A long way to go

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

Two recent articles in the New York Times illustrate how the context of our work can shape our clients and our practices. The first article describes how the New York State inspector general’s office “has documented significant racial and ethnic disparities in discipline across New York State prisons, finding that over a six-year period, Black inmates were 22 percent more likely to be disciplined than white ones... The report comes six years after The New York Times published a 2015 investigation into racial bias in state prisons. The Times found that Black prisoners faced more punishment than white ones, leading to loss of privileges, longer stays in solitary confinement and, ultimately, more time behind bars…

“State inspectors reviewed 385,057 misbehavior reports filed from 2015 through 2020 to expand upon The Times’s analysis. They found that the discrepancies had actually worsened over time, most significantly in 2020, when Black prisoners were 38 percent more likely, and Hispanic prisoners 29 percent more likely, to be cited in misbehavior reports.”

Importantly, “The inspector general concurred with The Times that these discrepancies were most pronounced for violations that were, according to the report, arguably more subjective. The largest disparities were for offenses like gang activity, assault on another inmate and “involvement in a demonstration detrimental to facility order,” which saw Black prisoners five times more likely, and Hispanic prisoners three times, to be found in violation than white inmates.”

In the second article, About 200 to 250 people incarcerated in Louisiana jails and prisons have reportedly been held beyond their legal release dates in any given month, with the average additional time lasting around 44 days in 2019. As one lawyer observed, “To our clients, it is an extremely scary experience because they do not know why they are being held, when they will be free or how they can get free,” he added. “All they know is they should not be behind bars.”

It can be easy to miss these stories in the seemingly never-ending parade of crime stories in the media. However, it seems that unless we pay attention, we ignore these practices at our peril. Many ATSA members have felt the anguish of not being able to change the often ineffective and sometimes unjust systems in which some of us have worked.

It behooves us to stay attuned to the fundamental unfairness and injustices that often surface in various corners of the criminal justice system. We do not say this to throw shade on any one individual or institution in any particular area. At the same time that these events are taking place, many other institutions and agencies are working to improve their approaches. Likewise, in our experience, those in the helping professions often want nothing more than to make positive changes that will reduce risk while simultaneously enabling individuals to build lifestyles that are incompatible with offending.

Nonetheless, it’s vital for us to understand and discuss how the broader systems in which we work end up causing harm to people, including those referred to us in treatment. The implications are far-reaching, including for risk assessments and classifications within the various systems that have authority over these individuals.

Our clients absolutely take note of these experiences. It makes sense that if the media and our clients notice these various injustices, and yet we don’t acknowledge, know about, or account for them, we shouldn’t be surprised when our clients conclude that we can’t understand their perspectives and that they can only work with us in a limited capacity. Psychotherapy clients who feel heard, understood, and respected benefit more from our interventions than those who don’t. Working with our clients means understanding their perspectives without writing them off as treatment-interfering factors. Unfortunately, in this case, understanding and working with their perspectives involves involves taking a long, hard look at the systems within which we operate and being prepared to respond to clients accurately, empathically, and without colluding either with them or the systems involved.

Whatever the potential biases of the journalists and the media outlets, the data are shocking and impinge on human rights. Further, they illustrate that at the very time we have information to guide our attempts to level meaningful sanctions, some of our systems are actually becoming worse and in need of more effective leadership. 

 

 

Redrawing sexual offenses: the role of technological evolutions in online sexual behavior - A report on a webinar organized by the Dutch Affiliation of ATSA

By Minne De Boeck, Lotte Valepijn, Ellen Janssen & Kasia Uzieblo

Sexuality is constantly evolving in terms of how we date, in terms of how we shape our sexual identity and in terms of how we consume pornography. Social media and technological evolutions encourage and influence these changes. Technological trends, including robots, drones, and VR, keep evolving and exerting influence on our sexual behavior. This can be about positive developments, but it can equally create new opportunities for misuse. Hence, these technological changes create many challenges on a societal level, but also for law enforcement and for forensic care, challenges that are difficult to keep up with. 

On November 22, 2022, a webinar on technological evolutions and their role in online sexual behavior was organized by the Dutch Affiliation of ATSA. The webinar was launched by the President of the Dutch Affiliation of ATSA, Minne De Boeck. She also took the opportunity to introduce her successor, Maaike Blok, who will succeed her in 2023.

The first presenter was Catherine Van de Heyning, Professor at the Faculty of Law, Antwerp University, public prosecutor and independent expert on the advisory committee of the Human Rights Council of the UN, Belgium. She discussed the legal framework in Belgium regarding online sexual penal law, which was thoroughly analyzed with a particular focus on Image-Based Sexual Abuse. She stated that the present age represents a true image culture caused and strengthened by social media, the omnipresence of smartphones and the COVID-19 pandemic. The perception that adolescents can be their own gatekeepers in an online setting because they grew up in a digital era needs to be debunked. Belgium is proud to be a pioneer when it comes to legislative developments to battle online sexual violence. Several phenomena such as sextortion, forced sexting and deep nude were discussed in light of the new Belgian legislation. Sexting (sending nude pictures) is not a criminal offence. It only becomes punishable once the vulnerability of the other person is taken advantage of, for instance in the case of coercion or violence, or when the sexting images are forwarded without consent. Likewise, sexting between minors is not always viewed as a problem. The presenter also shed light on certain unfortunate sexting trends that have arisen. For instance, doxing that occurs when the identity of the victim is broadcasted to inflict more damage is becoming a true problem. Another phenomenon that becomes increasingly prevalent is the misuse of deep nudes. This entails searching for nude pictures of (potential) victims and editing them in such a way that pornographic content is produced. All phenomena target victims in different ways. Predominantly victims between 15 and 30 years old are targeted and girls/women are targeted more often than boys/men. Moreover, female victims are more often confronted with widespread circulation of the pictures, which inflicts even more damage.

Jeroen ten Voorde (Professor of Criminal and Criminal Procedural Law, the Netherlands) shed some light on the Dutch legal framework to cope with sexual transgressive behavior, including online behaviors. His presentation included both recent developments and plans to deal with new trends such as robots and the use of sex dolls. More concretely, there are apparent problems regarding criminalization and penalization. For example, rape is only illegal when there has been a relevant interaction. With online sexual communication, there has to be an attempt to seduce or groom. Dutch policymakers want to tackle these discrepancies in the future by introducing an interaction criterium by law. In addition, there are certain scenarios which are not yet criminalized. For example, according to the Dutch penal law, watching child sexual abuse material as such is not punishable. This issue is expected to be solved with a new child pornography provision. However, the Dutch penal law does not have a solution for the spreading of deep nude/fake pornography. These presentations show how the legal framework keeps evolving and tries to keep up with new forms of transgressive behaviors.

Zohra Lkasbi (Clinical psychologist and behavioral therapist for children and adolescents, Belgium) focused primarily on adolescents and online sexual transgressive behavior, which is also the topic of her new book. The influence of the digital evolution on the concept of sexuality manifests itself in different ways, ranging from POPU (problematic online porn use) and the non-consensual spreading of sexual content to peer-to-peer online grooming. The latter is heavily facilitated by the fact that everyone has continuously access to smartphones and social networking sites. Special attention was given to dual offenders, who have committed both online and offline offenses. These offenders are often excluded from research, which causes a gap in our knowledge. Various therapeutic interventions such as the use of an internet-and media safety plan, the Flag System, an evidence-based tool for assessing acceptable and unacceptable sexual behavior or using internet zones to tackle online sexual inappropriate behavior are being applied but its efficacy has not been established in research yet.

Manon Kleijn (PhD-Student at Fivoor Science and Treatment Innovation at Tilburg University, the Netherlands), has studied online and offline child sexual offending. She examined how individuals approach minors online to abuse sexually and identified various pathways. First, she described the person who actively ‘approaches’ his victim by (1) bringing up his sexual intentions in the first few sentences and who mainly engages in short conversations, by (2) manipulating his victim (e.g., by giving compliments and showing affection with the aim of acting on sexual intentions), and by (3) discussing sexual topics. Second, she identified an ‘avoidant pathway’. These individuals do not take a lot of initiative and do not have clear intentions. Finally, a mixed group was also identified.

In the final part of the webinar, Dr. Dean Fido and Dr. Craig A. Harper (senior lecturers in Forensic Psychology, University of Derby and Nottingham Trent University respectively, UK), focused on image-based sexual abuse from a psychological perspective. This abuse encompasses phenomena such as revenge pornography, upskirting, cyber-flashing and deepfake pornography. The presentation shed light on each phenomenon. Firstly, revenge pornography was discussed, a phenomenon that always implies a core motivator as a response. Often, people think of “the cheating wife”, yet research suggests that most perpetrators are not the victim’s former partner. A potential hypothesis that was brought up was that revenge pornography supposedly is produced predominantly by men so they can brag about their sex lives. A second phenomenon, called upskirting, refers to individuals creating footage by taking pictures up the victim’s skirt. In light of this phenomenon, the presenters discussed the case of Gina Martin. She was one of the first females that wanted to report the situation after being a victim of upskirting, yet there was nowhere she could go since upskirting did not exist in any legal framework. Another upcoming phenomenon, cyber-flashing, is not illegal and can only be legally prosecuted under the guise of public harassment. With regard to creating and using deepfake pornography, two possible underlying mechanisms were discussed: hypersexuality of perpetrators and achieving sexual gratification. The presenters introduced the Beliefs about Revenge Pornography Questionnaire – a scale developed to assess social beliefs concerning revenge pornography.  Their recent studies suggest more lenient judgements of deepfake generation and dissemination for celebrities, males and when images were created for self-sexual gratification. Similarly, there is a stronger tendency to victim blaming when the victim is a male. Victims who are male and attractive are perceived to experience less harm in cases of upskirting behaviors. Interestingly, proclivity to make and distribute deepfake and proclivity in upskirting behavior seem to be linked to psychopathic personality traits.

We can conclude that there is still a lot of room for improvement in terms of judicial responses to these new phenomena, and preventive initiatives. More research on these new phenomena and the sharing of best practices are highly needed. However, we also need to acknowledge that social media and other technological evolutions are evolving so fast that it is impossible to keep up in clinical practice and in terms of judicial responses. Notwithstanding, practitioners, researchers and legislators need to remain aware and pay attention to current trends in order to prevent victimization and perpetration as adequate as possible.

How much do we really know about pornography?

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

Three research papers came up in a recent social-media discussion of pornography use. In the first, Beáte Böthe and her colleagues produced results from a large community survey of males and females. They differentiated between Problematic Pornography Use (PPU) and Frequent Pornography Use). The highlights of their findings were that:

·        PPU had positive, moderate links to sexual function problems in males and females.

·        FPU had negative, weak links to sexual function problems in males and females.

·        FPU and PPU should be discussed separately concerning its links to sexual outcomes.

As the researchers point out, high engagement with pornography is not necessarily the same as problematic engagement. In the authors’ words:

Taking findings together, while quantities of the aforementioned activities were often unrelated to maladaptive states and conditions, problematic engagement in these online behaviors has been related to maladaptive or harmful measures. Therefore, thorough examinations are needed when effects of potentially problematic online behaviors are investigated, taking into consideration not only the quantity of behaviors but also quality levels of engagement.

In a 2020 study, Beáte Böthe and her colleagues examined three non-clinical samples (of 14,006, 483, and 672 participants). From their abstract:

Results were consistent across all studies. 3 distinct pornography-use profiles emerged: nonproblematic low-frequency pornography use (68–73% of individuals), nonproblematic high-frequency pornography use (19–29% of individuals), and problematic high-frequency use (3–8% of individuals). Nonproblematic and problematic high-frequency-use groups showed differences in several constructs (ie, hypersexuality, depressive symptoms, boredom susceptibility, self-esteem, uncomfortable feelings regarding pornography, and basic psychological needs).

Of particular note was that the number of non-problematic high-frequency users far outnumbered the high-frequency users with problematic use, as defined by the Problematic Pornography Consumption Scale. Set against the backdrop of earlier studies, such as Kingston et al. in 2008, who found that “Statistical interactions indicated that frequency of pornography use was primarily a risk factor for higher-risk offenders, when compared with lower-risk offenders, and that content of pornography (i.e., pornography containing deviant content) was a risk factor for all groups,” these studies appear to confirm that “mainstream” pornography use is problematic for those already pre-disposed to repeated sexual abuse. It seems that the effects of pornography can vary and are dependent on factors beyond simply how much one views.

At the same time, however, a more recent study published last month is also very important. Katherine Jongsma and Patti Timmons Fritz examined the relationship of pornography use and intimate partner violence. From the abstract:

Two longitudinal actor-partner interdependence models using a structural equation framework to conduct path analyses demonstrated that (a) higher FPU among men at baseline predicted increases in IPV perpetration and victimization from baseline to 4-month follow-up for both men and women and (b) women's baseline FPU did not predict change in IPV over time for themselves or their partners. These findings suggest that frequent pornography use among male partners in different-sex romantic relationships may represent an under-recognized risk factor for IPV, and further research is needed to identify latent factors that may be contributing to this relation. Although women's baseline FPU did not predict changes in IPV over time, this may be because women used pornography less frequently than men.

Once again, the research is surprising with respect to the contributions of pornography to harm. As always, the full scope of the issues and implications is broader than can fit into a single blog post. 

While research has not found the clear link between pornography and sexual violence that one would expect, we now have a study providing some association between pornography and intimate partner violence. It is just one study, but this paper highlights the importance of continued caution and research in this area.

Taking these studies together, perhaps the greatest surprise is that frequency of pornography use is not particularly straightforwardly linked to impairment of functioning. It appears not to be like alcohol use, where drinking over a certain amount is statistically linked to poor health outcomes in a more linear fashion.  A considerable amount of high-frequency pornography use seems to have no appreciable effect for many. One implication of this is that while many politicians and activists argue that pornography is a public health issue, the data do not appear to support this.

Of course, within the field of treating sexual violence, there remain questions about high-frequency pornography use among those predisposed to acts of sexual violence. A scan of the Problematic Pornography Consumption Scale illustrates possible avenues of inquiry and the need to understand the context, values, and nature of the individual as well as what they get out of porn use.

However, it is clear that many men experience challenges in their lives as a result of their porn use and that many ask for help. Further study may reveal a deeper understanding of pornography as a precursor to intimate partner violence. It is still not clear that historical models or ideas (e.g., pornography addiction) are as comprehensive as they could be. For example, is reported erectile dysfunction really “porn-induced” or is it a combination of features such as frequency of porn use, moral incongruity, personal values and beliefs, and other aspects of the individual’s coping style and self-regulation that coalesce to form problems? If that is the case, shouldn’t we address these issues from that perspective instead of relying on more reductionist approaches?

As each of the papers highlighted in this blog post point out, more research is needed.

The challenges of child protection and safeguarding online.

By Kieran McCartan, PhD, David S. Prescott, LICSW, & Katarzyna UZIEBLO, PhD

Child protection and safeguarding are among the most challenging issues faced globally. The threats to children, new and old, are constantly evolving. It seems that every time we catch up and are aware of any given threat it changes and adapts. As part of his PhD, Kieran researched and examined Ulrich Beck’s idea of the risk society, which states that by the time we are aware of a risk it is often too late to change it and we instead must devote our time to risk management and damage limitation. This is very depressing from a prevention point of view; we desire to use existing knowledge to predict problematic behaviour and roll out interventions upstream to produce the harm from ever occurring. In child protection terms, this means identifying and working with at-risk populations (so at risk of committing an offence or at risk of being a victim), strengthening institution safeguarding practices, and upskilling communities about the realities of risk as well as how to intervene. Two distinct stories that highlight the challenges of child protection and safeguarding.

The first story is from the UK, where the online safety bill is being discussed, the core tenet of which is to keep children safe online from harmful material as well as risky (or more precisely dangerous) behaviours. The online safety bill has been discussed a lot over the past 12-18 months and has been through the hands of three Prime Ministers, with promises of a new wide-ranging bill that will redefine the online world and protect children. But this is seemingly not to happen, as with all policy it has been changed and altered, with core pieces dropped from the bill. One major portion was dropped this week, which was limiting access to legal but harmful material to children. The idea behind this change is that doing so would remove free speech and the right to choose from the online world. This is a strange argument; we have always safeguarded children in this way in the offline world by placing restrictions and verifications in place to make sure they cannot access inappropriate material. It begs the question of why we would do something online if we wouldn’t do it offline. This leads to the growing debate about the lived reality and the policing of cyberspace, and whether, how, and why behaviour is different on and off it? This then leads to another argument levelled against the tenets of the bill, which is that they are too hard, too complex, and too unwieldly to do. That should not be an excuse!

On a week where we are reminded of JFK’s famous statement about going to the moon (i.e., we do it because it is hard) we should refocus our attention on solving this issue. One response from the UK government is the use of age verification software and related policies, which we know is often a challenge and does not work, as parents often sign up for their children or allow them to use their accounts. Therefore, what next? We need tech and online companies to stand up and accept responsibility for what happens on their platforms, since only accountability changes policy and practice. What is the next big step forward in online child protection and safeguarding? And where is the corporate responsibility? Currently, it seems that we rely only personal and/or parental responsibility, which is not always as exacting or fit for the purpose as it needs to be.

This leads us to our second news story, which is about the explosion of child sexual abuse and exploitation in the Philippines through online platforms. Over the past 30 – 40 years we have seen the growth in sex tourism, especially in the far east, but over the past 10 – 15 years we have seen this evolve into cyber/online sexual tourism and abuse. The online sexual exploitation of children is a growing concern and often difficult to police transnationally. This means that the internet and the online environment has a role to play in preventing and responding to it, as it plays a key role in enabling it. The reality of the online sexual abuse of children, as with the trafficking of children for sex and the sexual exploitation of children is one of access, poverty, and hopelessness. All of this is set to increase with the current global costs of living crisis. How do we prevent sexual exploitation, both in person and online, when on some occasions it is being caused by the parents, family members and associates of the child? According to a report from the Dutch Centre against Child and Human Trafficking a family member is even involved in almost one fifth of the cases. On one level, it is about local education and prevention programs, but on another level its about the role of the internet in facilitating and not preventing its dissemination. Again, we hear narratives about the challenges of doing so, that it’s just too difficult and problematic. This time we hear that its because of culture and social differences; issues linked to cross-border and transnational working; that international law is sketchy at best; and the need for sovereign independence and the fact that it’s difficult to get a prosecution. All these things are true, to a degree, but it doesn’t mean that we shouldn’t do it. The internet spans borders; therefore, should its content and usage not span boarders too? If the internet is being used to exploit children in one country by someone from another, shouldn’t they be held responsible and therefore be accountable?

We have reached the stage where we need to hold the online community responsible for its actions, because harmful behaviour offline can be just as harmful online. It’s the content and behaviours that make something harmful, not merely the medium. When we think about how we respond to and prevent online sexual abuse and the tools we use, we need to future proof these and therefore we need innovation, not reinforcement of old ways. Whether we are managing the risks that our children face online or the way that they engage with technology we need to look at it from all angles, with fresh eyes.

We need to talk about sexual violence by … health care providers

 By Kasia Uzieblo, PhD., David S. Prescott, LICSW, and Kieran McCartan, PhD.

The forensic clinical field in the Netherlands has been shaken to its core several times in recent months by multiple serious incidents in psychiatric clinics following one another, including sexual and deadly assaults. Although serious incidents in these clinics are not a common occurrence, it is essential to reflect on the staff and patients affected and take further steps in trying to prevent such incidents.

When we learn that an incident has occurred in a forensic institution, we first assume that a patient has assaulted one or more staff members. Indeed, Dutch forensic clinical practice has faced very serious incidents in recent years, including a violent, sexual and deadly assault committed by a patient. Hence, such incidents occur and have a tremendous impact on the victim(s) and all those involved. Less often however, we hear about staff members mistreating or (sexually) abusing patients. Unfortunately, such cases occur as well. Without minimizing the seriousness of patients’ violent behaviors towards staff, we want to focus for a moment on sexually transgressive and violent behaviors caused by practitioners. We start from a recent case in the Netherlands.

In September of this year, it became known that an employee of a high-security forensic psychiatric clinic had been fired after sexually assaulting a patient. This employee had forced a patient to perform sexual acts. In April, this came to light during an interview with the woman in question. The employee was a sociotherapist who helps patients train pro-social behaviour and learn to cope with their mental health problems. When this came to light, the man was suspended and later eventually fired. On top of that, other problems came to light. At the same clinic, a staff member was fired for having a sexual relationship with a patient and an internship was stopped because the intern had started a relationship with a patient.

Especially the first case, but certainly also the other cases raise a lot of questions and concerns, first and foremost with respect to the patients. The patients that are admitted to such clinics have committed serious offences, but often also have a very traumatic past. Frequently, they have been mistreated, neglected and/or abused by those they should have been able to trust. These patients do not only struggle with their own often- extensive criminal past but also with their own repeated victimization. During their stay in the clinic, we try to teach them a prosocial lifestyle, which also means that they have to learn to trust others and to get attached again. This is anything but obvious to them and requires considerable work. Attachment problems and a deep distrust of others are characteristic of this population. It then almost speaks for itself, when the (little) trust they finally gained, is damaged, especially by someone to entrusted with their care. It leaves very deep wounds, Not to mention the psychological and physical damage they suffer from the sexual violence. The house of cards, being the new prosocial life, that staff and the patient have tried to build on often very weak foundations, then threatens to fall apart or just collapses at once.

The reach of this cannot be underestimated. Not only is the direct victim seriously affected, but also fellow patients. The questions then become whether their trust and faith in staff, and broader, in others, are still recoverable and how we, professionals, best try to restore it. And the third group we should not lose sight of is the staff. They, too, are badly affected by such incidents. They struggle with questions like “how did I not see this?”, “couldn’t I have prevented this?”, and “what now?”. Moreover, as was observed in this specific case, staff members were also confronted with stigmatizing remarks from the public. For instance, when the abuse was disclosed, staff members were confronted with condemning remarks in the vein of “You’re all the same,” and “you’re all rotten apples.” Also notable was the ripple effect: Staff from other clinics were very concerned, scared, and angry, and clearly felt the need to talk at length about this with colleagues, among others. Hence, the consequences of such violent and transgressive incidents are thus not limited to the setting where the incident took place but are felt far beyond.

Protocols for violent incidents by patients are in place in most, if not all forensic clinics. But do we have a protocol ready for situations when a staff member exhibits transgressive behavior? How can we best respond to this as a patient, as colleague, as manager, as society?

It is not our aim to propose specific guidelines here. However, we would like to point out some points of importance. As in other cases of (sexual) violence, we should start with the beginning and that is acknowledging the violence and the suffering it has caused. Abuse is abuse, no matter who the perpetrator is, no matter what status he/she has, no matter what position he/she holds, and no matter who the victim is. When you observe that the Dutch media described the abuse not as abuse but as 'sexual acts', you realize that this seemingly obvious starting point is already not obvious to many.

In addition, we need to have difficult conversations with our colleagues, within forensic clinics or in any workplace. Thinking that such cases certainly can't happen in your department implies closing your eyes to the fact that sexual violence can happen anywhere and that several characteristics of our work, e.g., relationships that are disproportionate in terms of power, are risk factors for (sexual) abuse. Increasing awareness and daring to ask difficult questions and engaging in not obvious conversations about prevention and identification of (sexual) abuse by professionals, (bystander) strategies when such abuse occurs, and rehabilitation after the abuse of all those involved, are already key starting points.

Another important question is how to involve patients and clients? Asking for help after a violent incident as a victim or a bystander is not easy, let alone when you are in a dependency relationship and vulnerable. Some organisations, for example, have started to develop guidelines for clients and patients. It would be useful to reflect within our field on this as well; to make suggestions available to our patients and to explore how we can make them more resilient within clinics or other settings.

So let’s have these conversations now, and let’s not wait until a complaint of abuse by a professional arrives at your own doorstep.

Therapy or Training?

By David S. Prescott, LICSW

A recent article titled, Accelerating the development of effective psychological interventions has become the source of some discussion within our field and beyond. In it, the psychology researchers describe using a “leapfrog” method for developing treatment approaches to combat depression. It has implications for professionals working in abuse prevention. Central to the authors’ argument is that traditional approaches to research can take a long time, and it often becomes apparent that changes to an approach are needed even before the results are published. Their leapfrog method involves being able to tailor approaches as the research is happening. While the fields of psychology, criminology, education, and medicine have long emphasized the importance of maintaining the highest standards of research, this article offers an alternative perspective on treating depression based on the lack of availability of mental health treatment for the masses.

With respect to the study itself, the authors have developed an online training program for people who suffer from depression. Because it is online, it can be delivered inexpensively to those who have internet access. It is not difficult to see how this could be a helpful triage for a lot of people, and these efforts are certainly worth pursuing. The authors make cogent observations about some of the most important characteristics of depression to treat and have certainly been creative in their approach. When it comes to conditions that rise to the level of public-health crises, innovations are welcome for consideration. Nonetheless, it seems that there are still many other factors to sort through before this can be meaningfully replicated and implemented with the public. Despite the attempt to streamline research, it seems that much further study is needed.

In fairness to the authors, the intent of their study was to investigate the feasibility of their approach more than to develop an effective treatment methodology. Just the same, there may be implications of this work that are worth considering. Not only does our field focus on preventing harm, we also need to ensure that our research and practice methods don’t cause further harm along the way. New ideas are welcome as long as we also guard against their potential misuse.

Unfortunately, much of the premise for this approach appears confusing. The authors make the point that there is a need for new treatments, as if there aren’t already many evidence-based approaches to mental health conditions such as depression. At the front lines, it seems that the problem isn’t that new treatments are desperately needed, it’s that access to the many existing treatments is limited by factors outside of the office. These factors include ease of access to treatment (including finding therapists, parking, transportation, insurance considerations, and the stigmas involved in getting help).  With respect to stigma, it often seems that one needs a confidential source simply to find the person to whom one can speak confidentially.

Interestingly, the authors don’t call what they’ve created treatment or therapy. Instead, it’s called training. This leads one to question whether we are giving up something that has a far deeper evidence base than online training programs. 

Setting aside the empirical underpinnings of their methods (and whether they’re the best approach in this case), there are still questions and concerns in resorting to this form of approach to depression. To start, there is much we still don’t know about the etiology of depression (and many other conditions), leading to confusion about the purpose of this training (for example, some research has found a link between inflammation and depression in some circumstances). Further, the current training seems not to account adequately for the depressing and anxiety-producing situations that people find themselves in during the current era. Again, some kind of self-study training in these situations could be welcome, but maybe it’s not prudent to consider it a full-blown intervention. A reading of the article showed no place for a licensed, responsible professional.

Thinking of the lessons we’ve learned in our field, consideration of the principles of risk, need, and responsivity suggest that this training is far from an actual treatment package. How does a one-size-fits-all training account for variations in risk for depression to continue? How is it tailored to address differences in depressive symptoms among individuals? And how is it adjusted to meet the specific-responsivity needs of clients, such as intelligence, learning style, or comorbid conditions?

Further, ethical considerations abound. Given that it is an online training and not interactive, where will responsibility lie when clients kill themselves? Will there be any feedback measures to ensure that the clients feel they are being helped and that the method is a good fit for them? Or will the measures used only examine symptom reduction? In some cases, will it not be even more depressing for clients that they have no one to talk to beyond the online training? One is reminded of comedian Rodney Dangerfield saying, “I called suicide prevention, but they put me on hold.”

Hundreds of research studies into “what works” in psychotherapy would also call this approach into question. The work of countless researchers, including Bruce Wampold, Zac Imel, Michael Lambert, Scott Miller, Jeb Brown, and many others, shows us that factors such as the therapeutic relationship, building hope and expectation that positive changes are possible, and ensuring that the goals of interventions match the client’s aspirations are critical components in efforts at change.  While any “training” is welcome, it seems that it can only fall short unless used in conjunction with an actual therapist.

A major reason to consider these issues is because similar efforts have taken place in the treatment of justice-involved individuals. One university developed treatment curricula that are so highly scripted that professionals administering them do not need a high level of education or experience. Common questions for which there have been few answers have included, “if it is this scripted, how do we tailor this curriculum to meet the needs of individuals in adherence to the principle of specific responsivity?” At the same time, it is also true that some organizations have developed self-help resources when no other options are available. “Helpful” is in the eye of the service user.

In line with the authors’ arguments, however, the trend in general psychotherapy seems to be in the direction of further medicalization. Fewer people look for therapists online than ask their physician for a referral. And that is against a backdrop of insurance companies that have so clearly prioritized profits over people in their business practices.

My hunch is that this approach will not bear fruit in the long term. Just because someone is trained does not mean that they will benefit in the long term from that training. It seems that the axiom most often forgotten in these endeavors is, “tell me and I’ll forget.  Show me and I’ll learn. Involve me and I’ll understand.” It’s easy to forget that people most often change not so much because of the insights they may gain from a book or training, but more through a relationship experience in which they can reflect on their lives, enact new skills, and build new futures.

ATSA conference 2022: Live again!

By Kieran McCartan, David Prescott, & Kasia Uzieblo

The annual ATSA conference has long been a time to come together, reconnect, establish new connections, partnerships, and develop new ideas and plans. This year’s conference was no different; except for the fact that it was. This was the first in-person conference that ATSA has held since 2019 in Atlanta, which meant that the reconnection was more powerful and relevant. Although the conference was online for the previous two years there is nothing like seeing people in person, attending sessions live, debating, discussing, catching up, and planning. The conference this year had excellence attendance with over 1,200 attending over four days (including the pre-conference workshops). Participants came from a range of countries including, but not limited to, the USA, Canada, Australia, New Zealand, UK, France, Norway, Denmark, the Netherlands, and Belgium to name a few. We will now look at each of our reflections on the conference and standout moments.

For Kieran the standout moment of the conference was the ability to reconnect with ATSA colleagues. This stood out more than most of the sessions and papers that he attended. The conference reignited the importance of collaboration, especially international collaboration, and the opportunity for people to come together and forge new paths. Additionally, the Keynotes by Apryl Alexander and Kelly Socia where standout performances. Their deliveries were powerful and commanding and their content powerful. Both focused on the power of truth at the individual and societal levels, as well as the need to engage, question, and step up. The conference had a range of posters, presentations, seminars, and workshops that covered everything from prevention, risk assessment, treatment, and desistance; it focused on the individual differences of many of the service users that we treat as well as support. The conference highlighted that sexual abuse is a global issue that needs global thought and collaboration that results in a nuance, globally informed response.

For David the standout moments of the conference included Drew Kingston and Liam Marshall provided an excellent pre-conference title on Compulsive Sexual Behavior Disorder. It is one agreed-upon term signaling a condition that has gone by many names over the years. Drew Kingston offered an excellent historical overview of the research and Liam Marshall offered ideas on treatment. As is often the case, what made it an excellent workshop was what was not said: All too often, presentations on this topic can become mired in the personal beliefs and moral judgments of the presenter. While no one is unbiased, especially when it comes to sexuality, Dr.’s Kingston and Marshall provided a refreshingly balanced overview of the issues at stake.

Dr. Alissa Ackerman gave an unforgettable talk on involving the “authors of sexual harm” – those who have sexually abused others – in restorative justice efforts. After providing an overview of restorative justice and how she has worked within it, she discussed topics such as processes for how these authors can make amends. As she often does, Dr. Ackerman shared how her own history of victimization led her to share her experiences with others, including in treatment groups for individuals who have abused others. As one might imagine, these can be powerful experiences that leave virtually no one unmoved. Dr. Ackerman’s work and charismatic style are a reminder that practicing restorative justice, and the accountability processes within it, can be very difficult work indeed.

For Kasia the standout moments of the conference included: The conference experience was again wonderfully diverse. As every year, it is enormously difficult to choose only a few items from the conference program. But what has stayed with me most of all is that feeling that we are more committed than ever to sexual abuse prevention. In doing so, new paths are being explored and we are clearly also taking the time to critically reflect on our current knowledge, on where things need to be improved, and on what we do not yet know.

Take risk assessment, for example. A topic that has dominated our field in recent years. Although several sessions focused on the important topic of accuracy, the gaps in our knowledge regarding risk assessment as well as the implementation of the tools were also extensively discussed. For instance, Maaike Helmus, Seung Chan Lee, and others raised the importance of cross-cultural comparisons regarding – for example – the accuracy of risk assessment tools. Differences are indeed found that may have negative implications for – for instance - already generally disadvantages minorities. A thoughtless application and interpretation of risk assessment outcomes within specific ethnic groups (among others) is clearly inappropriate and potentially harmful. However, more research is needed to assess how to deal with these differences in practice.

What I also strongly appreciated was the attention given to the person exhibiting deviant sexual interests and/or behaviors as such. This included extensive consideration of the psychosocial well-being of this group and the impact of social and self-stigma by Sara Jahnke, Nick Blagden, Maggie Ingram, and several others. In addition, several speakers (e.g., Caoilte O Ciardha and Gaye Ildeniz) delved into the help-seeking behaviour of this group, examining what factors facilitate or hinder this behavior. These sessions provided insights that are crucial for all professionals working on prevention, but certainly also for preventive projects such as Stop it Now! and Circles of Support and Accountability, which were also highlighted extensively during the conference. Various sessions also herald an exciting time in terms of the treatment of people who have committed sexual offences and/or are struggling with deviant sexual interests. For example, Eveline Schippers explored a crucial question of how sexual deviance develops and how we can use this knowledge in treatment. Wineke Smid, Ross Bartels, and Nina ten Hoor explored the implementation of EMDR treatment in these groups. Franca Cortoni, Michael Miner, and Ian McPhail described how they aim to unravel the black box for us by finding better ways to identify what changes are elicited by our treatment programs and whether these changes are indeed related to a reduced recidivism risk. I am already extremely curious to see what new insights all these research projects will bring at the next ATSA conference.

Despite all this enthusiasm from researchers and professionals that I was able to experience once again, my spirits did sink a little at the end when Allyn Walker took the stage. Walker described the horror they had to endure when their research got media coverage. Their story once again made one realize that what we do within ATSA and beyond should not be taken for granted, that still many are opposed to what we do. But Walker’s story and the public’s reactions also spoke of hope: it showed how we can support each other in the prevention of sexual abuse and how important is that we bring solace to each other. 

ATSA 2022 was also a time of change, we said goodbye to our long-standing Executive Director Maia Christopher and welcomed in our new Executive Director Amber Schroeder, in doing so we opened a new chapter in our organization. The annual conference has always been the hear and soul of ATSA, and the passing of the baton from one Executive Director to another was the ideal place to do it, the way that we have passed the baton from one president to another as well as from one board member to another. It solidifies the importance of ATSA and ATSA as almost everyone has noticed, the primary feature of this year’s conference was the enormous sense of homecoming. Friends who hadn’t seen each other in all that time were reunited, if only briefly. And the nature of the conference meant that we weren’t as affected by the (in)famous Los Angeles traffic nearly as much as we feared!

Outcomes from the Independent Inquiry into Child Sexual Abuse in the England & Wales

 

By Kieran McCartan, PhD.

The Independent Inquiry into Child Sexual Abuse (IICCSA) has released its final report, in which it outlines the scale and nature of Child Sexual Abuse and Exploitation in England and Wales. The IICSA was created by Teresa May, MP, in her role as Home Secretary. Over the 7 years that it was in existence, its role was to understand the roles and responsibilities of government, state, and private institutions duty of care to protect children from sexual abuse and exploitation, and why they failed to do so. Over its life the inquiry held more than 300 days of public hearings, processed over two million pages of evidence, heard from over 700 witnesses, and engaged with over 7,000 victims and survivors. The Inquiry, through 15 investigations identified, as the Australian Royal Commission into Child Sexual Abuse (2013 – 2017) had before it, that:

• “Child sexual abuse and exploitation takes many forms including contact and non-contact offences.
• Children, particularly those who are sexually exploited, are often degraded and abused by multiple individuals.
• Historically, inadequate measures were in place to protect children from the risk of being sexually abused – sometimes there were none at all.
• Children were believed to be lying when they tried to disclose their experiences of abuse.
• Those who had been victimized were frequently blamed as being responsible for their own sexual abuse.
• Within statutory agencies with direct responsibility for child protection, there was too little emphasis on the complex and highly skilled work of child protection. Decisions about children were not unequivocally based on the paramount interests of the child.
• Multi-agency arrangements still lack focus on child protection.
• There is still not enough support available to both child and adult victims and survivors.
• Child sexual abuse is not a problem consigned to the past, and the explosion in online-facilitated child sexual abuse underlines the extent to which the problem is endemic within England and Wales.
• The devastation and harm caused by sexual abuse cannot be overstated – the impact of child sexual abuse, often lifelong, is such that everyone should do all they can to protect children.
• Finally, this is not just a national crisis, but a global one.”

The IICSA reinforces current research on Child Sexual Abuse and Sexual Exploitation, as will as reiterating the changes that need to be made in policy and practice with an emphasis on prevention, reporting, multi-agency collaboration, and a call for greater community engagement. The Inquiry has made 20 recommendations in this report which are too detailed to go into in this blog, therefore will select a few to highlight:

• The UK government should collect a single database on all data collected in respect to child sexual abuse and exploitation.
•  The development of Child Protection Authorities for England and for Wales which work to improve child protection practices.
• Creation of a cabinet minister for Children, which is significant as they would have a government portfolio for child safeguarding and protection.
•  Improving compliance with the statutory duty to notify the Disclosure and Barring Service (DBS). (DBS helps employers in England, Wales, and Northern Ireland make safe recruiting decisions and prevents unsuitable people from working with vulnerable individuals).
• There should be an extension of the disclosure regime to those working with children overseas.
•   Increase Pre-screening to require regulated providers of internet search services and user-to-user services to pre-screen for known child sexual abuse before material is uploaded. 
• Increase Mandatory reporting of Child Sexual Abuse and Sexual Exploitation.
• Increase specialist therapeutic support for child victims of sexual abuse
• Introduce a code of practice on keeping and accessing records which relate to child sexual abuse.
• The development of a single redress scheme for victims and survivors of child sexual abuse and exploitation.
• The UK government should change the law to make sure that internet companies that provide online internet services and social media introduce better ways to check children’s ages.

The recommendations highlighted here reflect ongoing discussions in the fields of sexual abuse prevention, risk management, public safety, and reintegration. A lot of them are not new and have been discussed previously, like greater regulation of the internet and age verification, often not reaching a satisfactory conclusion or agreement. The creation of the policy roles and organisations is important in developing as well as maintaining other recommendations like the creation of a single database, better use of DBS checks and greater regulation, as well as compliance. However, the biggest gauntlet laid down is around the expectation that all suspected child sexual abuse and exploitation is reported, recorded, and (potentially) investigated which will place a range of services under pressure. The investigation of suspected Child Sexual Abuse and Exploitation is important, and necessary but it means that that the services that do this (i.e., police, social care, social work, etc) need the resources to do this in an appropriate and systematic fashion needs resources, which at the current moment with the looming financial crisis and potential cuts to public services will be a challenge. All these recommendations will take significant political commitment. This will be quite challenging in the UK now having lost its 2nd Prime Minster in less than two months. Hopefully seven years of work has not landed at the wrong time and on deaf ears; this report is significant needs to change the child protection landscape but whether it will remain to be seen.

We Have So Much Knowledge. When Will We Learn?

By David. S. Prescott, LICSW, McCartan, K. f., PhD, & Kasia Uzieblo, PhD

Two news items caught our attention this week.

The first is an article published this month by The Lawyer’s Daily in Canada. It describes how Circles of Support and Accountability (CoSA) has been defunded over time in Canada. One of the better-researched approaches to reducing re-offense, especially among high-risk individuals re-entering the community from prison. Ironically, CoSA began in Canada; the story of its origins is inspiring. However, as the article notes:

CoSA was funded by the government of Canada for 15 years starting in 2000. Its annual budget has never exceeded $2 million, compared to the $5 billion Canadian governments spend each year on jails and prisons. Moreover, the public and private costs of a single serious sexual assault have been estimated by Public Safety Canada as being several hundred thousand dollars. 

Despite this, funding for CoSA was terminated by the Harper government in 2015. In 2017 the federal government again provided funding of about $1.5 million per year to support 15 sites across the country that provided circles for approximately 300 people with sex offence convictions. 

This funding expired in March 2022 and has not been renewed. As a result, all four CoSA sites in Atlantic Canada and Quebec have been forced to go on hiatus and three sites in Saskatchewan have cut back programming. Our sites in B.C., Alberta, Manitoba, Nova Scotia and Ontario are preparing for reduction or closure if sustainable funding is not secured in the next six months.

The international research evidence supporting CoSA is good. A quick glance at the finances above shows just how cost-effective it can be in helping Core Members successfully integrate into society and learn to manage their desistance journeys, and therefore risk of reoffending. The evidence for keeping people in prison until their mandatory release date is very poor, and the high financial costs of incarceration are well known, as well as its absence of a meaningful return on investment.

All this leads one to wonder what drives politicians, governments, and policymakers to de-funding CoSA? With the governments of countries like Australia, Belgium, Germany, the Netherlands, Norway, Iceland, and New Zealand looking to establish, expand or revive CoSA programs, why is the Canadian government pulling its support? Is this about public outrage, a significant re-offense problem, a high-profile case, media outcry, or the impact of tightening public spending? This has been on the books for a while and we in the international community had heard rumors of further de-funding as far back as 2020. It certainly appears to be more ideologically than research-driven, which is always an ever-present challenge in the reality of sexual abuse policy practice.

On the other hand, the question remains of which ideology is driving this? Is society more invested in punishment than in doing what we can to prevent re-offense? Or are politicians, and to a degree policy makers, giving the people what they think they might want? With the growing recognition that offending behavior is linked to a range of social, economic, health, and wellbeing outcomes,  shouldn’t we ensure that programs (like CoSA), which are grounded in this knowledge don’t fall by the wayside in traditional criminal justice debates that have become outdated?

Elsewhere in Canada, which has certainly been a world leader in producing knowledge and practice approaches, a judge in Newfoundland and Labrador relied on rape myths to acquit a teenager on charges that he had sexually assaulted a 15-year-old friend. Despite her overt attempts to fight back and stop the assault, the judge apparently indicated a belief that the young woman could have stopped the assault. From the article:

“The trial judge said if the complainant had been telling the truth, she could have simply left the house when the boy asked her to find a condom, and also suggested she may have been upset due to the "thoughtless and callous manner" the boy left her house.

 

"[The complainant] did not take the opportunity to leave the situation when she says it was offered to her.… There is no plausible explanation as to why she just did not leave the house and seek help," the trial judge said. 

 

"The impermissible myth — a woman can prevent a rape if she really wants to — was part of the judge's foundation in rejecting this testimony from the complainant," the appeal decision said.

It is by no means the first time a judge’s leniency has created backlash. Many readers will remember the Brock Turner case at Stanford University; the judge in that case faced a recall vote and was forced to ask not to hear any more criminal cases. Also, internationally in the UK this week,  a barrister at a private family hearing in Belfast stated that a judge had suggested that “only stupid women can be raped.”

What puzzles us, however, is the trend away from using knowledge that has been well-known for decades and has been the subject of very considerable media attention, and not simply during the #metoo movement years. However, these cases, over many years, highlight that legal professionals need additional training in respect to rape and sexual assault. This is urgent given the volume of cases resulting in a conviction is dropping, especially in the UK with calls for specialist rape courts to be established. But if judges and lawyers are not trained to understand the reality of sexual abuse and its impact, then how can they be expected to challenge rape myths? The real myth here as that our knowledge base automatically updates as society evolves and grows. We need to give people the skills and knowledge to make informed, professional decisions. In addition, we must also recognize that training will be insufficient for some since their attitudes and beliefs are so intractable that they are difficult or even impossible to change.  For such cases, we also need to find an answer.

The two cases that we have discussed this week may be rooted in Canada but as we have seen, they are not dissimilar to cases and policies internationally. We need to remind ourselves that social change takes time, and we all need to be involved. These cases also reinforce the need for us to lead in and have pro-social, educated, and engaged conversations on changing attitudes as well as practices around sexual abuse.

Current storms in the UK demonstrate the need to think about sexual abuse prevention and accountability

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

To say that the past couple of weeks in the UK has been turmoil is an understatement. We’ve seen the death of a monarch, a new prime minister, the cost-of-living crisis expanding, increase in gas and electricity prices, as well as a falling pound and a problematic financial outlook. In addition, there have been a number of criminal justice challenges, like the inquest into the death of 14-year-old Molly Ringwall, which highlighted the challenges and responsibilities of social media (it found they directly contributed to her suicide). There was also  a statement from members of Parliament that IPP (Indeterminate Imprisonment for Public Protection; the UK equivalent of Civil Commitment) are flawed and in need of reform and all prisoners on them need to be resentenced. Finally, there has been a recognition that the cost of living crisis puts more women and children at risk for domestic violence.  It’s been a challenging week on the topic of sexual abuse as well, with two news stories at either end of the offending spectrum that ask questions about prevention and response.

Last Friday a news story broke about a Finnish Ice Hockey player joining the UK Elite League team the Glasgow Clan. Lasse Uusivirta was charged with rape for an incident that occurred while he was a university student at UAH (University of Alabama in Huntsville) in 2013. He admitted the rape of an 18-year-old college student at the time but left the USA after he was charged but before he could be arrested. The USA authorities decided not to pursue the international case and return him to the country for trial but stated that the case was still active, and he would be arrested if he ever returned to the USA. It emerged over the course of the next 24 hours that the Glasgow Clan had been aware of this and either ignored it or tried to water it down. It resulted in the suspension of their Coach and General Manger on Friday morning and the rescinding of Uusivirta’s contract. Across this period, there was massive fan backlash against the club and sponsors threatening to pull funding  demanding that they be more socially and morally forthright. The incident raises a lot of questions about accountability and responsibility at an individual and corporate level. The issue is not about redemption or desistence from offending, but rather about accepting responsibly and being held to account by the state. The reality is that Uusivirta committed rape, admitted to it, and then left before he could be held accountable. Knowing this, the club attempted to boost their playing potential by ignoring his outstanding criminal accusations. Unfortunately, this is not the first, nor will it be the last, example where double standards of sports stars and athletes mean that clubs are willing to look the other way and not act with moral authority.

This doesn’t only happen in the UK. For instance, in Belgium, the soccer club of Antwerp appointed Marc Overmars as a new director, knowing that Overmars left a Dutch club, Ajax, just a month before his new appointment in Belgium because of sexual misconduct towards his colleagues. The club decided to do nothing despite the negative reactions surrounding the appointment of Overmars. After some of the Belgian club’s successes, you get the impression the misconduct never took place.

The players may be fugitives from justice and accountability, but the teams have made themselves fugitives from morality.

In the UK case, had there not been the backlash from the fans, sponsors, and media the team may not have changed their minds. This case clearly evidences the need to hold organizations to account and emphasizes the importance of the community voice in standing up to sexual abuse.

Another example of the lived reality of sexual abuse prevention came on Monday with the trial of Wayne Couzens, who was convicted of raping and murdering Sarah Everard while on duty as a police officer during the Covid-19 pandemic, for previous incidences of indecent exposure (i.e., exhibitionism). This led to a debate in the UK press about the role of exhibitionism as a predictor for contact offending. Exhibitionism is often seen as a nuisance crime, with several myths surrounding it about the psychological and social nature of the individuals that perpetrate it. Like all sexual crimes, it is under reported, but is believed to happen to one to two thirds of women at some point in their lives. By comparison to other sexual offenses, exhibitionism is significantly under researched with a lot of the evidence being old and outdated. However, the research does demonstrate relatively high recidivism rates and a likelihood of escalation from exhibitionism to contact offenses, 5-10%, but this is intertwined with other risk factors like antisocial behavior. The reality of this story was not about the underreported or problematic nature of exhibitionism, but rather if Wayne Couzen’s exhibitionism was a predictor of his future offending and the murder of Sarah. Would Sarah’s death have been prevented if there had been an intervention earlier on? It’s difficult to say, but it does raise the question of what are the role of risk predictors, how do we use them, and ultimately what interventions can be provided to reduce escalation?

Although these two cases seem different, they are not. They illustrate the importance of understanding the impact of sexual abuse across the lifespan, including in terms of prevention and risk of first time offending and in terms of accountability and desistance from offending. These cases highlight the individual complexity of sexual abuse and the need for an informed community, a professional response to it, and the responsibilities of all involved, including organisations and employers. Sexual abuse impacts us all and with the challenges that the UK (and western world) faces in the coming years with the cost-of-living crisis, these are set to increase the potential for a reduction in support services and greater likelihood of offending. While we have mostly left behind the Covid pandemic, we are still experiencing a sexual abuse pandemic which is soon to be followed by a larger poverty pandemic.

To cancel or not to cancel: Should this be the question?

 By Kasia Uzieblo, Ph.D

September 12. After almost three years without concerts, we were finally back in front of the Antwerp Concert Hall. Unfortunately, with very mixed feelings. Arcade Fire was performing, one of the most successful indie rock groups of all time. However, the group found itself in the eye of an unexpected storm, at least for outsiders like us. On August 27, Pitchfork published an article on alleged sexual misconduct by Win Butler, the front man of the band. Three women and one gender-fluid person made allegations of inappropriate sexual interactions and sexual assault. A couple of days later, the Canadian singer-songwriter Feist, announced that she would leave the tour with the band following these allegations. What followed was a veritable Twitter storm: people shared their disappointment en masse, numerous fans wanted to sell their tickets at rock-bottom prices, and many fulminated over the fact that ticket sellers did not want to provide refunds. The images of the first concerts in the UK were telling: many shared pictures of half-filled halls. Various radio stations around the world decided to stop playing the group’s music. It looked very much like the group would be completely cancelled. But it gradually became clear that the group had decided to face the storm with their heads held high and allow the tour, which involved dozens of people, to go ahead.

In Belgium, however, the mainstream media remained conspicuously silent on the issue. The contradiction between the (online) noise and the silence on the Belgian platforms where you would expect discussions were striking. I noticed that I did miss those discussions, I missed a debate. I missed some footing and a sharing of reflections. This also surprised me; I’ve been working on the topic of sexual violence for almost a decade, I have worked with people who are confronted with such violent behavior and people who resort to such behavior, as well as with people who both were victimized and who committed sexual offences. And yet.

Rationally, we know – as someone working in the field- that a person is more than his/her misconduct. We know that a person can have both good sides and talents but at the same time may be able and willing to go beyond other people's boundaries. We also know that, whatever Butler will say about this, his version of the facts will hardly get a chance.

But of course, no matter how much experience one has, no matter how many discussions one has had on the topic, reason and emotion sometimes go their separate ways. Before the concert, we struggled with a lot of questions: With attending the concert, do you condone the acts of which Win Butler is accused of? By applauding, do you endorse possible abusive behavior? By singing (in my case: blaring) the band’s songs along, don’t you a wrong signal to victims of sexual misconduct? And many more.

After the concert, a couple of not-very-profound pieces on these dilemmas appeared in (very) few newspapers. These were unfortunately limited to describing some reactions from people who attended the concert. Some of the reactions: “To go or not to go: I have had the discussion at home with my friend, but as far as I know, it remains only accusations and there is no official complaint. If he were under suspicion, only then would I reconsider my decision." and "We have to admit that we didn't actually think about it". A few fans also didn’t want to react because they didn’t want to contribute to “misplaced mass hysteria”. But also: “I don't condone that - neither Butler's behaviour - but eliminate everyone who has never committed a mistake and 1,000 people are left on earth." and “as long as it sticks to accusations, it is unfair to punish the whole group.”. At first, I was somewhat relieved reading the responses: people appeared to be able to give people a second chance and not go along with black-and-white thinking and with thinking in terms of monsters versus angels. But soon cynicism crept in and many questions arose: aren’t these people just finding reasons to justify any lack of reflections on the matter and/or their enthusiasm for the concert? Would they be so nuanced about my clients as well? Other comments in an English newspaper that tended to apologize the alleged misconduct did not reassure me either: “He’s a rock start, it comes with the territory, it's the lifestyle.”, “Women are chasing him every day of the week. They are one of the biggest bands in the world.” or “No offence to the male species but a man’s a man.”

What I notice is that people are beginning to tire of the subject of sexual misconduct. The debate on how we as a society should or could best respond to (alleged) misconduct is hardly held anymore, especially when it comes to more ‘ambiguous’ cases that do not correspond to people’s general perception of sexual violence and to cases that concern a person who does not adhere to the general view of the monstrous sexual predator. As we see in the examples above, victim blaming tendencies and a wide range of cognitive distortions then lurk around the corner. In my view, even more dangerous is that we increasingly seem to be looking away, ostensibly hoping that when we look away, the problem does not exist or will pass by itself. With the many problems the world is currently facing (climate, war, inflation, just to name a few) and the fear and anxiety that come with it, issues on (sexual) misconduct seem to fade again into the background. And when it is discussed, only two possible ‘solutions’ are often put forward: should we cancel the perpetrators or not?

The apparent arbitrariness with which these choices are made within society (to look or not to look, to discuss in depth or to ignore, cancel or not to cancel) also affect our clients and patients. They see this happening. For some, such observations may provide confirmation that their behavior may not have been so bad after all. Many will however be left with rather a sour feeling: Why do others get a second chance, and not me? Why am I ‘canceled’, and not them?