Friday, January 13, 2023

A cautious welcome to 2023

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

We deliberately opted not to do a year in review post this month. Our colleague, Katie Gotch, summed up the attitude of many towards the New Year with a quote she’d heard: "I need 2023 to come in, sit down, shut up, and don't touch anything."  The quote summarizes the main reasons why we took a different approach this year: we want to move on and engage with 2023 rather than dwell on what did not achieve or simply pat ourselves on the back about what we did well.

For David, one of the signal events of 2022 happened at the margins of our field. Joanna Moncrieff and her colleagues published a paper that many felt put the last nail in the coffin of “Serotonin theory”: the belief that Serotonin plays a causal role in depression. Whatever the nuances of SSRI medication and depression, it was surprising to see how many professionals responded by blaming the media and saying words to the effect of, “We’ve known this for years.” It brought to mind the massive marketing ploys of the pharmaceutical industry, that hyped the idea of depression being caused by “chemical imbalances.” Whatever the actual statements by individuals, there was no attempt by “Big Pharma” or their related professional organizations to disabuse professionals of this notion. Of course, we are now seeing similar hype related to the use of psychedelic drugs, which appear to be very helpful to some and a nightmare to others. A leading proponent of these methods, Rick Doblin, has stated publicly that he hopes to help create a “spiritualized humanity” by 2070. Elsewhere, pharmaceutical companies were compelled to settle any number of lawsuits related to the opioid epidemic.

While there is no question that medications can help people, one hopes we can see a return in 2023 to a quieter and broader focus on those therapeutic principles that research has shown really do help people change. In an era where treatment providers remain exhausted from the conditions of the pandemic, David’s biggest hope is that our field can focus more on the characteristics of effective therapists,  and the factors common to all effective forms of psychotherapy. Study after study has pointed to the importance of these areas in treatment, even as they do not receive as much attention as other, more aggressively marketed approaches. The mechanisms of change are complicated; perhaps we can go back to the basics of good therapy. In line with the request for 2023 not to touch anything, let’s give the last word in this area to Public Enemy, who famously sang, “Don’t believe the hype.”

Also in 2022, we unfortunately failed (again) to completely wipe sexual violence (and other types of violence) off the map. On the contrary, through the war in Ukraine, we Europeans closely observed how common sexual violence is within a war; how it is used as a torture technique and how soldiers make use of their power and the chaos to commit such acts with impunity. With all this chaos and the countless problems that these Ukrainian families are facing, Kasia holds in her heart the prevalence rates of domestic violence since the start of the war. In addition, many scandals have erupted in Belgium and several neighboring countries, and the general community has been (again) harshly confronted with the facts: sexual transgression can happen anywhere and can be committed by anyone.

If we can speak of a silver lining at all, it is the fact that sexual violence still receives attention from society and policy. But it is high time that we don’t just exclaim this realization through hashtags or similar on social media or during political shows, but actually take action in 2023, action that focuses on prevention and draws on both empirical insights and practice. Kasia briefly touches on two issues that could facilitate such actions or at least offer interesting opportunities. The first issue has to do with a personal experience. Although she has been lecturing to various audiences for many years, in 2022 she gave a lecture on the prevention of sexual violence at a conference organized by victims of sexual violence. This has been one of the biggest challenges of her professional career: what language can I use and what can I not? Does this audience want to hear about prevention? Does this make me seem to minimize what has happened to them? These are some of the questions that kept her awake. Fortunately, an attack with rotten tomatoes or a reverberation of boos never came. On the contrary, the audience reached out afterwards: They wanted to hear more about research and clinical experiences, and they wanted to help think about how they could help support effective prevention programs. Kasia therefore hopes that 2023 will be the year when the ‘world’ dealing with those who have committed sexual offences and the ‘world’ dealing with those confronted with such offenses will move another step closer together and join forces to push for more effective prevention.

And that brings her to her second issue, which is the policy and legal changes that are looming in Belgium. 2024 is an election year in Belgium. That makes 2023 a year when politicians want to score or at least attract attention to themselves. Kasia hopes that after implementing mainly harsher punishments for perpetrators of sexual violence in 2022, they will now take the little time that is left, to develop and/or implement evidence- and practice-based strategies to prevent sexual violence, that they will be guided by the insights of experts from science and the field, and that they will think long(er)-term. In 2022 steps have been taken to -among others- develop a substantiated risk assessment and management policy for probation officers and to require thorough risk assessments in court investigations. But Belgium still faces major challenges in the actual implementation of these new policies, and in areas such as treatment (e.g., various groups of offenders are excluded from therapies and hence do not get an opportunity to work on themselves). 2023 can be seen as the year of last chances for the current government, including within our field of work. On that front, Kasia hopes for two things: that policymakers will prove this year that they have the right goals in mind (adequate prevention) and that colleagues in the field will not hesitate to speak up when things threaten to go in the wrong direction.

For Kieran, building on what Kasia has said, 2023 offers us the opportunity for connected global efforts aimed at effective prevention and coordinated responses to sexual offending. In Europe, there have been increased conversations and co-ordination between policymakers, professionals, and organization around reduction of violence against women and girls. These have occurred alongside an increased interest in epidemiological criminology approaches that examine sexual and domestic violence from a health perspective. This feels like a watershed moment in the prevention of sexual abuse, as there are opportunities to develop effective and evidence-based policies within and across countries: the opportunities for transnational offending have opened up in the wake of the pandemic, both in terms of travelling to commit contact offenses as well as in the opportunities for online offending. Sexual and physical abuse are global issues requiring a coordinated approach. Therefore, it is important that we use all the opportunities that we have to “lean in” and further the conversation.

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