How do we honor and stay present with others’ pain?

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

It’s been just about a year since we published the first of two blogs, an article, and a conference presentation about sexual and other interpersonal abuses in what is referred to as the psychedelic therapy “community.” These followed a thoroughly sourced podcast by Lily Kay Ross and Dave Nickles, whose work has been featured in media reports throughout much of the world (including this interview).  Still, very little has changed. Some organizations have commented on abuse and floated ethics policies and statements but taken no further action. There is little doubt of the sometimes-transformative power of psychedelic drugs.  The worrisome part is the unacceptable level of risk for trauma outside of ethical practice, which itself is not always carefully defined.

Strikingly absent, however, has been any accountability  at the source of abuse, either the ones who perpetrate it or who are responsible for the environments where it occurs.  Like the #MeToo movement, organizations have made statements  announcing that they do not tolerate abuse, but have done little more. Indeed, those abused are often blamed, or told that they shouldn’t have been allowed into treatment and/or research studies due to the personality characteristics they presented with. Unfortunately, one challenge with trauma is that it can be hard to understand from the outside looking in, and hard to explain from the inside looking out.

Even among trauma experts, there can be a lack of compassionate responses. Some practitioners employing  psychedelics in treatment have openly  minimized those who speak out about and disclose abuse so they “don’t end up derailing the movement.” Other psychedelic proponents have suggested that subjects of abuse, while worthy of support, are not credible commentators since they are still so raw and vulnerable in the wake of their experiences. These subjects rightly point to public perceptions that they can only be taken seriously when they are the “perfect victim.”

Meanwhile, opponents speaking out against these abuses are occasionally surprised at the reactions they get. Some responses come from people with similar experiences of abuse, while others      pose questions that have already been answered in easily available articles and podcasts. For these individuals, disclosing the worst experiences of their lives perpetuates the aftermath of the very discussions they’d hoped would no longer be necessary.

Most recently, Ross and Nickles engaged with the production team of John Oliver’s Last Week Tonight, who were interested in learning more about the potential risks and harms in current psychedelic-assisted therapy. As the Psymposia website describes it, “Last Week Tonight has a history of highlighting the self-serving tactics of unaccountable corporations, the failures of regulatory agencies to act in the public interest, and the complicity of the mainstream media in advancing narratives that serve the powerful.” Even so, the resulting program made no mention of the widely emerging concerns documented, and instead simply bolstered the dangerous hype that is already surrounding psychedelic therapy.            

There is ample cause for concern. Psychedelic-assisted therapy is becoming big business, with numerous media articles addressing the pros and cons of investment in the industry. Entire papers have been published on the legalization of psychedelic drugs, while others address patents for them. How can there be so little consideration for preventing abuse? Especially against a backdrop when so many claim that “there’s no such thing as a bad trip”? One training appeared to minimize the issues by referring to instances of abuse as “erotic transference” in its title.

Perhaps more importantly, how can we ignore the voices of those who have been victimized by the people they trusted, while under the influence of powerful drugs? These survivors could inform prevention efforts as well or better than anyone. In a recent conversation, one person who publicly disclosed abuse while in psychedelic therapy stated, “Maybe it’s because so many people don’t know what to do with it.”

This idea, that most people simply don’t know how to handle accounts of abuse and trauma, is an excellent point. Bearing witness to abuse, suffering, and anguish is not easy, particularly for anyone who never had to. Thinking back on the #MeToo movement, Black Lives Matter (and other) protests, the Jeffrey Epstein abuses, and so many other circumstances, it often seems that most people simply want abuse and exploitation to go away. It can be hard to listen to accounts of abuse; it can be even harder to sit with another’s pain. More challenging still is bearing witness to the aftereffects of prolonged abuse (for example, being abused while on psychedelic drugs in a purportedly therapeutic situation that was supposed to help resolve a history of trauma). Most people who are able to show up and be present with survivors have learned their skills the hard way, through their own victimization.

While many therapists (and friends and allies) show up to this work every day, it’s easy to avoid, forget, or not see the sheer depth of human suffering. The literature provides all sorts of material about effective trauma treatment techniques, protocols, methods, and models. However, few educational programs provide much focus on the simple act of sitting in a room with a person in anguish and remaining clear, compassionate, and present with them.

New approaches to reducing suffering are welcome, although the current hype of the psychedelic movement is reminiscent of many “miracle cures” of the past.  Until we as a society can look at our own suffering and prioritize the needs of people who have been victimized, it is difficult to see how anything will improve. While we rush into the heady promise of new drugs, maybe we can also remember the importance of being an ally to those who suffer.

What does ATSA’s name change mean for prevention?

By Joan Tabachnick and Judith Zatkin

We believe that ATSA has always been a leader in the fight against sexual abuse and continues to offer unique insights into the world of prevention.  The unique lens we offer is a deeper understanding into preventing the perpetration of sexual abuse. 

In 2014, ATSA’s prevention committee wrote an important framing document that helped to clarify that all of ATSA’s work is about prevention – meaning that the treatment and management of adults who have sexually abused as well as our work with children or adolescents engaging in problematic sexual behavior is about protecting victims and preventing future harm.  This framing document suggested that we always talk about our work as prevention.  It goes onto explain that a well framed response to the question “What do you do” needs to address WHAT we do as well as HOW we do our work in a way that incorporates our values and WHY.  This helps our audience see a more complete picture.  So, the framed answer is: 

I work every day to prevent sexual violence and to keep children and other vulnerable people safe. The way I do my work is by preventing the perpetration of sexual violence. I work with (adults, teens, children, women, kids with learning disabilities, or others) who are at risk to sexually abuse others or who have sexually abused in the past. Through a variety of professional approaches, I  work to ensure that no one is sexually abused again. It is difficult work, incredibly rewarding, and my successes mean a safer community.

If what we all do is prevention, why did we need to add “prevention” to our name to become the Association for the Prevention and Treatment of Sexual Abuse? 

The name change offers us an opportunity to more clearly focus a part of our work on primary prevention – preventing sexual abuse before anyone is harmed.   According to the CDC, primary prevention is defined as:  Approaches that take place before sexual violence has occurred to prevent initial perpetration or victimization.  A few years later, the Stop SV Technical Package focused on CDC’s “emphasis on the primary prevention of perpetration, or stopping SV perpetration before it starts”.

What these documents demonstrate is that when one truly wants to prevent sexual abuse before anyone is harmed, one needs to look at preventing the perpetration of sexual abuse and preventing the development of these behaviors in children, youth and young adults.  ATSA envisions a world without sexual abuse, and we believe ATSA can do more to increase our work in primary prevention to move toward this vision.

The important work of ATSA members involved in the assessment, treatment and management of individuals who have caused harmed is considered secondary and tertiary prevention – interventions that take place after someone is harmed.   The assessment tools that have been developed look at the Risks, Needs, and Responsivity of those who have already harmed to ensure that they do not reoffend. This work, at its core, shares values with primary prevention work.  

With this name change, ATSA is now offered the challenge and the opportunity to look at the risk and protective factors for first time perpetration.  How can our collective knowledge be used to inform prevention programs and use what we know for primary prevention?  Our name change gives us a chance to embrace primary prevention work as a central part of our organization, alongside the incredible treatment and prevention our members do already.  By taking on this more comprehensive look at sexual abuse, we continue our commitment to create a safer and more respectful works for everyone.   We look forward to seeing our organization work together in innovative ways as we create ATSA’s future together.

The challenges of community risk management

By Kieran McCartan, PhD, and David Prescott, LICSW

Community risk management is always a difficult balancing act, and we are grateful to the supervising agents and clinicians who make it happen! On one level it involves preventing someone from reoffending, while simultaneously helping them develop a post-conviction, and often post-prison lifestyle that is incompatible with offending, while at the same time protecting the public. Often these goals can seem paradoxical, as we need to give someone the opportunity to desist while in a less-than-completely-controlled environment. What makes this challenge more difficult is the reality that risk management discussions between professionals and the public don’t always match up. The public often sees prison sentencers as too short, and not understanding the release conditions governing how people are managed in the community. At the same time, professionals often argue for nuanced and flexible risk management plans that offer individuals the opportunity to road test their risk management plans, desistance skills, and opportunities for non-offending in safe, controlled circumstances. In the UK, as well as in other countries, risk management plans are governed by risk, assessment and tied to sentence length, via index offense severity. This means that there is a recognition that risk is individualized and dynamic. It also means that risk management, like incarceration, is expensive. The public often want professionals to manage and contain the risk, whereas the reality is that professionals provide the context for the individual to manage their own risk. This leads us to the high-profile risk management story of the week, the recall of Gary Glitter.

This week, former pop star Paul Gadd (known professionally as Gary Glitter), who once sold over 20 million records and is among the top 100 most successful chart acts ever in the UK, was recalled to prison after only a few weeks of freedom in the community. He had served roughly half of a 16-year sentence for sexually abusing three young girls decades ago. Glitter was released at the halfway point in his sentence, as is often the case in the UK, and moved to a hostel in January where he was recorded tying to access the dark web and download child sexual abuse imagery on his smartphone. This breach of his license conditions was filmed by another person living in the hostel and reported to the authorities. According to the New York Times, “In 2012, Mr. Gadd had been arrested as part of an inquiry set up to investigate accusations of sexual abuse against Jimmy Savile, a longtime BBC host. That arrest led to Mr. Gadd’s conviction in 2015 on one count of attempted rape, four counts of indecent assault and one count of sexual intercourse with a girl under the age of 13.” Previously, he was convicted in 1999 for downloading and possessing thousands of child sexual abuse images; he was acquitted on a charge involving the sexual abuse of an underage girl in the 1970s. From there, he lived in Thailand and then Vietnam and was convicted of sex crimes in each country. Mr. Gadd is now 78 years old.

We are not going to critique that Gary Glitter case, but instead use it as an example of the challenges of managing risk in individuals released on license. Glitter is a good example of a chronic repeat offender who uses every opportunity to reoffend, as is demonstrated by his litany of offenses, trials, breaches, and recalls. The challenge that the HM Prison and Probation Service (HMPPS) faces is how to control and monitor his rehabilitation, treatment, risk management, and limit his opportunities for re-offending within the context of his current sentence. Do they keep him in prison indefinitely? Do they place him in an open prison or another form of secure setting? Do they limit his access to mobile phones, technology, and other similar resources? In addition to the other balancing acts, HMPPS is tasked with protecting both the public and the human rights of prisoners and people under the care of probation, and it is all rooted in difficult decisions about the risks that people on license pose to the community and to themselves. These are all challenging questions that apply not only for Gadd, but other high-risk individuals. In addition, with the glitter case his celebrity is an additional factor that needs to be considered above and beyond other potential risky offenders. A glimpse into his history reveals the kinds of flight from justice (via his yacht!) that others could only dream of.

Gadd’s case is a reminder both prices paid by society to manage people at elevated risk of re-offending and the human toll that abuse takes. At 78, one might easily assume that Gadd would be easy to supervise in the community. On the other hand, technology (including access to social media) has completely changed the profile of possible risks that require monitoring. And throughout everything, little is known about the wishes of those who Gadd abused. The average community supervision agent working with these individuals must possess knowledge of criminal re-offense trajectories across the lifespan, technology, the habits, and schedules of each client, etc. and keep in mind that each client can be very different. In Gadd’s case, he remains quite wealthy and resourceful.

The Glitter case highlights the important nuances of risk management. In his case, recall to prison is a risk-management success rather than a failure. It highlights that the system can work; but the real question is, what next?

Restorative Justice and sexual abuse: Emerging research from Scotland

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

The field of sexual abuse can be emotionally charged, challenging, and often causes us to reflect on our lives and actions. There are times when professionals draw lines (quite often artificial) between people who work with those who have harmed and those that have been harmed. It is common to hear that professionals in each field have different agendas and want different things, to the point of being at loggerheads. We disagree, even as we acknowledge that it can sometimes appear that way when we make snap judgments of others without really understanding where they are coming from.

 

Instead, we would say that the “victim side” and the “offender side,” as they are often called, want the same thing (i.e., the abuse to stop, victims to be support and people who have offended to be held accountable and manage their risk moving forward). The real difference is in the perspectives they bring to their daily work. One area of rehabilitation and therapeutic work in the wake of sexual abuse that brings these sides together is Restorative Justice. We have discussed Restorative Justice on the blog before and recognize the sensitives it involves and the process for both sets of participants, so this is not a rehashing of old ground but rather an opportunity to discuss new research and practice. As much as any approach, Restorative Justice shows that there aren’t different “sides” to the issues, but diverse roles that we can all play in our attempts to end sexual violence.

 

Scotland has always had a reputation for being forward thinking in its approaches to health, justice, risk, and risk management, particularly in the areas of sexual abuse, drugs/alcohol, and youth crime. Recently, there has been momentum in Scotland to understand the role that Restorative Justice can play in helping to repair the damage created by sexual abuse. In 2021, a nationwide consultation was led by Thriving Survivors (with a number of other organizations across the sector) on  with survivors of Domestic Abuse and Sexual Violence to Establish Awareness, Opinion, and Demand Related to the Ongoing Development of a National Restorative Justice Policy and Practice Framework for Scotland. The consultation highlighted “the importance for survivors of domestic abuse and sexual violence that their voices are heard and that they have a choice related to how they deal with the aftermath of their victimization, including access to Restorative Justice.” This resulted in a series of recommendations including more research, development, and consultation on the issue, which led to the publication of a second report with some of the key players from the original, published last week, called “Restorative Justice & Sexual Harm: the voices of those who have harmed”.

 

The new report is based on a mixed-methods research design with people convicted of sexual offenses and their views on the relevance, use, and impact of Restorative Justice. The research found that the 44 participants who understood what Restorative Justice is described it as a process led by those who have been victimized, and that if it was not handled properly, it could be retraumatizing and activating for victims; caution is required. The participants felt that the benefits of doing Restorative Justice, if done properly and thoughtfully, outweighed any potential negative outcomes. This resulted in the authors suggesting that although cases should be looked at and considered in an individual light, they should be considered as people who can understand, be receptive to, and benefit from the use of Restorative Justice. The report gave some key recommendations, including that facilitators running Restorative Justice programmes in sexual abuse cases need to be specially trained; the consent of the participants need to be properly obtained; that the process needs to be trauma-informed; all participants should be fully briefed on what to expect from the process; if a traditional face-to-face approach is not appropriate then an alternative approach should be investigated; and the cognitive ability, neurological level, and psychological wellbeing of all participants should be checked as well catered to throughout the process.

 

In many respects, this publication reinforces previous research and policies in Restorative Justice (i.e., look at individual cases and then tread gently), but what makes it stand out is that it has been done with people convicted of sexual offenses. This is an important report in that it reinforces what a lot of research in the field of sexual abuse has indicated over the years: that people convicted of sexual offenses in the main want to understand the harm that they have done, become accountable, and move on an offense-free life. Additionally, this report also recognises the importance of trauma-informed approaches to this work, indicating that men convicted of sexual offenses offend have trauma histories that they are recovering from and that have contributed to their offending, and therefore the restorative justice process can help their healing.

Educator Misconduct and the Need for Meaningful Prevention

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

The current issue of the Sexual Abuse journal opens with a study by Elizabeth Jeglic, Cynthia Calkins, and their colleagues. It explores sexual misconduct by teachers serving US students from Kindergarten through 12^th grade. According to their findings:

 

Overall, 11.7% of the 6632 participants reported having at least one form of educator sexual misconduct during grades K-12, with 11% reporting sexual comments and less than 1% reporting other forms of sexual misconduct (e.g., receiving sexual photos/messages, being kissed, touched sexually, or engaging in sexual intercourse/oral sex). Those who reported misconduct showed significantly more difficulties in current psychosocial functioning than those who did not report educator misconduct. Academic teachers most often perpetrated the abuse (63%), followed by coaches and gym teachers (20%). Educators who engaged in sexual misconduct were primarily male (85%), whereas students who reported experiencing educator misconduct were primarily female (72%). Rates of disclosure were very low (4%) and some sexual grooming behaviors like gift giving (12%) and showing special attention (29%) were reported.

 

It can be difficult to comprehend what this all means. Doubtless, there are observers who believe that the 1% figure of being kissed, touched, sexual intercourse/oral sex is encouraging and could be worse. Others (including us) believe that any sexual abuse is unacceptable. A quick Google search suggests that there are over three million educators in the US, suggesting a tremendous amount of abuse that goes undetected. That 11.7% of students should report sexualized comments made by teachers, and that such commentary and possible victim-access behaviors correlate with psychosocial difficulties, shows a high degree of need for prevention efforts. Whatever the intentions of an individual teacher in a particular set of circumstances, this study is clear in its findings. 

After polling a small number of teachers, it seems that all too often teacher-education programs stress what to do if one is concerned that someone else is abusing a child. It is rare that these same programs emphasize that this behavior is unacceptable to engage in, and rarer still that teacher-education programs provide information on why even sexualized comments are unacceptable. Our K-12 teacher colleagues report that the lion’s share of discussion around the potential harm of abuse happens during job interviews. Our programs can easily do far better than this.

At a time when conspiracy theories abound about organized groups of influential people grooming children, this paper shows something far more basic: that too many students experience their teachers as violating boundaries and trust. Making matters worse is not just the inherent power imbalance, but the not-unfamiliar feelings of affection that kids can feel towards teachers and caregivers. As we (and others) have said before, abuse is abuse and kids need safe spaces for education. The problem of abuse in schools is not simply the “hot for teacher” trope that one might hear in popular media. Abuse prevention needs to move beyond what we can do to prevent and intervene in others’ abuse and also focus on what we all need to do to maintain our best boundaries. While discussions of prevention often discuss “abuse” as a broad, unspecified category that happens elsewhere in our communities, education about checking out one’s own motives (not to mention ongoing education about the potential unacceptable risk of sexualized comments) would be timely.

Likewise, our public discourse in these areas often focuses on rage against abuse in general and the use of terminologies and person-first language that are, in fact, in widespread use elsewhere. The reality of abuse prevention is entirely different: abuses take place in our schools, churches, police departments, and other venues where trust is paramount. Posting hateful messages that unnecessarily alter lives and careers on Twitter is easy; offering ideas for prevention to those in charge of schools and teacher education is another matter. Our message to society is that if we want to prevent child sexual abuse, it is time we look in the mirror.