Treating Abuse Before It Happens: Getting the Balance Right

By David S. Prescott, LICSW

Past posts to this blog have shown how providing the right treatment to people who have a sexual interest in children can help prevent abuse. There is a small but growing number of people reaching out for help, often saying, in essence, “Help! I have this interest and I never want to act on it. Can you help me to live a better life?” Often, this interest is accompanied by any number of other conditions, such as anxiety, depression, backgrounds of trauma, substance use disorders, and others.

Treating people who ask for help and are not known to have abused need not be a controversial topic, but it is in many quarters where people have not studied the issues involved. Our field understands the treatment needs of people convicted of sex crimes and has shown that the right interventions have the potential to prevent abuse and other harms. Our track record demonstrates better outcomes than simply punishing people. Likewise, psychotherapy has a long history of efficacy with the other conditions above. We have every reason to believe that the right treatment with the right client can help them to prevent acting on their interests. The evidence for optimism is there, even as much more research and treatment innovation are needed.

Where providing therapy to these individuals becomes controversial, of course, is in the actual context of treatment. Proper balancing of individual rights and mandatory reporting laws, for example, can be complicated. Much has been written in this area, including misconceptions around language. For example, Allyn Walker, Robert P. Butters, and Erin Nichols surveyed 200 students preparing for entry into social service professions at a public university. From the abstract of their paper:

Survey results show that more than half of the students believe clients who identify themselves as pedophiles must be automatically reported to the police, which has implications for providers’ understandings about the term “pedophile,” as well as their knowledge of guidelines for when clinicians may break client confidentiality. This belief was not significantly affected by taking ethics courses, nor courses that discussed mandated reporting guidelines. Despite this finding, 91% of students did not believe that they would need to report a client who had attractions to children, but who had never committed a sexual offense against a child. The majority of students indicated a willingness to work with minor-attracted clients, and commonly indicated in comments that they wanted more information about MAPs and when to break client confidentiality in their programs of study. Study results indicate a need for education among social service students about these issues.

To be clear, “person with a sexual interest in children but who has never committed a sexual offense” and “pedophile” can be the same thing. This study illustrates that words matter. The paper’s title further illustrates the problems that clients and clinicians alike can have: “‘I would report it even if they have not committed anything’: Social service students’ attitudes toward minor-attracted people.” One can rightly wonder if the status quo could possibly make it more difficult to get help.

More recently, a study by Agatha Chronos, Sara Jahnke, and Nicholas Blagden explored the treatment needs and experiences of people with pedohebephilic interests. According to their paper, the authors examined “findings from 22 qualitative, 15 quantitative, and 3 mixed-method studies on the treatment needs and experiences of pedohebephiles.”  From the abstract:

Research suggests that this population experiences significant levels of distress, depression, and anxiety related to their sexual interest. Many individuals belonging to this population would seek (median = 42.3%), or have sought (median = 46.5%), treatment to cope with their sexual interest or with potential related mental health repercussions. Their experiences in treatment have been mixed, with some reporting positive experiences with empathic therapists and others reporting rejection. Most frequently, pedohebephiles report fear of exposure and rejection as barriers to seeking treatment, in addition to fear of the legal repercussions. The current study is the first to summarize and discuss previous findings on the treatment needs and experiences of pedohebephiles. The findings indicate that the treatment needs of pedohebephiles often remain unaddressed. Suggestions to increase the fit between treatment services and the needs of pedohebephiles are put forward.

It is not surprising that so many people would not want to enter treatment under these conditions. Nonetheless, one finding in particular offers implications for the way forward: some clients reported having positive experiences with empathic therapists and others reporting rejection. The idea that therapist empathy is critical to successful treatment goes back to Carl Rogers and earlier. Moyers and Miller (2013) reviewed the evidence and concluded that low therapist empathy can be “toxic.”

In the author’s experience, one of the best ways forward can be to use the components of the therapeutic alliance to ensure that one isn’t tacitly rejecting their client while working to remain empathic and compassionate. This is not easy. Many therapists enter treatment assuming that their number one goal at each step is to prevent offending. At the same time, clients can have other needs that go addressed. For example, one client in a discussion group described a situation along the lines of, “I told my therapist about how I went to see the new superhero movie. They asked if that was a good idea given that there would undoubtedly be children present. They went straight to, “What are your triggers there?” That wasn’t the point. I needed to talk about the cravings for alcohol I was having at the time and what I did to keep myself sober. But my therapist kept coming back to prevention, prevention. I’m not a ticking time bomb, at least not all the time. I wish I could get help for my other issues.” It is entirely likely that attention to elements such as alcohol use and cravings can be as effective in the prevention of abuse as well as other undesirable outcomes.

It often seems that in our rush to prevent abuse quickly, we can easily overlook the crucial foundations of our interventions, including the working alliance, as defined by Edward Bordin in 1979. Practitioners and programs might work to create a culture of feedback and get feedback from their clients, asking in essence:

— Are we working on all the goals that are important to you?

— Do we have agreement on how I fit into your life and how we work together?

— Is my approach a good fit for you?

These may seem like obvious questions, but it is amazing how rarely clinicians actually ask them. From there, it can be possible to have discussions about what is and isn’t working. There is certainly a time and a place to suggest that going to a particular movie likely doesn’t serve a client’s long-term interests. However, there is no reason this can’t take place in a context in which the client’s other needs are met. Given the current state of trust between clients and their therapists at present, and the often challenging context of treatment, returning to the basics of the working alliance has never seemed more important.

Preventing abuse by offering help is critical to healthy communities. For all of our knowledge about what works in treatment, the question for practitioners is how best to be the therapist that each client can respond to.

What does a second chance mean?

 By Kasia Uzieblo, Ph.D.

*Disclaimer: We realize that David Prescott has written a blog about the case of Van de Velde before. However, during her summer break and unaware of David’s blog, Kasia Uzieblo wrote her own blog about the same case. Since this blog offers an additional perspective, we decided to publish this 2nd blog as well.*

What a crazy summer of sports. After the UEFA European Championship and the Tour de France, sports enthusiasts like me can now fully enjoy the Olympic Games in Paris. For many athletes, the Games are one of the—if not *the*—highlights of their sports career. This is also true for 29-year old Steven Van de Velde, a Dutch beach volleyball player who was selected to represent his country in Paris. However, his participation is overshadowed by his past, a past he carries with him daily and can never escape, as shown by British and -broader- international media coverage.

When he was 19, he was a rising star in the Netherlands; more than that, he was described as one of the greatest talents Dutch beach volleyball had ever known. During this period, he met a girl via Facebook. He stated that he was going through a turbulent time and found understanding and support from her. When he found out that she was not 16 but 12, he broke off contact for a while, but this break did not last long. One day, he booked a ticket to England, where he met her, gave her alcohol, and had sex with her multiple times, according to Steven. He also stated that he soon realized he had made a big mistake. The facts came to light when the girl went to the hospital due to physical complaints. Steven Van de Velde confessed his crimes and received a four-year prison sentence in 2016 for child rape. After serving 12 months in a British prison and one month in a Dutch prison, he was released. The conviction was also adjusted to Dutch law, and the charge of rape was changed to fornication. He tried to rebuild his life and hoped for a second chance: “I did what I did. I can't undo it, so I'll have to face the consequences. You can judge, of course. It's the biggest mistake of my life,” he said in a TV interview. After his release, he gradually rebuilt his life, under professional guidance and supervision from probation. He is currently married and has a child. Experts estimate his chances of reoffending as very low, even negligible.

However, international media and various organizations, including national sports organizations and women's safety groups, do not support this second chance, nor believe in the safety measures taken (e.g., the Dutch Olympic committee (NOC*NSF) and Van de Velde decided that he would not enter the Olympic Village and that he would not engage with any press, amongst others). Many newspapers describe him as a child rapist, a convicted rapist, and a sex monster. Many are extremely concerned that he will make new victims in Paris. For example, Ju’Riese, CEO for the US Center for Safesport, said in a statement to CNN: "deeply concerned that anyone convicted of sexually assaulting a minor could participate in the 2024 Olympic Games. With teams from around the world about to convene in Paris, many of which include minor athletes, this sends a dangerous message that medals and money mean more than their safety. Participation in sport is a privilege, not a right[1]."

The story of Steven Van de Velde illustrates the complex and controversial nature of second chances for people convicted of serious crimes, often sex offenses. Despite his efforts to take responsibility and rebuild his life, he continues to face his past, which he also accepts. This raises the question of whether and to what extent someone deserves a new chance to lead a normal life and achieve professional success, for example, in sports.

For many who work with such clients, it is a familiar story. As professionals, we want to support the restorative and reintegration processes as well as possible, often encountering the limits of these processes and facing numerous dilemmas. The call for increasingly severe penalties for sex offenders remains loud. However, by focusing on punishment, we seem to be avoiding important discussions: What happens after punishment? Is there a post-sentence period possible/acceptable? How do we, as a society, but also as sports organization, scouts, schools, academic institutions, film industry, etc., deal with people who have committed a sex offense but are trying to rebuild their lives afterward? We want them to acknowledge the harm they caused and to take responsibility for their crime and reintegration process, but if they do, is that enough? Can this person hold a public position anymore and is this person allowed to achieve (professional) success? After how much time does someone deserve a second chance? And what should or could that second chance look like? And if second chances are not possible: will we then develop a uniform policy for everyone who has exhibited transgressive or criminal behavior? Or will we only focus on people who have committed a sex offense (and of whom this is known)? In sum, what does restoration and re-integration truly means for people who committed sexual offences?

We clearly struggle with these questions. I do not claim to have all the answers to these questions either. Each case is a difficult balancing exercise where, as a professional, you constantly navigate between the well-being and safety of (potential) affected persons, the (criminogenic) needs and well-being of the person who committed the offense, and society. The "easiest" way is to completely exclude the person, to cancel them, as it were. These actions can give us the—albeit false—feeling that we are in control, that we can take revenge on the person in question, that we are fighting for justice. However, we know that such cancel culture can have the opposite effect, causing enormous harm to the person in question, their family and friends, and may even hinder the recovery process of the persons with lived experience. It can even paradoxically increase the risk of recidivism.

It is not the intention of this blog here to make a plea for or against the participation of the aforementioned athlete; nor is it the intention to disregard the suffering caused by people who commit such acts. On the contrary, in formulating answers to the previous questions, it is essential to centralize the recovery process of the persons with lived experience and give them a voice in the debate. However, assuming that they all want their offenders to be punished forever is not giving them a voice, but is deciding for them what is best. From my conversations with many persons who have been affected by various and sometimes the most gruesome crimes, I have learned that their wishes and needs can vary greatly. In which way the voice of the affected person in question was heard in this particular case, I can only guess.

But there must be a debate. We know that numerous individuals cause harm, that many will remain in society, even after the behavior or offense has become known, and that, if imprisoned, most of them will return to society one day. It is therefore a utopia to believe that we can avoid such questions. We have noticed this over the past years with, for example, the recurring discussions about various people who have exhibited (sexually) transgressive behavior and/or have committed sexual offences within the entertainment industry, educational institutions, the Church, etc. Time and again, we encounter the same questions, the same dilemmas.

The space for debate and for an in-depth discussion is however seldom there, as the current case shows. For the media, it certainly seems much easier to avoid difficult discussions and to focus solely on the offenses and on click-worthy headlines, rather than addressing the more difficult questions. But I truly hope that this case will invite at least some to start or continue nuanced conversations with family, friends, colleagues, policy, journalists. Also, I truly hope that this case will (finally) encourage institutions such as -but certainly not limited to- sports organizations and educational institutions to reflect on this and to build[2] a consistent, well-founded, and thoughtful policy which also includes guidelines for dealing with the persons who have engaged in the transgressive/criminal behavior, and this - where feasible and desirable – based on evidence-based rehabilitative and restorative practices.

In any case, these are complex questions that require complex thought processes and often complex and nuanced answers, where we will keep encountering issues as long as we avoid these conversations.

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[1] But see, EN-Olympic-Charter.pdf (olympics.com) in which participant in sports is being described as a human right.

[2] Or strengthen if a policy is already available.