Thursday, November 23, 2023

‘Tis the season of restoration

 By Kieran McCartan, PhD

Our friends in America celebrate Thanksgiving this week, a sometimes fraught and challenging holiday.  Families and friends come together to celebrate reunion, restoration, and a rekindling of relationships. It sounds easy, but it’s not! It can be difficult and sometimes irreconcilable. Establishing and re-establishing a sense of family or community is not always easy.

Interestingly, this week is also Restorative Justice week. Across Europe, it’s a time to discuss restorative practice in the criminal justice system. Like Thanksgiving in the US, restorative practice is also challenging and complex. It can also help people resolve issues, rebuild lives, and move forward from the trauma they experienced or caused. Restorative practices are common across social justice; we have seen them used in personal, community, and social conflict cases. My first exposure to restorative practice was long before studying criminal justice; it was in my native Northern Ireland, where the process was encouraged as a community-building device in the peace talks and the creation of the Good Friday agreement. However, there is one area where restorative practice is not always accepted, where it’s seen as challenging, difficult, and, at times, a risk: Sexual abuse!

Last week, Thursday and Friday, I chaired two separate and quite distinct events for the Thriving Survivors organization. One was an event hosted by the Lord Provost of Glasgow, where members of the organization discussed their work and highlighted their good practices. The second event was a traditional conference focusing on restorative justice and sexual abuse, calling for the need to have systematic change in the way that restorative justice is responded to. The events focused on the need for a coherent restorative practice to offer to victims of sexual abuse, one that’s victim-led, holistic, strengths-based, and sustainable. The conference illustrated how those who are victimized by sexual abuse should have access to and engagement with the services that they want, not just the services that the state and third parties want to offer them (or, even worse, feel that they should have). The conference showed that sexual abuse is a complex and multifaceted issue that cannot be separated from real life, especially when the abuse is committed by and connected to family systems, friend groups, and peer networks. Sexual abuse needs to be confronted, and people who are victimized seek help as well as support in whatever form they feel comfortable. The speakers (including Dr Marie Keenan; Dr Estelle Zinsstag; and David Russell) and organisations (Stop it now Scotland; The Consent Collective; Restorative Justice Council; All party working group on restorative justice) reiterated the importance of personal choice, support, collaboration, and taking a victim-centred approach. This was brought together by a keynote from Professor Judith Herman, who talked about her new book emphasizing the importance of the voices of those victimized in the healing process. That system-wide change is needed to make the criminal justice system less traumatizing for victims. One way of doing that is through thoughtful, well-planned restorative practice.

The two days reinforced the importance of personal choice and careful, detailed, trauma-informed, and strengths-based services. If done well, restorative practice can support victims in moving forward and finding closure or acceptance. Restorative practice needs to be victim-led, flexible, and accessible to all. The system needs to change to hear the voices of those harmed. In this season of restoration, please ask yourself what everyone needs to come together and talk about and the best way to do this.

Friday, November 17, 2023

Bridging Science and Various Practices: Insights from NL-ATSA Symposium

 Kasia Uzieblo & Minne De Boeck

An essential goal of the Dutch-speaking affiliation of ATSA, NL-ATSA, is to bring science closer to local professionals, and thus, strengthening the bridge between theory and practice. In our countries, professionals traditionally attend fewer international scientific conferences due to limited budgets and language barriers. Often, our researchers travel abroad to share their insights, having limited chances to connect with local professionals.  Therefore, NL-ATSA provides a platform for individuals who have spoken at the annual ATSA conference. This year, NL-ATSA organized a 'Best of ATSA' symposium with a specific focus: offering Dutch-speaking colleagues who presented at the ATSA conference in 2022 the opportunity to share their insights with local professionals. Additionally, we invited Russell Pratt from Australia as our international guest speaker.

Russell Pratt's Insightful Lecture

Forensic psychologist and D. Psych, Russell Pratt delivered an online lecture titled 'Treating Youth Engaging in Harmful Sexual Behaviour: Considering Developmental Trauma and Pornography Consumption.' Pratt emphasized the importance of approaching minors engaging in sex offenses from a developmental perspective rather than an adult one. He explored how developmental trauma impacts adolescent behavior, including harmful sexual behaviors, through its influence on attachment and brain development. Pratt expressed concerns about easy access to pornographic material and its impact on the well-being and sexual behavior of minors. He stressed the need for addressing such issues from an early age through educational programs, preferably starting at age 6. He discussed The SAVVY CONSUMER Model, a simple, effective framework for professionals and parents to assist children and young people to critique pornography as well as assist in developing their understanding of healthy sexual practices.

Insights from our Dutch Professionals

Minne De Boeck (criminologist and program manager Stop it Now! Flanders) and Kelly van den Heuvel (Stop it Now! the Netherlands), presented The Stop it Now! model of perpetration prevention. On the occasion of its 30th anniversary in 2022, the following three questions were discussed: Where are we now? What innovative projects are currently being implemented? And where do we need to go from here? They described how CSA can be approached using the comprehensive framework for the prevention of child sexual abuse (Smallbone et al., 2008), and demonstrated how specific preventive initiatives (e.g., helpline services, online self help tools, conversation guides, support groups for relatives…) fit in this framework and contribute to the prevention of CSA. By means of the framework, they discussed what is needed for effective prevention of offending behaviors according to Stop it Now!. Furthermore, they presented a case study to illustrate how Stop it Now! helplines work and how prevention can be achieved. They concluded with current common challenges, like the extensive grow of CSEM material, uncertain funding and difficulties with professional secrecy and the rules of mandatory reporting. Furthermore, they formulated suggestions to move forward in offender-oriented prevention, emphasizing the need of social awareness, research, and a public and political shift.

Nina ten Hoor, clinical psychologist and psychotherapist at De Waag, a forensic outpatient service in the Netherlands, shared her research on utilizing EMDR treatment for individuals who have engaged in sexual offending. Her exploration included restructuring distorted implicit cognitions and personal vulnerability factors, reducing emotional responses associated with offending, and addressing deviant sexual arousal. In addition, she looked at how EMDR can also help our clients with processing one’s own trauma as well as offending-related trauma. She presented a case study of a man convicted of child sexual abuse, highlighting the application of EMDR therapy to directly address one’s deviant sexual arousal. A 5-year follow-up conversation with the former client revealed that although his interest in young girls seemingly returned, this client to avoid letting these feelings overwhelm him.

Eveline Schippers, project manager and researcher at the Forensic Care Specialists (the Netherlands), presented her doctoral research on understanding the origins of deviant sexual interests. Defining sexual deviance proves challenging, and Schippers emphasized that we mainly tend to consider its impact on the individual and/or others, and not the nature of the sexual interests/behaviors itself. Despite acknowledging the risks associated with deviant sexual interests in our clients, theoretical explanations for their development remain limited. Still, it is vital to gain insights into how these develop so that we could implement more targeted interventions. Schippers discussed factors such as the excitation transfer between emotions and sexual arousal, highlighting how emotions like dominance/aggression and fear can contribute to stronger sexual arousal. In addition, she presented her study in which she found evidence for four overarching themes within unusual sexual interests, being "forbidden-extreme," "light BDSM" and "BDSM-heavy" and "fetish-forbidden, emphasizing that these interests occur in the general population. Finally, she discussed her meta-analysis showing that child abusers with pedophilia exhibit stronger sexual interests in children than control groups, but at the same time exhibit less sexual interests in adults, suggesting that the latter may be a meaningful factor in treatment.

Promoting Collaboration across Work Fields

The symposium served not only as a meeting ground between theory and practice, but also as a successful meeting ground for professionals working with offenders and those working with victims of sexual offenses. This cross-pollination of ideas, insights, and experiences between the two fields is encouraging and should be stimulated. It became for instance evident that professionals working with offenders may not fully appreciate the many questions those working with victims often have regarding the underlying mechanisms of sexual violent behavior and prevention, amongst others. Encouraging further collaboration between these fields is crucial in our collective effort against sexual violence.

In conclusion, the symposium highlighted the importance of bringing together science and various practices. The engaging lectures underscored the need for ongoing collaboration and the sharing of knowledge to enhance our collective understanding of and response to sexual offending behavior.



Friday, November 10, 2023

The Impact of World Events on Our Work.

By David S. Prescott, LICSW

I recently discussed the Good Lives Model with a psychologist from the UK. She was not the first to ask a question along the lines of, “How do I work in treatment with a client on the goal of ‘living and surviving’ when they have no job, little help from the government, and are at risk of losing their residence?” It became apparent that the best way forward under the circumstances was to provide resources for her client to remain housed and employed. She had been thinking of living and surviving in the abstract, viewing it through a purely clinical lens.


At a time when so many are focused on maintaining fidelity to evidence-based treatment approaches, we can miss the fact that our clients sometimes have urgent needs. Therapeutic conversations and case management can have a role in our work. We may even overlook not only the solutions around us, but our own strengths and resources in finding solutions with our clients. In so doing, we can improve our alliances and specific responsivity. 


It's clear that many aspects of our changing world have at least moderately close relationships to risk. Global conflicts, climate change, decreased funding, and the evolving nature of public discourse around inclusion and equity can all influence client risk and protective factors. Although we have historically improved our ability to understand individual clients’ functioning, there is much we don’t understand about how a changing and increasingly uncertain world intersects with re-offense risk. To examine this further:


·         While climate change is beyond the scope of this blog and ATSA’s mission beyond, if the trends continue, treatment providers, supervising agents, and clients will all be affected. For example, how does extreme weather interact with risk factors such as relationship stability, self-regulation, and proneness to rapidly escalating affect and emotions? We’ve already seen how community distress can quickly result in looting. Are treatment programs and providers in a position to address these challenges with their clients?


·         Recent reports show that housing  and food insecurity are growing, while resources to alleviate them are not. These have occurred contemporaneously with deaths of despair and domestic violence. Meanwhile, within our field, many professionals have had difficulties finding staff due to cost of living increases. One might reasonably ask how we are all doing managing our own risk factors? Have our anxieties had an effect on our own self-regulation skills?


·         Further, in many quarters, funding for treatment has decreased, while expectations around billing, documentation, and the threat “clawbacks” of payments already made to providers have increased. At the same time, many states maintain high standards for professionals working in this field. One wonders about a possible collision course between decreasing pay and the ever-increasing responsibilities that come with this work.


·         Finally, there are the lingering after-effects of the pandemic. We still don’t know the full impact of the past several years on other forms of interpersonal violence, although we know that violence interacts with sexual re-offense risk.


Other questions remain. What are the effects of other world events? As of this writing, there are two major wars in the headlines. Coverage of them has been rife with partisan rhetoric that can make violence seem acceptable in the eyes of clients who have their own violent histories. 


Speaking only for myself, I’ve experienced both sensitization and desensitization in response to world events and the ways that media outlets report on them. It can be difficult to place current events into any meaningful or predictive context. Certainty about anything in short supply. We professionals are experiencing these changes, often intensely.  There is no way our clients aren’t as well. The question is how we respond to this, empirically and in practice.


Professionals in our field, like our clients, can be remarkably resilient and creative. The hope of the author and the intent of this blog post is that by outlining some questions that don’t often get discussed, we may be better poised to find solutions.