and time again. In this blog post, we ask the question of why do things not change? Why does policy change, but not necessarily public attitudes, beliefs, or practice? As a society and as professionals, we need to ask ourselves, what does it take to change mindsets?

Our beliefs about the world are often ingrained in who we are, they are not hard wired but the older we get the more they are influenced and reinforced by social norms, culture, education, and personality. This does not mean that we cannot change our beliefs or behaviours, but it means that they are harder to change. If this is true of us as individuals, then it’s true if us at a community and societal level. Social and political change is hard regardless of the topic. 

The reality of social change is that it:

- needs to be personal to each individual and they must believe that they can make a difference.

- must focus on an issue that communities can come together on and feel inclusive in tackling; it needs to represent the ideas and beliefs of everyone and make people feel that a shared outcome is possible.

- needs to involve a groundswell across society allowing different communities to come together, contribute, and enact changes. Individuals need to feel that they can carry out society’s mandate for change in their own lives and communities with the understanding that everyone else is working towards the same goal.

Although the desire and drive to prevent, report, and respond to sexual abuse meets the above criteria, there are significant stumbling blocks along the way that have not been addressed, including:

- The perception of responsibility – This often looks like, “It’s an individual behavior that impacts others, but not me! It’s not up to me to police other behaviours and social change is too complicated for me to think about.”

- The reality of time – Some may be able to change attitudes and beliefs overnight, but this is not the case for everyone, especially if they do not perceive the topic as a problem. Real social change needs time and space to evolve and does not result from brief attempts to influence others. 

- The monitoring and enforcement of change – There are broader questions of who is monitoring what change, and how are they doing it? Is there discussion about what progress is happening, and how acceptable that progress is? This is particularly relevant when everyone and no-one owns the issue with the belief being someone else will monitor it. 

- The shared understanding of good practices – Making progress in any social change involves defining what good practices are and their relationship to the evidence base, especially when the evidence base is new, emerging, or non-existent. What do you implement? Who leads? Is there a single voice?

- The noise of “expertise” – Because sexual abuse is a broad area, there are many different voices. Some are positive and some negative. Who are these experts? How do you determine good from bad? How, do they align to your politics, culture, context, and location? How do we nurture an evolving consensus?

- The lived reality of sexual abuse – Given the scale and nature of sexual abuse, everyone reading this post knows several people who have experience sexual abuse (or have perpetrated sexual abuse) with an array of different outcomes. This means that we will hear stories of hope and stories of frustration and desperation. These stories can influence us for better or worse, leading to unrealistic hope or pessimism. As our friend and erstwhile co-blogger, Alissa Ackerman has observed, we are never more than a stone’s throw from a survivor of sexual abuse.

Therefore, what can we professionals do? 

- Perhaps the most important thing is to keep talking about it. We can meet, communicate, and discuss sexual abuse in shared forums.

- We can continue to identify the best practices we want to implement (as well as bad practices we want to eliminate) and expand our growing evidence base.

- We can maintain a realistic sense of what is achievable and set realistic times for their completion.

- In implementing new practices, we can appoint someone or some organisation to be in charge – to drive the bus, as it were – and make them hold us all to agreed actions and follow their judgements.

- We can agree that  we are changing social norms as well as individual actions and agree to continue to work on it in the short and the long term.

- We must continue to demand our place at the policy table and to intervene in public debates to bring and keep the nuanced, evidence- and practice-based vision in the conversation. 

50 years ago, there was almost no public discourse about sexual abuse and offending. People started talking and kept talking about the issues, resulting in a groundswell of support for change at a societal level. With that change came new challenges, involving not only our responses to offending, but the need to accept that we continue to have double standards. Ultimately, we need to help the public understand that this is about all of us.


Friday, June 10, 2022

ATSA is changing its name.

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


ATSA’s legacy and recognition are important to the overall health of our organization and its place in the world. So, too, is accurately describing our activities! ATSA has always been an ever-evolving organization within a constantly changing field. This means that it’s important every so often to stop and take stock of where we are at and what we are doing. This post focuses on the recent organizational name change from “Association for the Treatment of Sexual abusers” to the “Association for the Treatment and prevention of Sexual Abuse,” the logic behind it ,and what it means moving forward. It is the result of nearly two decades of discussion by members and various boards of directors.


ATSA was originally established to provide support and insight to professionals who worked in the field of providing treatment for people convicted of a sexual offense. It began at a time when research was scant and few resources existed. ATSA was created to champion, as well as nurture, evidence-based practice in the field and develop good practice. This is still one of the central tenets of the organization, as evidenced by submissions to the journal, the ATSA Forum newsletter, and the annual conference; but it has evolved beyond these activities with an increased focus on policy, prevention, international collaboration and diversifying research, trans-disciplinary and multi-agency teamwork. To a certain degree, ATSA has been a victim of its own success. It evolved to a position where it leads the field in North America and is a growing player internationally. ATSA is seen as one of the main go-to organizations for people working in the field, and the most important conference for academics to showcase their work. All this success begs the question of why we need to change the name. This was a question that the ATSA board struggled with, but ultimately thought that it was important so for several reasons, including:


- A lot of the work that ATSA now does is oriented towards the prevention of sexual abuse, whether that is preventing first time sexual abuse or preventing people from committing sexual abuse again. We have had a committee focusing on prevention for approximately 20 years.


- The relevance of terminology, as the field is moving away from the blanket use if terms like “sexual offender” and “sexual abuser.” Many have argued that a less stigmatising and pejorative terminology can be used. This is significant,  as the international landscape is stating to change, especially in westernized and anglophone countries, towards person- first language and away from a labelling approach. A couple of years ago NOTA, the sister branch of ATSA in the UK and Ireland, changed its name from the National Organisation for the Treatment of Abusers to National Organisation for the Treatment of Abuse for that very reason.


- A recognition that ATSA addresses abuse as a broad concept, and does not focus on just one aspect of it. Where ATSA once focused just on the assessment and treatment of individuals who abuse, we now also focus on the impact of abuse on individuals and/or the community’s reaction to it. This broader use of “abuse” in our name means that the full remit of ATSA and its partnerships are incorporated. This expanded focus is also reflected in the increasing attention paid to these three target groups at the annual conference, in scientific research and in the weekly blogs. 


- There is an additional dimension to the name change as well: there can be certain funding or partnership opportunities that would otherwise be closed to ATSA because we might be seen, incorrectly and from a distance, simply as an abuser charity/organization. While the work of ATSA is still mainly oriented in the direction of those who abuse, it is to reduce and individuals’ risk of abusing and therefore it’s about community protection, safeguarding, and victim support as well as helping people to establish lifestyles that are incompatible with harming others. Making it clear from the outset what ATSA stands for in the name is an easy way to avoid these complications.


- There is also another, significant but understated reason. ATSA frequently advocates trauma-informed, person-centered and strengths-based approaches that recognize how people who commit sexual abuse may also be the victims of other forms of abuse or trauma. Since individuals who abuse have often been victimized themselves, it’s therefore  important to recognize their dual status in our name as one would in practice.


Having received positive feedback from the membership and making the decision to move forward with the name change and put it to a vote, the members of ATSA’s board had to decide upon what the change would be. Would it be a complete overhaul or an adaption? The board felt that an adaption would be best, as many felt strongly that ATSA was a strong brand with clear messages. Therefore, the role of the name change would be to strengthen and clarify this, not to undermine it. The board decided that the word prevention should be added to the name that that abuser should be replaced with abuse. However, it was decided that the acronym should remain as ATSA and not be changed to ATPSA, as that would be too confusing and, ultimately, unnecessary. Additionally, it was felt that the twitter handle “make society safe” was also fit for purpose.


Yes, the official name of ATSA is changing but the core principles, although evolving and diversifying, are the same at heart – to provide a clear and evidenced approach for working with people impacted by sexual abuse, including those who abuse.


Tuesday, May 31, 2022

Celebrating the 5th anniversary of Stop it Now! Flanders: Moving into the right direction, but still a bumpy road ahead.

 By Kasia Uzieblo, Ph.D.

For several Stop It Now! projects worldwide 2022 is a festive year.  This year, Stop it Now! US is celebrating its 30th anniversary, Stop it Now! the Netherlands its 10th and Stop it Now! Flanders it's 5th.

On May 19, Stop it Now! Flanders organized a symposium for practitioners to mark this milestone. As the coordinator and founder of the Flemish branch, Minne De Boeck stated in her introduction: It has been a long and winding road, but all the ups and downs have finally brought them to where they are today, a recognized organization committed to the prevention of child abuse and exploitation. To illustrate, from 2017 until 2021 1913 people contacted the helpline with on average 34 contacts per month. Of those who contacted them, 48% were worried about their own behavior and/or sexual interests, 19% were worried about someone else’s behavior and/or sexual interests and 10% were professionals. Even many more people are finding their way to the website (in 2021: 33.523), where there is a lot of information made available for the three target groups, ranging from self-help modules to tools on how to address concerns about someone's behaviour. In short, Stop it Now! Flanders has achieved a great deal in five years and clearly had reason to put its organization in the spotlight.

During the symposium, specific aspects of the functioning of Stop it Now! Flanders and Stop it Now! the Netherlands were illustrated. Wouter Wanzeele, Vincent Lambrecht, and Jeroen Heylen, all therapists and staff members of Stop it Now! Flanders explained how support via chat or telephone works in practice. They also illustrated this with a concrete case. This session not only gave us a good view of how things work behind the scenes but also illustrated how important the cooperation between Stop It Now! and, for example, specialized outpatient services is. The coordination of these services does not always appear to be as straightforward as it could be and raises important (ethical) questions for professionals: For instance, when is it important to lift the anonymity of the client? Is it justifiable that clients referred by Stop it Now! are given priority over all other people seeking help from the same specialized service? These are all important questions for which there is clearly no easy answer.

Ellen Janssen, the coordinator of Stop it Now! The Netherlands explained how they support relatives of persons who have exhibited sexually inappropriate behavior or thoughts towards minors. More specifically, they organize a series of five meetings for partners, parents, family, and other close relatives of MAPs. In these groups, they can find the necessary support and can exchange experiences with each other. Participants also obtain information (e.g., on the possible reasons why some people start watching online images of child sexual abuse or why someone commits abuse), learn how to recognize risk signals and how to set positive goals for themselves and their relatives. Janssen indicates that there is a clear need for such initiatives and that we should not forget these relatives, because they also experience suffering and are faced with countless questions, and very often have the feeling that they are alone in this.

But despite all these achievements and laudable initiatives, the symposium also made it clear that there is still much work to be done. And that became very clear from the start of the symposium. The symposium started with a poignant short film “Painfully Beautiful” by filmmaker Yvonne Nouwen, depicting a testimony of the struggles a man with his sexual interests in minors and his partner encounter every day. A must-see. But Yvonne indicated that it was not easy to start this project because her supervisors showed resistance to the theme. We, the audience, were grateful that she persevered despite these negative reactions.

Alexander F. Schmidt, from the University of Mainz (Germany), highlighted the ongoing stigmatization of sexual interests in children. This stigmatization does not only lead to self-stigmatization and psychosocial problems for the people who experience such interests but paradoxically also increases the risk of sexual offending. We, as professionals, might think yes, but this is observed in the general population, fortunately, professionals think differently. Well, Schmidt shattered this illusion when describing their recent study. They conducted an online survey in 427 Swiss outpatient therapists and the results were sobering: 21% stated that they are not willing to treat non-offending minor-attracted persons (MAPs), and only 16% stated that they were fully willing to provide treatment to these persons. As could be expected, there was even less willing to deal with offending MAPs: Only 9% indicated they would be willing to treat such a client. In addition, a substantial group of therapists had misconceptions about minor attraction and assumed, for example, that such an attraction will eventually lead to child sexual abuse. These results show that it is anything but easy for MAPs to find adequate professional help.

This was in line with our findings regarding help-seeking behaviour in MAPs, which I had the opportunity to present at the symposium. Of our 163 participants, only 40% had ever sought help. These people also indicated that they found this search for help (very) difficult. They turned out to seek help primarily via informative websites about pedophilia, from friends and family, and from the helpline Stop it Now!. Those who did not (yet) seek help were, among other things, afraid of the consequences of their disclosure; even with the anonymous helpline Stop it Now! Flanders, they had their doubts: they did not believe it was anonymous and feared that the helpline would pass on all information to the police.

 

All these problems were also acknowledged by Debby Versteege, a psychosocial therapist, who counsels clients with pedophilic interests. She is also a volunteer counselor for the website www.pedofilie.nl where she has a supporting role during for instance the group chats. She described how she deals with these clients, how she tries to increase their psychological flexibility, and - unfortunately - what resistance she encounters from her colleagues, colleagues who regularly express quite wrong and stigmatizing ideas about pedophilia and are not willing to work with MAPs. Versteege had invited for her session, Gabriël Levy. Gabriël describes himself as a non-offending MAP and has been working as a volunteer with the aforementioned website for years. It was striking that all questions from the audience after this session were addressed to him. This clearly shows that professionals, even when working with MAPs, have many questions of their own and that it is so important that we not only talk about MAPs but first and foremost with them if we are to fully understand and adequately address their experience and their concerns. 

Our fellow blogger and colleague, David S. Prescott, the online session addressed many questions that professionals may have when working with offending and non-offending MAPs. He emphasized how important it is to pursue three goals in treatment: enhancing well-being, enabling self-acceptance and self-compassion, and reducing risks. He eloquently described how he worked and what he focused on in psychotherapy. He emphasized how, among other things, empathy and a non-judgmental attitude are of immense importance if a therapeutic relationship is to develop and if counselling is to lead to positive results. He also did not shy away from taboo subjects such as (chemical) castration and lie detection. What was clearly appreciated by the audience was not only the content of his lecture but also the fact that he spoke mainly from his own clinical experience and shared his own insights with the audience. The online Q&A afterward clearly showed that the audience appreciated the content of his lecture, and also the fact that he spoke mainly from his own clinical experience and shared his own insights with the audience. This shows how important it is to create a platform where professionals can share not only best practices but also their own positive as well as less positive experiences.

The symposium made clear what Stop it Now! Flanders achieved this in a relatively short time thanks to the efforts of all those actively involved and the partner services of the helpline. Yet, it also made it painfully clear that a lot still needs to be done and that we should initially dare to take a critical look at our own attitudes and knowledge about MAPs and of those of our fellow professionals. The organizers were rightly pleased with the turnout of more than 100 people. But the question it raises for me is: How can we effectively reach all those other professionals who clearly have misconceptions and exhibit negative attitudes? How can we avoid that we only preach to the choir? It is obvious there is a need to include this topic in the relevant training programs at for instance colleges and universities. But will that be enough? Stop it Now! Flanders clearly takes its responsibility in this regard and beyond. But it needs all of us to achieve its important objectives. So, let’s put our shoulders together under Stop it Now! Flanders (and similar projects worldwide) to make sure that they can further optimize and expand their important initiatives, and that they can blow out 10 candles in 2027.

 

Wednesday, May 18, 2022

The Return of the annual NOTA conference: Leeds 2022.

 By Kieran McCartan

Two weeks ago something out of the ordinary, well for recent years, and very familiar happened in Leeds at the Queens Hotel: the annual NOTA [in person] Conference!! The conference took place from the 4th– 6th of May with 230+ people in attendance. This blog will give you an overview, and a flavor of the conference.

NOTA debated long and hard about whether to have an in-person conference, we thought about doing the conference online again or moving to a hybrid model. In the end, we decided on doing it in person as it felt that this was the direction of travel for a lot of conferences and training coming out of the pandemic and, after talking with members and presenters, something that attendees would value and benefit from, given the increased opportunity for networking and conversation. The conference was originally going to be at the Queens Hotel Leeds in the autumn of 2020 but got moved online, and after some successful negotiating by the NOTA general manager, we were able to move it forward to 2022. Some of the eagle-eyed among you will notice that the conference has moved from September to May, this is something that the NOTA board has been discussing for a while (thanks NOTA Scotland for agreeing to move your annual conference too late August) and so, post-pandemic, it seemed like a good opportunity to try it out. Which, I feel as both conference chair, presenter, and attendee, has worked out well.

Planning an in-person conference in the shadow of COVID, which is still present in the UK, was a challenge as we did not know who would attend and if people, including presenters and attendees, would have to cancel at the last minute; some did but not many!! The choices of keynotes, we decided, would be focused on people from the UK and Ireland to limit the potential complications and fallouts from international travel.

The conference kicked off with Sarah Brown, Chair of NOTA, welcoming everyone back and stating that it was great to be back in person at a live conference. The first keynote was Simon Hackett who kicked us off with a recognition of COVID and its impact, from a personal and professional perspective, before going on to discuss how the field of working with Harmful Sexual Behaviour in youths has changed over the years and if we need to redevelop concepts and practice. This was followed by Jessica Woodhams talking about the impact of working with other people’s trauma, especially for case investigators, and how we need to train and support staff better with compassionate leadership. This was followed by two sets of workshop sessions, each with 8 parallel streams, that included everything from emerging research on paraphilias, to harmful sexual behaviour, to the treatment of those convicted of a sexual offense, and the reality of online harm's as well as ways to safeguard against them. During the reception on Wednesday, we had a first for NOTA, a posters presentation session, and we had 10 Ph.D. and postgrad posters on display; it was a great success, a particular thanks to Dulcie for all her help with this, and will be something that we are looking to replicate again next year.

The Thursday keynotes started with Stuart Allardyce and Peter Yates discussing the emerging field of Sibling Sexual Abuse, or Behaviour as they referred to it, which dovetailed nicely with Simon’s keynote the day before. In discussing Sibling Sexual Abuse, they stated that, although it was not a new concept, professionals had to better equip themselves to understand and respond to it more effectively, especially to help identify as well as respond to it. This was followed by Russell Knight and Claire Barker, from the Independent Inquiry into Child Sexual Abuse talking about the progress of the Inquiry with a special focus on the truth project and how they listened to as well as integrated the victim’s voice into the process in a trauma-informed way. Interestingly, trauma-informed practice became a central theme of the conference, although it was not intended to be, which shows the salience of the issue. After the AGM we had two sets of workshop sessions, each with 8 parallel streams, which covered several topics including Sibling Sexual Abuse, partners of men arrested for IIOC, as well as presentations by Stop it now, Lucy Faithful, and Barnardo’s.  Thursday night was the conference networking event, which was for many the highlight of the three days as it gives us the opportunity to catch up and meet new colleagues.

The final day of the conference started with Tamara Turner-Moore and Mitch Waterman discussing ideas around sexual deviance and the DSM-V, which was interesting as they challenged many of the main foundations of the DSM assumptions through their data. They argued that many of the DSM definitions, and understandings, are premised on myths that are not appropriate or that do not hold up to the continually developing evidence base. The final keynote of the conference was a roundtable led by me on the new Council of Europe recommendations on the assessment, treatment, and management of people accused or convicted of a sexual offence. I provided an overview, and context, of the recommendations before Mark Farmer, Jon Brown, and Sarah Brown reflected on the impact of these on policy, practice, and research respectively; with the feeling being that these recommendations were a positive thing and that the UK was already quite compliant with them with the prospect of interesting adaptations being opened up.

The NOTA 22 conference was a great success, with attendees leaving feeling refreshed and upskilled. The highlight of the conference for me, as well as many others, was the opportunity to be in a room with each other discussing research and practice in the field of sexual abuse. The opportunity to talk and network, was significant as the research and practice knowledge grained. The NOTA 2022 conference, which was the 30th Anniversary conference, would not have been possible without the organization and support provided by the conference team, especially Malcolm and Andi as well as their colleagues behind the scenes. 

We hope to see you at NOTA 2023 which will be from the 3rd – 5th of May in Cardiff with the call for papers going out over the summer!!

Thursday, May 12, 2022

ATSA’s New Webinar Series on Campus Sexual Misconduct.

 By Joan Tabachnick and Jennifer Cinicolo

During the past decade, effective victim advocacy, changes in public policy, and a growing spotlight on horrific cases have focused the public’s attention on campus sexual misconduct.  Research confirms the need for increased attention in this area, as college-aged women experience the highest rates of sexual violence of any group. According to a 2020 study by the American Association of Universities, 26% of female and 7% of male undergraduate students experience nonconsensual sexual contact during their four years on campus.[1]

ATSA is defining it’s voice in the response to campus sexual misconduct, first drafting a public policy statement, which outlines what is known about the perpetration of sexual misconduct and identifies the potential for ATSA’s critical contributions to the campus world[2].  ATSA then submitted comments regarding the proposed US Department of Education Title IX regulatory changes[3].  The most recent changes opened to door for ATSA members by requiring equitable services for the students who have been harmed and the students who have been accused or found responsible for sexual misconduct. Even with this opening, there continue to be concerns and questions about how this current policy handles those who engage in sexual misconduct.

Campuses have begun to seek out expert guidance about effective interventions for the students who have been accused or found responsible for sexual misconduct. This is where ATSA members have a unique voice and expertise to offer.  By offering access to the research and practice knowledge about individuals who have sexually harmed, colleges and universities will be able to make more informed decisions about those students who are in the system.  With this information, campuses will also be able to move one step closer to achieving the important goal of preventing sexual misconduct.

We also recognize that the campus world is very different from the current criminal justice environment that most ATSA members work within.  Through surveys conducted by ATSA’s prevention committee, we learned that many ATSA members have interest in this work, but need more information, background about changing regulations, and insights into working with a broader range of behaviors as well as non-adjudicated students. 

To address these identified areas, a working group of the Prevention and Public Policy Committees created a new listserv to share resources, research, and case consultation advice for ATSA members beginning to work within the campus setting. 

Beginning in June 2022, ATSA will be hosting four free webinars, bringing in both outside experts as well as ATSA members with this unique expertise to cover two key areas:

I.         What do ATSA members need to know about the campus world?

II.       How can ATSA members apply and modify their unique knowledge and expertise to the diverse needs of the campus world? 

We are pleased to announce our first webinar on June 1, 2022 at 3pm EST (12p PST). This webinar features Rachel King, PhD, an expert in restorative justice practices and former Title IX coordinator at Curry College.  Rachel will provide an overview of the campus environment, Title IX process, and restorative justice.

1.       Campus 101: Overview of the Campus Process and Everything you needed to know about how the campus world will respond with Rachel King, PhD of RKResolutions (June 1, 2022)

 To register for this June 1 Session at 3pm EST click here.  

The following sessions will focus on:

2.       What is Changing and What is Possible with Jay Wilgus JD (on June 20, 2022, 3pm EST)

3.       Risk/Needs Assessment with Campus Populations:  Differences, Similarities and Practical Applications with Katie Gotch, MA, LPC (September 2022)

4.       Applying ATSA Member's Knowledge:  Case Conceptualization on College Campuses with a clinical ATSA panel moderated by Jennifer Cinicolo, LMHC (September 2022)

Look for more information about each of these webinars in the coming months.   Please consider joining this listserv and one or more of these webinars.  We hope you will join us! 

Friday, April 29, 2022

Maia Christopher is Leaving ATSA

By David S. Prescott, LICSW

 

Last week, the announcement came that Maia Christopher has resigned from her position as Executive Director of ATSA. It has long been one of my proudest accomplishments to have led the search committee that resulted in her hire during my year as President Elect. With this blog post, I hoped simply to offer some historical reflections on her accomplishments.

 

One can only imagine the challenges of being an Executive Director for ATSA. We wanted a person competent in administration, management, and organizing a conference while also needing someone with not just an understanding of the field, but a deep appreciation for it. Maia was clearly it. With the help of then-President Robin McGinnis and “Dream Team” member Jacque Page, Maia basically saved the 2007 ATSA conference in San Diego. That may seem long ago and far away, but the finances of each conference are naturally a major signpost of ATSA’s health and way forward. The next year, 2008, was the same: Maia and her team managed to pull off an excellent conference at a time (the beginning of the Great Recession in the US) when energy prices had gone through the roof, state agencies were prohibiting travel, and all sorts of things conspired to make it a difficult go. And so it went. Maia was the perfect choice at the perfect time.

 

Tyffani’s description of Maia’s leadership touches on important areas. At the same time, it is difficult to overestimate the amount of effort she has put into making sure that every detail of every conference has worked to our advantage. Some of us use the Hare PCL-R to assess psychopathic traits on a case-by-case basis; Maia was dealing with entire hotel chain managements that seemed to score above the cut-off for psychopathy. Beyond that, Maia has always taken excellent care of her staff. I personally sat in many meetings watching her put the office staff’s needs well ahead of her own. This has long been obvious to outsiders who have seen how well our office staff function as a team.

 

Before stepping into the Executive Director role, Maia co-chaired the committee that produced what were then called the ATSA Standards and Guidelines. That particular round of revisions faced many challenges, and Maia’s ability to thread the needle and get the document past an entire board of individuals who were all quite opinionated in how documents should be edited was impressive. That in itself would have been a remarkable accomplishment for any ATSA member. It seems worthwhile to mention all this today in considering the depth of Maia’s long-term commitment to ATSA.

 

Placed even further into context, Maia followed two other Executive Directors whose tenures were brief and perilous. Their departures left us all with the sense that we could actually hear the bullets that we had just dodged. And before that was another Executive Director who also gave her all to ATSA and, in an unforgettable board meeting, announced that after years of putting ATSA first she had simply run out of vision for the future. It was an amazing high-water mark in the concept of honesty.

 

Why say all of this?

 

·       ATSA members have more reason to be grateful to Maia than we often realize. Being ATSA Executive Director is hard work in the best of times.

 

·       ATSA has also been here before, survived, and emerged stronger thanks to the efforts of a diligent, competent, and effective board.

 

·       This can’t possibly have been easy for anyone involved. Thank you, Maia Christopher, for your service and leadership through all the ups and downs of our organization.

 

Thursday, April 21, 2022

Abuse in Psychedelic Therapy

By David S. Prescott, LICSW and Natalie Villeneuve, MSW

Amended version: Since the publication of this blog, we learned new information. Out of our deepest respect for the people whose harm is referenced below, we have added some important details and observations to this blog post.

Cover Story: Power Trip is a podcast hosted by New York Magazine. It went to #1 on Spotify’s list of True Crime podcasts and consists of nine episodes to date. Featuring Lily Kay Ross, who holds a Ph.D. in Sociology and a Master’s Degree in Divinity, it addresses abuses – sexual and otherwise – that have taken place in treatments incorporating psychedelic medications. These treatments are mostly used for addressing trauma, making these violations even more egregious and noteworthy.

Before delving into the issues covered in the podcast, it’s important to emphasize that whatever one might think about the use of these drugs in therapy, the themes involved are relevant to all who assist those harmed by abuse. They include the willingness of those in authority to dismiss or otherwise turn a blind eye to the experiences of people who trusted, consented to participation in treatment (in some cases within research studies), and found themselves violated and in worse shape than before.

The medications involved (including MDMA, DMT/Ayahuasca, Psilocybin, and others) are certainly not new. In many cases, their use in traditional healing methods, particularly within Indigenous contexts, dates back countless years. In 2018, an entire issue of Psychotherapy Networker focused on their potential use in psychotherapy, with contributors as prominent as Bessel van der Kolk and Rich Simon. In 2019, author Michael Pollan further brought the potential of these drugs to the forefront in his best-selling book How to Change Your Mind. Advocates use terms such as “psychedelic revolution” and “movement” while others recall that drugs such as LSD also have a dark and unfortunate history in CIA attempts at mind control (described in Stephen Kinzer’s “Poisoner in Chief”).

Cover Story: Power Trip provides accounts of individuals whose lives were altered by sexual abuse while using these drugs in a therapeutic context. One tells the story of being pressured into sex by the very person whose job it was to guide her through the experience. She recounts how he told her that all his clients fall in love with him. He was not licensed as a professional in any mental health discipline, and it turns out that he had studied with others who themselves were the subjects of prior allegations of sexual abuse. When the individual who was harmed complained to the people in charge, the only result was an email on which she was blind copied, explaining that he was not to be in contact with her until such time as they could resolve their issues. There was neither validation of her experience nor any consequence from her complaint.

In another case, a woman is guided through a psychedelic experience by two “therapists” (male and female) One of these (the male) had previously been open about having problematic sexual boundaries. During the experience, when she became upset, the guides grabbed her by the wrists and held her down, stuffed part of a towel into her mouth, subdued her, and then lied down next to her. The man spooned her and kissed her on the forehead. As if that wouldn’t be shocking enough, this took place in a small office as part of research by a group called the Multidisciplinary Association for Psychedelic Research (MAPS). Although the incident took place in 2015 and the women subjected to abuse reported it to MAPS, it apparently took them six years to review the video. Even then, their conclusion was that the session had not proceeded in accordance with the protocols. Beyond that, there was never any apology or accountability.

The woman involved in the above incident released the video of this abuse, which is available here. In it, the man can be heard advising his client to lie back and spread her legs. It is very difficult to watch. For those who do wish to see what words can’t adequately describe, it is important to know that it is only a small section of an hours-long video. The edited clip makes it appear that the woman eventually gave up resisting, but she didn’t. In fact, she fought back for hours. Those who know the indomitable spirit of this woman are not surprised by this, but others might not know the full extent of harm caused; the video is brief.

In a separate discussion of the podcast, Lily Kay Ross had this to say about the video:

“In sexual violence resistance education, we talk about the data and the statistics around how […] the use of one active resistance form, like verbal or physical, whether it’s yelling ‘no, get off me’, or trying to punch somebody […] When you use one of those resistance strategies, the chances of rapists advancing and continuing to try to complete the assault, go down a lot. And then you use two strategies, they go down even more. […] The vast majority of people who are intent on committing an act of sexual harm will be deterred if there are forceful resistance strategies deployed against them. And what we see in these videos is this, you know, an hour or so of somebody using what we would teach as resistance strategies to stop something from happening. And they don’t stop, for such a prolonged period of time, they don’t stop. And I don’t understand what kind of person, and what kind of state of mind, a person has to be in, to so clearly see somebody suffering like that and to keep doing what they’re doing.”

Throughout the entire podcast, themes emerge:

·       There is so little accountability – none, really – that any reasonable person would wonder why no one could even say, “that should not have happened” much less apologized. After all, forcing yourself onto a person who by definition is not able to give consent is sexual abuse.

·       Virtually all of those who reported abuse received responses along the lines of gaslighting: Many were told that their reactions to abuse – or their not wanting to have sex with their guide – indicated blockages and resistance in their relationships. Likewise, many were told that their despair in the wake of abuse and attempted abuse were symptoms of other disorders that they needed to come to terms with.

·       In a case in which a woman complains to MAPS about her treatment, describing her condition as being “suicidal every minute,” her response is coded as “lowering of mood” as a side effect and not included in reports to the Food and Drug Administration. By all appearances, the number of the subjects in the studies is surprisingly low for medical trials.

·       Many women felt pressured not to discuss their experiences, so as not to undermine the “psychedelic movement.”

·       Not surprisingly, there is very considerable financial investment in ensuring that these medications are made legal.

·       There are unspoken undertones: It is hard not to notice that the people who are abused are primarily women while the research and professional authorities are (with several surprising exceptions) men. Likewise, it is difficult not to sense an unspoken attitude of victim-blaming in that it is easy to fault women for placing themselves in a vulnerable position.

To be clear, the actual abuse is not the only issue at stake in these scenarios. Very clearly present are those who either don’t notice or care enough to put the brakes on research studies. Following the leads offered in this podcast, one quickly finds responses that are more legalese than actual communication. They add up to an unacceptable betrayal of the vulnerable individuals who trusted them. Again, how hard can it be to apologize? Like the other elements in this podcast, a lack of accountability is something that readers of this blog face every day.

It is tragic that these circumstances have occurred. By most accounts, the proper use of these medications can be enormously helpful, often being the only successful treatment in the lives of some who have experienced trauma. The podcasters, their subjects, and the authors of this post are all in agreement that more research and innovation would be welcome, if it takes place in a space that is truly safe for all involved.

Also frustrating is that beyond the intersection of big money and abuse are many practitioners who use medications as responsibly as possible and take every precaution to provide genuine safety to their clients. We cannot make this point strongly enough.

As an aside, this podcast is not the first to call attention to abuse in this context. Author, therapist, and teacher Will Hall provides a concise and comprehensive review of the issues, as well as his personal experience at the Mad in America website in a 2021 article titled, Ending the Silence Around Psychedelic Therapy Abuse. This article helped to expose apparent abuses by highly influential leaders in the psychedelic therapy arena (Françoise Bourzat and Aharon Grossbard). Their fall from apparent grace has been a difficult experience for many thousands of devotees.

Abuses in similar contexts where charismatic leaders hold enormous power over their vulnerable followers are also not unfamiliar. Yoga legend Pattabhi Jois is alleged to have sexually abused countless numbers of students. The Shambhala meditation tradition has also recently been plagued by sexual assault scandals. While many spiritual movements have emphasized devotion to leaders, it’s nonetheless wise, given these experiences, to be very cautious in how we limit our own autonomy along the way.

What is the best way forward? To start:

·       We can remind one another and ourselves that abuse is abuse, plain and simple.

·       We can recognize that the abuse dynamics in this podcast (and in the article by Will Hall) are similar to those that have occurred elsewhere throughout human history and unite against them.

·       We can be aware that, despite the many potential benefits of these forms of therapy, abuses can and do occur.

·       We can ensure that our professions (and individual practitioners) take action and contribute to the solution instead of tacitly delegating responsibility to outside groups and politicians.

·       We can further work to develop and enforce the most stringent codes of ethics and professionalism to prevent these abuses. This can include advisory committees that include those who have experienced harm as well as experts in trauma. Of course, this will include raising awareness and mobilizing resources, since on their own, ethical codes, like laws, are not enough on their own to prevent abuse.

·       We can revisit what informed consent actually means in the lives of our clients and in our treatment settings, including when one is under the influence of medications that induce ecstatic and suggestible states.

·       We can accept that the Western scientific perspective can be flawed, and that it cannot be our only perspective. We can incorporate Indigenous knowledge into this work and give voice back to those who have a deeper understanding and connection to plant medicines. One area for further reflection can be the colonialist roots of current psychedelic science.

·       We can hold individuals who cause harm accountable while nevertheless regarding them with compassion and supporting opportunities for them to change.

·       We can move beyond the assumption that the criminal justice system will deliver justice, and consider how a restorative justice approach may instead bring healing to those harmed by psychedelic abuse.

·       We can always remember that just as the helping professions are rooted in the idea of doing no harm, we can also focus on ensuring that we do no further harm.

These calls to action are not about vilifying psychedelics, nor is this an attempt to undermine the advancement of psychedelic science, as many stakeholders may fear. Rather, this is a question about how a group of individuals can unite over a common objective. There already exists a community of people who are passionate about psychedelics, and who would largely agree that psychedelic medicines have the power to be life-changing. After a psychedelic experience, many individuals have reported feeling a greater sense of connection to others and the world around them, and they describe leaving the experience with a more open mind.

If we are truly committed to learning from psychedelic medicines, then how can we apply these teachings to address this issue of therapy abuse? How can we proceed with compassion, and how can we bring people together in conversation? Most psychedelic therapists and guides would agree that their goal is to help people, not to further traumatize them. And while justice can look different for every survivor of abuse, a common theme amongst survivors of sexual abuse is that they want to feel validated, and for the person who harmed them to take accountability and admit that they are telling the truth.

It is understandable why anyone would meet accusations of sexual abuse with denial, blame, and even threats of lawsuits (as was the response by Grossbard and Bourzat following allegations of sexual misconduct; for additional legal activity, see here and here). After all, even after having so-called transcendent experiences through psychedelics, these people are still human, and will thus seek to protect themselves in face of fear. If cancel culture has taught us anything, it is that there is no opportunity to recover from your worst mistakes. When fearing punishment, career loss, legal recourse, and ostracization, what would motivate someone to take accountability? How can we expect people to be brave, to take responsibility, and to commit to change if the risks are so great? 

Yet, if we can unite on the common ground that we want psychedelic healing to progress safely, then we have a bridge to connection. If someone communicates (verbally and non-verbally) that they do not feel safe, this must be received with openness and a willingness to learn. If it is true that psychedelics can dissolve the ego, expand one’s consciousness, and increase empathy (as well as suggestibility), then it is fair to believe that we can unite, embrace accountability, learn from our mistakes and harm, and ensure that psychedelic therapy is as free as possible from abuse.

 

(The authors are grateful to Geral Blanchard for his helpful comments on an earlier draft of this blog post.)  


Friday, April 8, 2022

Changes in abuse during the pandemic?

By David S. Prescott, LICSW, & Kasia Uzieblo, Ph.D.

 A recent article in the New York Times compiles data on physical and emotional abuse of teenagers during the pandemic. It is based on research involving 7,705 students conducted in the first half of 2021 and published by the US Centers for Disease Control. Among the findings:

·         44.2 percent described  persistent feelings of sadness or hopelessness that prevented them from participating in normal activities.

·         9 percent reported an attempt at suicide and 20 percent said they had considered it.

·         55.1 percent of teenage respondents said they suffered emotional abuse from a parent or another adult in their house in the preceding year.

·         11.3 percent said they suffered physical abuse.

This contrasts sharply with data from David Finkelhor and his colleagues, published in 2013, finding that (among other things) 13.9 percent of respondents ages 14 to 17 reported emotional abuse during the preceding year, and 5.5 percent reported physical abuse.

Further, in the most recent study, 29% reported that a parent or another adult in the home lost a job, and 24 percent said that they had experienced hunger. One in three high-school students simply reported poor mental health.

In all, it seems that our field is finally starting to see the data we feared we would. Those professionals who have watched the unfolding of the past 25 months or so are very aware that it’s not just the kids; parents and teachers are also experiencing intense stress. It doesn’t end there: a recent survey found that one in five physicians plan to leave their practice in the next two years.

Where do we go from here? Clearly, we have a lot of work to do, and the pandemic is not actually over yet. Setting aside the fact that the world continues to face other crises (such as the war on Ukraine and climate change) there is some good news:

First, we have an opportunity to learn from these data and anticipate cases that will come to our attention. One implication is that developing an appreciation for the context and circumstances in which abuse occurs will be important to consider as well as the characteristics of the person who abuses.

Second, we have a better opportunity to intervene. These data paint a clearer picture than we had before about the nature of suffering behind closed doors. We knew it would be bad, but at least we are better prepared to work with people whose lives have been affected by abuse (including by perpetrating it).

Third, we have expertise that we can share when we work with others in the community. This can include our knowledge of abuse dynamics and trauma as well as our (often hard-won) ability to remain compassionate in the face of the horrific circumstances of our clients.

Importantly, these findings show that times have changed, and we in turn need to adapt our understanding of abuse and neglect. Ultimately, these times – where existential crises unfold on a daily basis – show how important it is that our field shares what we know in order to ease the suffering of others in whatever circumstances we find ourselves.