Friday, February 23, 2024

Imposter Syndrome

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

At last year’s ATSA conference, David had the good fortune to facilitate two discussion groups for people who, due to their circumstances, don’t have many colleagues with whom they can speak openly. By far the two biggest topics that came up were working in isolation and imposter syndrome, also known more recently as “imposterism.”

During these sessions, newcomers to the field heard from us old-timers, who all agreed that we still feel it often. It all reminded me of the time — years ago — when a world-famous researcher openly discussed how even his submissions have occasionally not been accepted for the ATSA conference. While many simply acknowledged having had the same experience, many more thanked the researcher profusely, saying they were grateful to know that they were not alone; it can happen to anyone! 

Have you ever had that feeling that someday you will be outed as the fraud you fear you might be? I (David) am very lucky that I was far along in my career, with nothing to prove to anyone, when a disgusted colleague approached me.  My name had come up in conversation with a prominent researcher who said, “Don’t forget… He’s not Dr. Prescott, just Mr. Prescott.” My response was probably along the lines of “whatever,” but doubtless it would have hurt had I still been an early career professional. Not everyone has been so lucky. 

The reason I mention all this is not because of all the research showing just how common imposterism is across professions. Nor is it to illustrate that men are just as prone to it as women and nonbinary people. It’s to emphasize something about ATSA members learned across many decades now: we have your back! We support you and want you to succeed! What you do and who you are matters. As much as we may argue over research and practice within ATSA, the work you do on a day-to-day basis is likely to help our clients and communities. 

While there are legitimate questions about treating and over-treating the truly low risk, and similar questions about the structures of our laws (lifetime supervision, civil commitment, etc.) the fact remains that everyone doing this work has something to contribute to our broader goals of stopping offending, helping clients live better lives, and building community safety. 

If there is anything most ATSA members learn from membership and attendance at our conferences, it’s that we all support each other and especially our newer members and students. As a part of this, it’s worth mentioning that those of us who are further along in our work lives don’t always have to project a perfect image of ourselves. Allowing ourselves to be open about our doubts and failures can also be inspiring and reassuring precisely to those who look up to them or are making their way in the field. We all have an obligation to help the next generation along.

Psychologist Jill Stoddard recently wrote a book on this topic titled, Imposter No More. In it she advocates flexible thinking skills that can help individuals find their way through the often crippling effects of imposterism. In her TED Talk and interviews, she discusses her own experiences, including how her family teased her with weight-related nicknames. She is now a highly regarded practitioner of Acceptance and Commitment Therapy, often referred to simply as ACT. Every time she shares her story, making herself vulnerable along the way, she touches hearts and inspires others. Her work is worth a look. 

In his recent interview with ATSA Executive Director Amber Schroeder, Karl Hanson also emphasized the importance of proceeding fearlessly with our careers while remaining open to the feedback that helps us become more effective. 

In the end, the message from ATSA’s leadership and blogging team is simple. We have your back! If you’re feeling like you have no one to talk with, feel free to reach out. No one should feel alone in this work.

Thursday, February 8, 2024

The challenge of balancing human rights for all

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

Last week’s blog post focused on an unfortunate reality: We can’t always discuss things publicly lest we be labelled as political partisans. Although no one is without some degree of biases and leanings, it is simply too easy to attack and be attacked for statements taken out of context. We recall the sad fate of someone who commented in social media that balancing the human rights of the client and the community can be a challenge. His statement was sent to a local politician, who went to the media and scored significant political points saying that this doctoral level researcher and policy wonk had a “catch-and-release policy towards predators.” (It is worth noting that many human rights are enshrined in international law as well as state and agency policies; the Tokyo Rules are one example. In the US, the death penalty has been ruled unconstitutional for sex crimes, but that hasn’t stopped some states from trying.)

Working in the criminal-justice field often presents many paradoxes and contradictions that leave professionals conflicted about their roles, and/or their belief systems. In some cases, we have to and having to justify our roles to others. On the one hand, compassionate treatment approaches are the most effective. On the other hand, the practitioner may have to work hard to to look beyond their own biases and beliefs to do so. Important to remember is that having compassion for someone does not mean that you condone or endorse their behavior; it means that you can see into their situation, try to understand, and prioritize their highest needs (which means developing a lifestyle free of harming others).

Over the years, this blog’s authors have written about the early-life adversity that has influenced our clients and the need for trauma informed practice in order to ensure the most effective participation in treatment. What we often talk about less is human rights, although many have done so. It’s easy to respect the human rights of law-abiding people, but more difficult top do that for people who have hurt and harmed others.

In recent weeks there have been many cases across Europe that have called for us to have respect for others, to call in question our moral lens and to advocate for human rights in difficult cases. We have seen a call for care homes to be built for aging individuals convicted of sexual crimes, an individual being tried and convicted of manslaughter on the grounds for diminished responsibility for the murder of three people last year in the UK, and the change in incarceration conditions for Josef Fritz as a result of his dementia diagnosis. These cases beg the question of how we best treat those whose who have committed horrific crimes when their capacity to understand their punishment is gone. Where are our human rights thresholds?

Not surprisingly, many have found it difficult to tread a line between compassion and punishment, especially when the system is built on the grounds of punishment. Public, as well as political, sentiment often reflects that. However, its important to remember that many professionals are in the field of rehabilitation, even as we work in environments that stem from punishment.

Rehabilitation, treatment, and support cannot be seen as an afterthought or an add-on to punishment. We all want people to come out of the criminal justice system better able to manage themselves in society than when they went in, or at least no worse. We have seen the damaging legacy of doing nothing through the failed “nothing works” doctrine of the 70’s and 80’s started by Robert Martinson, and that became a hallmark of the Reagan-Bush and Thatcher eras. We know though research and practice that treatment works, but that it can take effort and that it works in different ways, at different times, for different people. This can make it complex and not easy to rationalize or fund when one can’t entirely predict the outcomes. Although it can seem like we are in a revised nothing-works era currently, that is not true with the influence of public health and prevention policies in criminal justice. We are still talking about treatment and rehabilitation; but it’s challenging for professionals at times to engage in these conversations and find support.

We need to be compassionate in our work and think about the human rights of often risky and at-times dangerous people. How can we hope for them to reduce their risk and to integrate back into society if they can’t learn about pro-social, empathic, and good behavior from us? How can we best accept our clients even as we don’t accept their behaviors? How do we process our work with others? How do we explain it? Where do we seek help? And, more importantly, do we get help when we ask? It is important to provide a rationale, critically discuss, and support each other in the challenging times we are experiencing. Supporting people who have seriously offended and are dangerous is as much a collective endeavour as an individual one.


Friday, February 2, 2024

We’re Losing Ground Again

By David S. Prescott, LICSW, ATSA-F

I’ve long felt sympathy for our colleagues working in the area of family and interpersonal violence. These issues are widespread but receive little attention. It is well known that violence against women has only gotten worse in recent years, and yet many governments have considered abandoning the Council of Europe Convention on Preventing and Combating Violence Against Women and Domestic Violence, known as the Istanbul Convention. Too often, the reasons have been political, with governments claiming that while they are against family violence, they want to preserve traditional family values. Observers are quick to note the political aspects of these decisions; one media outlet noted Turkey’s objection to “promoting LGBTQIA identities” (although the treaty’s only reference to sexual orientation merely stipulates non-discrimination).

Of course, it’s not just governments that have difficulty finding ways to prioritize ending family violence. One might reasonably ask how we can end violence when so much of our media and political discourse contain violence and violent themes? Recent media coverage of ideologically based death threats suggests that matters are only getting worse. In my former state of Maine, a Diversity, Equity, and Inclusion coordinator recently fled the state in response to threats made against his life.

A central concern of this blog post is that at a time when too many people view violence as normal and sometimes desirable, those seeking to reduce its harm are too often lost in the mix. Whatever the data may show in one legal jurisdiction or another, we are all up against a cultural maelstrom in which violence and threats of violence have somehow become more acceptable.

What’s not acceptable is that our attempts to stop violence have become wrapped up in politics. Further, most people in our field understandably don’t want to talk about politics. As recently as a few days ago, a listserv for psychotherapists was taken offline for a period of time because of arguments over the current situation in the Middle East. It seems that even when we are open to talking about politics, we’re not particularly good at it.

ATSA has always championed ending sexual abuse. Unfortunately,  at the individual member level, too many potential discussions are off-limits because they are so hard to talk about. Wouldn’t it be great if professionals could talk about the relevant issues without political impediments?

All of this seems relevant at a time when a former US President has recently been found liable by a jury for sexually assaulting a woman. Another jury awarded her more money than most of us can realistically imagine. Lest readers think that mentioning this reflects a political agenda, it is vital to remember that there have been plenty of allegations across the political aisle, including in the 1990s. Indeed, questions of sexual abuse in national politics is nothing new.

It makes sense that discussing the actions of our leaders is difficult at best. Nonetheless, some important points emerge

- Sexual abuse and other forms of violence exist at all levels of society.

 Current public debates make even acknowledging this fact challenging.

- Many of our policymakers have engaged in the same behaviors they seek to regulate.

- Given all of these things, we are compelled once again to look at sexual abuse through a public-health lens.

 It would be unconscionable for us, and society, to soften our stance on ending violence simply because there is so much of it on the world stage. In truth, the mission has only become more critical.

Friday, January 26, 2024

What has research ever done for us?

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

This week Kieran has been involved in several different conversations about research outcomes, Key Performance Indictors (KPI) and how we measure them. This has been equally engaging and frustrating. This week has really enforced in Kieran the need to emphasis the role, purpose, and use of research, which is often an afterthought or a bolt on for many organisations and programmes. This is a shame, as research should be seen as core business and essential to the development, roll out, and maintenance of any service or endeavour. This blog discusses why research matters and why we should all be concerned about doing it and getting it right.

Good quality research is essential for developing an evidence base that informs practice and policy; we all know that. We look to organisations like ATSA and NOTA through their publications and conferences that facilitate our access to this research and allow us to learn methods, theories, and outcomes. But it must be stated that not all areas of sexual abuse share a research parity or depth. Some areas may be over-researched (e.g., risk assessment, treatment, work with adolescent and adult males) and other areas having less (e.g., prevention of sexual abuse, women who sexually offend, Siblings/intrafamilial). This changes by country and region (e.g., outside of north America sex offender registries are barely researched). To borrow a phrase, “All research is equal, but some research is more equal than others”!

In universities, many researchers are adapting their methods towards being more impactful and being more grounded in practice, professional development, and policy rather than just being about publications. As a result, more research is about being collaborative and about co-creation with professionals, policymakers, and service users/clients. This means that research can also help shape ongoing policy and practice, research needs to be at the start and in the lifecycle of our professional activities, not [as is far too often the case] bolted on at the end or neglected all together. Research needs to be central to good practice and building an evidence base, but it’s also central to commissioning, funding, recruitment and retention of staff, referrals, partnership working, sustainability, and quality assurance. However, the value of research is not always seen as these things with frontline services not always seeing the value reading studies and wanting to focus more, and understandability so, on their clients and practice. In worst case scenarios research can be seen as an add-on or a costly burden, which can mean that it’s not always well developed, well-funded, or at times well executed.

Therefore, it’s important to understand the role and purpose of research and what it brings to practice and policy. One of the best ways to do this is to think about research as a core business for any organisation and/or practice. So, whether you are working in sexual abuse prevention, treatment with men convicted of sexual offences, community risk management or policing; what does research mean to you and your organisation? Maybe the place to start is to think about the role that research has played in your daily practice, in shaping what you do and how you do it. To borrow from and emulate Monty Python…

What has research,
what has research,
what has research ever done for us?

An practice evidence base.
...they, they gave us a practice evidence base...

Yes, they did give us that, that's true
And evidence for future funding Yes, that too
A practice evidence base I'll grant is one
thing the research may have done
And the policies, now they're all new
And the great theories too

Well, apart from the theories and evidence,
And the risk assessment tools
Public health for all the nation

Apart from those, which are a plus,
what has research ever done for us?

Along these lines, it may be helpful to think about how research has improved our professional lives (as well as our personal lives, such as research into health care). Research in our field has informed our understanding of assessment and evaluation measures; how we communicate risk; what goals to work on in treatment; how to work with different individuals; how to understand denial; how to understand human sexuality, etc. In some corners of social media but also in practice and policy, it has become fashionable to disrespect science and scientists. At the end of the day, however, we would do well to stay respectful and keep current with the advances of science; it often advances in multiple directions (as we blogged about last week).

Friday, January 19, 2024

Extending a Previous Blog Post: Ethical Considerations on the Costs of Resources

By David S. Prescott, LICSW, ATSA-F

In our December 13, 2023 blog post, Dr. Sophie King-Hill asks:

In many harmful sexual behaviour (HSB) services for children and young people (CYP) how resources are funded, developed, and delivered is coming under increasing scrutiny as frontline and third sectors organisations are having budgets cut and services reduced. Given this context, is it ever ethical to charge for these resources? . . . At face value the ethical principles of HSB work may appear clear-cut (i.e., work in a trauma informed way, do no harm, protect the patient/service user) . . . However, after scrutiny, the lines seem blurred. . . Whilst a multi-agency approach is clearly needed for HSB, a by-product of this way of working is that no steadfast and explicit ethical principles exist due to the range of specialisms involved. This lack of a sense of measure, accountability and consistent public pledge has perhaps created an environment where profitable endeavours have gained traction and power without the rigour of adequate ethical questioning.”

This last sentence regarding “profitable endeavors” is particularly intriguing and leads to questions about how we prioritize and think about resource allocation. In her discussion, she also notes the way some services are trained and delivered. She raises the age-old question of how best to combine implementation and training efforts in situations where staff turnover is a reality (this blog post from 2015 explores this question further).

Here in the US, I’ve long wondered about how we prioritize not just our resources, but the way we think about them. I’ve never forgotten an experience many years ago in which I was on a grant to implement an empirically supported trauma treatment package. The content of this treatment was clinically sound and under most circumstances easy to implement. However, it had been developed for use with adult women, while our agencies were tasked with implementing it with adolescent males and females. The positive findings in studies had occurred in outpatient treatment settings. We were tasked with implementing it in home-based services. In some cases, the clients were very clearly not ready to advance at the pace of the curriculum, while for others the curriculum itself was getting in the way of more substantive conversations that the clients were desperate to have. The curriculum had not been written specifically with the caregivers of these young clients in mind.

The clinicians in this project found themselves in a dilemma: meeting each client’s needs to ensure treatment engagement meant slight changes in adherence to the manual. On the other hand, even the slightest changes were considered a problem for treatment fidelity and needed to be approved by the outside consultant. Further, every session was video recorded for quality assurance purposes, making clinicians more likely to make momentary clinical decisions that prioritized the video review over the needs of the client. All of this took place in a context where those licensed professionals charged with administration of the curriculum had to take their orders from an unlicensed and sometimes irritable consultant.

There were many ways that these dilemmas could have been resolved, and doubtless many who are reading this post could have helped move the process forward. Unfortunately, the constellation of players was, as a group, ill-suited to get this implementation right. It can serve as a lesson for all of us. These were high-stakes circumstances: some of the clients felt retraumatized after participating in this treatment. The problem was not the content, which was indeed evidence-based, but in the implementation processes, which were not.

Virtually everyone wants to engage in evidence-based practice (EBP). Yet so many of us remain unaware that there is more to EBP than the research studies telling us that a treatment method has found to be effective. For example, the above efforts would have benefited from a solid foundation in implementation science, which examines the application of research. For example, Dean Fixsen and his colleagues outlined numerous conditions under which implementations of EBPs will be more and less effective. As encouraging as some studies can be, others have found that it can take a considerable amount of time to demonstrate significant improvements in wellbeing at the individual-client level.

Likewise, there is very little accumulated knowledge on adapting EBPs to meet local conditions. In the example above, applying a treatment developed in one context to another created problems and arguably caused harm to some clients. On one hand, there are the understandable concerns that changes to an empirically supported protocol reduces fidelity to the model, which in turn can potentially reduce its effectiveness. On the other hand, the APA definition of EBP emphasizes how it is a tripartite model involving the integration of best available research, clinical expertise, client characteristics, culture, and preferences. This discrepancy leads to questions about how those with genuine clinical expertise can effectively use protocols that may not be the best fit for clients. 

Dr. King-Hall’s original questions lead to others. We might well ask about the ethics not only of training costs and access to treatments, but of emphasizing implementation of a particular treatment approach without considering the evidence regarding successful implementation, or local conditions involving clinical expertise or client characteristics and culture.



Friday, January 12, 2024

Reflections on the recent NOTA & Lucy Faithfull Foundation sexual abuse prevention conference

By Megan Hinton, Victim and Survivor Advocate, Marie Collins Foundation

I recently joined the Marie Collins Foundation (MCF) as a Victim and Survivor Advocate. My role involves working alongside those with lived experience of technology-assisted child sexual abuse to champion and amplify their voice and embed it into policy, practice, and academia.

As a survivor myself part of my position includes speaking about my lived experience at conferences and events. So, when the Lucy Faithfull Foundation reached out to ask if I wanted to give the opening address at the Preventing Child Sexual Abuse Conference organized jointly with NOTA, I felt honored.

Prior to the conference, I needed to gain more knowledge about prevention methods and believed most prevention work was done through PHSE lessons in schools and charity-led awareness campaigns. Joining the conference, I felt intrigued to learn in order to identify any cross-over that may help with my role. But I also felt apprehensive about attending as I knew the conference would heavily focus on perpetrators rather than the voice of survivors.

During my presentation, I spoke about the importance of prevention from a survivor’s perspective, referencing my own experience and embedding key messages from MCF’s Lived Experience Group. During my address, I quoted one of our Lived Experience Group Members who said, “Survivors get a lifelong sentence”. I also emphasized that whilst child sexual abuse can take place over many years, it can also happen in as little as a few hours, and yet the impact is the same; it fundamentally changes who you are as a person. My hope was for my address to encourage attendees to anchor their thoughts on the children, victims and survivors they work to protect. I wanted attendees to challenge their thinking and reflect on how they could apply what they learned from the conference to their work and day-to-day life.

My apprehensions about the conference's content quickly dissipated as I listened to the presentations that followed my own. It was heartening to see each speaker cover a point I had made during my address, which ensured survivors' voices were visible throughout the day. Some key points that I was particularly happy to see focused on included challenging stereotypes of victims and offenders and highlighting that schools cannot be the only place where conversations about child sexual abuse take place. MCF’s Lived Experience Group told us they want to ‘blow the lid off’ child sexual abuse and the silence that surrounds it. Victims and survivors regularly tell MCF that sexual abuse is still rarely spoken about and that makes it difficult for children to identify abuse or find the words to explain what is happening to them. So it was encouraging to hear practitioners with similar views who were committed to raising awareness and involving wider society in conversations about child sexual abuse.

The impact of child sexual abuse can be profound and devastating and that impact does not stop with the victim or survivor, it can ripple through ‘secondary victims’ such as family, friends and the communities that surround the child. So, seeing each presentation looking at prevention through a multi-agency public health lens was excellent. The presentations were informative and easy to digest and covered a range of different aspects to prevention. I particularly enjoyed learning about the three levels of prevention – primary, secondary and tertiary - and how these would fit into a public health model. I also appreciated the level of detail given so that I could begin to understand the thinking and evidence base that supports compassionate and restorative intervention work.

The conference really challenged my own way of thinking positively. One personal learning point was the realization that tertiary prevention work is not about justification, excuses, or minimizing the harm caused to victims; it’s about preventing reoffending and protecting children. I found it encouraging to hear about the success rates of these types of interventions.

The conference definitely inspired people to learn and improve but also celebrated how far prevention work has come in such a short space of time. Seeing people so passionate about their work, recognizing the challenges that they face, and striving to improve their services gave the conference a real undertone of hope.

As a survivor myself, the concept of prevention rarely crossed my mind. I could lose years of my life thinking about ways my abuse could have been prevented but wasn’t. As many other victims and survivors will know, we often feel blame and accountability for our abuse, and it can make it seem as though it was inevitable. But this conference allowed me to consider how prevention strategies and services work, how they can improve and enabled me to reflect on how we can better evaluate outcomes.

Leaving the conference, I felt passionate about the messaging in primary prevention and how difficult it is to assess and measure outcomes for this type of intervention. In early prevention work, we often see too much responsibility placed on children to ‘keep themselves safe’, particularly online. Through MCF’s direct work with children and their families affected by technology-assisted child sexual abuse, we know this e-safety messaging can silence victims from disclosing as they expect blame and shame. Instead, we must focus on creating an environment where children and young people and adults feel empowered to talk about these issues without threat or fear of victim-blaming.

In addition, we see widespread societal blame on parents, who often do all they can to safeguard their children. I believe actively engaging and listening to those with lived experience, including parents whose children have lived experience, could offer an insight into what primary prevention messages do and don’t work and, more importantly, why. The incredible group of brave victims and survivors in MCF’s Lived Experience Group is a testament that consultation with lived experience can, and does, positively improve services, practice, and policy. What we learn through our direct work can feed into prevention work, and MCF values partnership working. We know partnerships and collaboration improve outcomes for children, victims, and survivors, and this conference has further cemented the long-standing working relationship with LFF, NOTA, and MCF. I am excited to see how we work in partnership in the future.