A long way to go

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

Two recent articles in the New York Times illustrate how the context of our work can shape our clients and our practices. The first article describes how the New York State inspector general’s office “has documented significant racial and ethnic disparities in discipline across New York State prisons, finding that over a six-year period, Black inmates were 22 percent more likely to be disciplined than white ones... The report comes six years after The New York Times published a 2015 investigation into racial bias in state prisons. The Times found that Black prisoners faced more punishment than white ones, leading to loss of privileges, longer stays in solitary confinement and, ultimately, more time behind bars…

“State inspectors reviewed 385,057 misbehavior reports filed from 2015 through 2020 to expand upon The Times’s analysis. They found that the discrepancies had actually worsened over time, most significantly in 2020, when Black prisoners were 38 percent more likely, and Hispanic prisoners 29 percent more likely, to be cited in misbehavior reports.”

Importantly, “The inspector general concurred with The Times that these discrepancies were most pronounced for violations that were, according to the report, arguably more subjective. The largest disparities were for offenses like gang activity, assault on another inmate and “involvement in a demonstration detrimental to facility order,” which saw Black prisoners five times more likely, and Hispanic prisoners three times, to be found in violation than white inmates.”

In the second article, About 200 to 250 people incarcerated in Louisiana jails and prisons have reportedly been held beyond their legal release dates in any given month, with the average additional time lasting around 44 days in 2019. As one lawyer observed, “To our clients, it is an extremely scary experience because they do not know why they are being held, when they will be free or how they can get free,” he added. “All they know is they should not be behind bars.”

It can be easy to miss these stories in the seemingly never-ending parade of crime stories in the media. However, it seems that unless we pay attention, we ignore these practices at our peril. Many ATSA members have felt the anguish of not being able to change the often ineffective and sometimes unjust systems in which some of us have worked.

It behooves us to stay attuned to the fundamental unfairness and injustices that often surface in various corners of the criminal justice system. We do not say this to throw shade on any one individual or institution in any particular area. At the same time that these events are taking place, many other institutions and agencies are working to improve their approaches. Likewise, in our experience, those in the helping professions often want nothing more than to make positive changes that will reduce risk while simultaneously enabling individuals to build lifestyles that are incompatible with offending.

Nonetheless, it’s vital for us to understand and discuss how the broader systems in which we work end up causing harm to people, including those referred to us in treatment. The implications are far-reaching, including for risk assessments and classifications within the various systems that have authority over these individuals.

Our clients absolutely take note of these experiences. It makes sense that if the media and our clients notice these various injustices, and yet we don’t acknowledge, know about, or account for them, we shouldn’t be surprised when our clients conclude that we can’t understand their perspectives and that they can only work with us in a limited capacity. Psychotherapy clients who feel heard, understood, and respected benefit more from our interventions than those who don’t. Working with our clients means understanding their perspectives without writing them off as treatment-interfering factors. Unfortunately, in this case, understanding and working with their perspectives involves involves taking a long, hard look at the systems within which we operate and being prepared to respond to clients accurately, empathically, and without colluding either with them or the systems involved.

Whatever the potential biases of the journalists and the media outlets, the data are shocking and impinge on human rights. Further, they illustrate that at the very time we have information to guide our attempts to level meaningful sanctions, some of our systems are actually becoming worse and in need of more effective leadership. 

 

 

Redrawing sexual offenses: the role of technological evolutions in online sexual behavior - A report on a webinar organized by the Dutch Affiliation of ATSA

By Minne De Boeck, Lotte Valepijn, Ellen Janssen & Kasia Uzieblo

Sexuality is constantly evolving in terms of how we date, in terms of how we shape our sexual identity and in terms of how we consume pornography. Social media and technological evolutions encourage and influence these changes. Technological trends, including robots, drones, and VR, keep evolving and exerting influence on our sexual behavior. This can be about positive developments, but it can equally create new opportunities for misuse. Hence, these technological changes create many challenges on a societal level, but also for law enforcement and for forensic care, challenges that are difficult to keep up with. 

On November 22, 2022, a webinar on technological evolutions and their role in online sexual behavior was organized by the Dutch Affiliation of ATSA. The webinar was launched by the President of the Dutch Affiliation of ATSA, Minne De Boeck. She also took the opportunity to introduce her successor, Maaike Blok, who will succeed her in 2023.

The first presenter was Catherine Van de Heyning, Professor at the Faculty of Law, Antwerp University, public prosecutor and independent expert on the advisory committee of the Human Rights Council of the UN, Belgium. She discussed the legal framework in Belgium regarding online sexual penal law, which was thoroughly analyzed with a particular focus on Image-Based Sexual Abuse. She stated that the present age represents a true image culture caused and strengthened by social media, the omnipresence of smartphones and the COVID-19 pandemic. The perception that adolescents can be their own gatekeepers in an online setting because they grew up in a digital era needs to be debunked. Belgium is proud to be a pioneer when it comes to legislative developments to battle online sexual violence. Several phenomena such as sextortion, forced sexting and deep nude were discussed in light of the new Belgian legislation. Sexting (sending nude pictures) is not a criminal offence. It only becomes punishable once the vulnerability of the other person is taken advantage of, for instance in the case of coercion or violence, or when the sexting images are forwarded without consent. Likewise, sexting between minors is not always viewed as a problem. The presenter also shed light on certain unfortunate sexting trends that have arisen. For instance, doxing that occurs when the identity of the victim is broadcasted to inflict more damage is becoming a true problem. Another phenomenon that becomes increasingly prevalent is the misuse of deep nudes. This entails searching for nude pictures of (potential) victims and editing them in such a way that pornographic content is produced. All phenomena target victims in different ways. Predominantly victims between 15 and 30 years old are targeted and girls/women are targeted more often than boys/men. Moreover, female victims are more often confronted with widespread circulation of the pictures, which inflicts even more damage.

Jeroen ten Voorde (Professor of Criminal and Criminal Procedural Law, the Netherlands) shed some light on the Dutch legal framework to cope with sexual transgressive behavior, including online behaviors. His presentation included both recent developments and plans to deal with new trends such as robots and the use of sex dolls. More concretely, there are apparent problems regarding criminalization and penalization. For example, rape is only illegal when there has been a relevant interaction. With online sexual communication, there has to be an attempt to seduce or groom. Dutch policymakers want to tackle these discrepancies in the future by introducing an interaction criterium by law. In addition, there are certain scenarios which are not yet criminalized. For example, according to the Dutch penal law, watching child sexual abuse material as such is not punishable. This issue is expected to be solved with a new child pornography provision. However, the Dutch penal law does not have a solution for the spreading of deep nude/fake pornography. These presentations show how the legal framework keeps evolving and tries to keep up with new forms of transgressive behaviors.

Zohra Lkasbi (Clinical psychologist and behavioral therapist for children and adolescents, Belgium) focused primarily on adolescents and online sexual transgressive behavior, which is also the topic of her new book. The influence of the digital evolution on the concept of sexuality manifests itself in different ways, ranging from POPU (problematic online porn use) and the non-consensual spreading of sexual content to peer-to-peer online grooming. The latter is heavily facilitated by the fact that everyone has continuously access to smartphones and social networking sites. Special attention was given to dual offenders, who have committed both online and offline offenses. These offenders are often excluded from research, which causes a gap in our knowledge. Various therapeutic interventions such as the use of an internet-and media safety plan, the Flag System, an evidence-based tool for assessing acceptable and unacceptable sexual behavior or using internet zones to tackle online sexual inappropriate behavior are being applied but its efficacy has not been established in research yet.

Manon Kleijn (PhD-Student at Fivoor Science and Treatment Innovation at Tilburg University, the Netherlands), has studied online and offline child sexual offending. She examined how individuals approach minors online to abuse sexually and identified various pathways. First, she described the person who actively ‘approaches’ his victim by (1) bringing up his sexual intentions in the first few sentences and who mainly engages in short conversations, by (2) manipulating his victim (e.g., by giving compliments and showing affection with the aim of acting on sexual intentions), and by (3) discussing sexual topics. Second, she identified an ‘avoidant pathway’. These individuals do not take a lot of initiative and do not have clear intentions. Finally, a mixed group was also identified.

In the final part of the webinar, Dr. Dean Fido and Dr. Craig A. Harper (senior lecturers in Forensic Psychology, University of Derby and Nottingham Trent University respectively, UK), focused on image-based sexual abuse from a psychological perspective. This abuse encompasses phenomena such as revenge pornography, upskirting, cyber-flashing and deepfake pornography. The presentation shed light on each phenomenon. Firstly, revenge pornography was discussed, a phenomenon that always implies a core motivator as a response. Often, people think of “the cheating wife”, yet research suggests that most perpetrators are not the victim’s former partner. A potential hypothesis that was brought up was that revenge pornography supposedly is produced predominantly by men so they can brag about their sex lives. A second phenomenon, called upskirting, refers to individuals creating footage by taking pictures up the victim’s skirt. In light of this phenomenon, the presenters discussed the case of Gina Martin. She was one of the first females that wanted to report the situation after being a victim of upskirting, yet there was nowhere she could go since upskirting did not exist in any legal framework. Another upcoming phenomenon, cyber-flashing, is not illegal and can only be legally prosecuted under the guise of public harassment. With regard to creating and using deepfake pornography, two possible underlying mechanisms were discussed: hypersexuality of perpetrators and achieving sexual gratification. The presenters introduced the Beliefs about Revenge Pornography Questionnaire – a scale developed to assess social beliefs concerning revenge pornography.  Their recent studies suggest more lenient judgements of deepfake generation and dissemination for celebrities, males and when images were created for self-sexual gratification. Similarly, there is a stronger tendency to victim blaming when the victim is a male. Victims who are male and attractive are perceived to experience less harm in cases of upskirting behaviors. Interestingly, proclivity to make and distribute deepfake and proclivity in upskirting behavior seem to be linked to psychopathic personality traits.

We can conclude that there is still a lot of room for improvement in terms of judicial responses to these new phenomena, and preventive initiatives. More research on these new phenomena and the sharing of best practices are highly needed. However, we also need to acknowledge that social media and other technological evolutions are evolving so fast that it is impossible to keep up in clinical practice and in terms of judicial responses. Notwithstanding, practitioners, researchers and legislators need to remain aware and pay attention to current trends in order to prevent victimization and perpetration as adequate as possible.

How much do we really know about pornography?

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

Three research papers came up in a recent social-media discussion of pornography use. In the first, Beáte Böthe and her colleagues produced results from a large community survey of males and females. They differentiated between Problematic Pornography Use (PPU) and Frequent Pornography Use). The highlights of their findings were that:

·        PPU had positive, moderate links to sexual function problems in males and females.

·        FPU had negative, weak links to sexual function problems in males and females.

·        FPU and PPU should be discussed separately concerning its links to sexual outcomes.

As the researchers point out, high engagement with pornography is not necessarily the same as problematic engagement. In the authors’ words:

Taking findings together, while quantities of the aforementioned activities were often unrelated to maladaptive states and conditions, problematic engagement in these online behaviors has been related to maladaptive or harmful measures. Therefore, thorough examinations are needed when effects of potentially problematic online behaviors are investigated, taking into consideration not only the quantity of behaviors but also quality levels of engagement.

In a 2020 study, Beáte Böthe and her colleagues examined three non-clinical samples (of 14,006, 483, and 672 participants). From their abstract:

Results were consistent across all studies. 3 distinct pornography-use profiles emerged: nonproblematic low-frequency pornography use (68–73% of individuals), nonproblematic high-frequency pornography use (19–29% of individuals), and problematic high-frequency use (3–8% of individuals). Nonproblematic and problematic high-frequency-use groups showed differences in several constructs (ie, hypersexuality, depressive symptoms, boredom susceptibility, self-esteem, uncomfortable feelings regarding pornography, and basic psychological needs).

Of particular note was that the number of non-problematic high-frequency users far outnumbered the high-frequency users with problematic use, as defined by the Problematic Pornography Consumption Scale. Set against the backdrop of earlier studies, such as Kingston et al. in 2008, who found that “Statistical interactions indicated that frequency of pornography use was primarily a risk factor for higher-risk offenders, when compared with lower-risk offenders, and that content of pornography (i.e., pornography containing deviant content) was a risk factor for all groups,” these studies appear to confirm that “mainstream” pornography use is problematic for those already pre-disposed to repeated sexual abuse. It seems that the effects of pornography can vary and are dependent on factors beyond simply how much one views.

At the same time, however, a more recent study published last month is also very important. Katherine Jongsma and Patti Timmons Fritz examined the relationship of pornography use and intimate partner violence. From the abstract:

Two longitudinal actor-partner interdependence models using a structural equation framework to conduct path analyses demonstrated that (a) higher FPU among men at baseline predicted increases in IPV perpetration and victimization from baseline to 4-month follow-up for both men and women and (b) women's baseline FPU did not predict change in IPV over time for themselves or their partners. These findings suggest that frequent pornography use among male partners in different-sex romantic relationships may represent an under-recognized risk factor for IPV, and further research is needed to identify latent factors that may be contributing to this relation. Although women's baseline FPU did not predict changes in IPV over time, this may be because women used pornography less frequently than men.

Once again, the research is surprising with respect to the contributions of pornography to harm. As always, the full scope of the issues and implications is broader than can fit into a single blog post. 

While research has not found the clear link between pornography and sexual violence that one would expect, we now have a study providing some association between pornography and intimate partner violence. It is just one study, but this paper highlights the importance of continued caution and research in this area.

Taking these studies together, perhaps the greatest surprise is that frequency of pornography use is not particularly straightforwardly linked to impairment of functioning. It appears not to be like alcohol use, where drinking over a certain amount is statistically linked to poor health outcomes in a more linear fashion.  A considerable amount of high-frequency pornography use seems to have no appreciable effect for many. One implication of this is that while many politicians and activists argue that pornography is a public health issue, the data do not appear to support this.

Of course, within the field of treating sexual violence, there remain questions about high-frequency pornography use among those predisposed to acts of sexual violence. A scan of the Problematic Pornography Consumption Scale illustrates possible avenues of inquiry and the need to understand the context, values, and nature of the individual as well as what they get out of porn use.

However, it is clear that many men experience challenges in their lives as a result of their porn use and that many ask for help. Further study may reveal a deeper understanding of pornography as a precursor to intimate partner violence. It is still not clear that historical models or ideas (e.g., pornography addiction) are as comprehensive as they could be. For example, is reported erectile dysfunction really “porn-induced” or is it a combination of features such as frequency of porn use, moral incongruity, personal values and beliefs, and other aspects of the individual’s coping style and self-regulation that coalesce to form problems? If that is the case, shouldn’t we address these issues from that perspective instead of relying on more reductionist approaches?

As each of the papers highlighted in this blog post point out, more research is needed.

The challenges of child protection and safeguarding online.

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

Child protection and safeguarding are among the most challenging issues faced globally. The threats to children, new and old, are constantly evolving. It seems that every time we catch up and are aware of any given threat it changes and adapts. As part of his PhD, Kieran researched and examined Ulrich Beck’s idea of the risk society, which states that by the time we are aware of a risk it is often too late to change it and we instead must devote our time to risk management and damage limitation. This is very depressing from a prevention point of view; we desire to use existing knowledge to predict problematic behaviour and roll out interventions upstream to produce the harm from ever occurring. In child protection terms, this means identifying and working with at-risk populations (so at risk of committing an offence or at risk of being a victim), strengthening institution safeguarding practices, and upskilling communities about the realities of risk as well as how to intervene. Two distinct stories that highlight the challenges of child protection and safeguarding.

The first story is from the UK, where the online safety bill is being discussed, the core tenet of which is to keep children safe online from harmful material as well as risky (or more precisely dangerous) behaviours. The online safety bill has been discussed a lot over the past 12-18 months and has been through the hands of three Prime Ministers, with promises of a new wide-ranging bill that will redefine the online world and protect children. But this is seemingly not to happen, as with all policy it has been changed and altered, with core pieces dropped from the bill. One major portion was dropped this week, which was limiting access to legal but harmful material to children. The idea behind this change is that doing so would remove free speech and the right to choose from the online world. This is a strange argument; we have always safeguarded children in this way in the offline world by placing restrictions and verifications in place to make sure they cannot access inappropriate material. It begs the question of why we would do something online if we wouldn’t do it offline. This leads to the growing debate about the lived reality and the policing of cyberspace, and whether, how, and why behaviour is different on and off it? This then leads to another argument levelled against the tenets of the bill, which is that they are too hard, too complex, and too unwieldly to do. That should not be an excuse!

On a week where we are reminded of JFK’s famous statement about going to the moon (i.e., we do it because it is hard) we should refocus our attention on solving this issue. One response from the UK government is the use of age verification software and related policies, which we know is often a challenge and does not work, as parents often sign up for their children or allow them to use their accounts. Therefore, what next? We need tech and online companies to stand up and accept responsibility for what happens on their platforms, since only accountability changes policy and practice. What is the next big step forward in online child protection and safeguarding? And where is the corporate responsibility? Currently, it seems that we rely only personal and/or parental responsibility, which is not always as exacting or fit for the purpose as it needs to be.

This leads us to our second news story, which is about the explosion of child sexual abuse and exploitation in the Philippines through online platforms. Over the past 30 – 40 years we have seen the growth in sex tourism, especially in the far east, but over the past 10 – 15 years we have seen this evolve into cyber/online sexual tourism and abuse. The online sexual exploitation of children is a growing concern and often difficult to police transnationally. This means that the internet and the online environment has a role to play in preventing and responding to it, as it plays a key role in enabling it. The reality of the online sexual abuse of children, as with the trafficking of children for sex and the sexual exploitation of children is one of access, poverty, and hopelessness. All of this is set to increase with the current global costs of living crisis. How do we prevent sexual exploitation, both in person and online, when on some occasions it is being caused by the parents, family members and associates of the child? According to a report from the Dutch Centre against Child and Human Trafficking a family member is even involved in almost one fifth of the cases. On one level, it is about local education and prevention programs, but on another level its about the role of the internet in facilitating and not preventing its dissemination. Again, we hear narratives about the challenges of doing so, that it’s just too difficult and problematic. This time we hear that its because of culture and social differences; issues linked to cross-border and transnational working; that international law is sketchy at best; and the need for sovereign independence and the fact that it’s difficult to get a prosecution. All these things are true, to a degree, but it doesn’t mean that we shouldn’t do it. The internet spans borders; therefore, should its content and usage not span boarders too? If the internet is being used to exploit children in one country by someone from another, shouldn’t they be held responsible and therefore be accountable?

We have reached the stage where we need to hold the online community responsible for its actions, because harmful behaviour offline can be just as harmful online. It’s the content and behaviours that make something harmful, not merely the medium. When we think about how we respond to and prevent online sexual abuse and the tools we use, we need to future proof these and therefore we need innovation, not reinforcement of old ways. Whether we are managing the risks that our children face online or the way that they engage with technology we need to look at it from all angles, with fresh eyes.

We need to talk about sexual violence by … health care providers

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

The forensic clinical field in the Netherlands has been shaken to its core several times in recent months by multiple serious incidents in psychiatric clinics following one another, including sexual and deadly assaults. Although serious incidents in these clinics are not a common occurrence, it is essential to reflect on the staff and patients affected and take further steps in trying to prevent such incidents.

When we learn that an incident has occurred in a forensic institution, we first assume that a patient has assaulted one or more staff members. Indeed, Dutch forensic clinical practice has faced very serious incidents in recent years, including a violent, sexual and deadly assault committed by a patient. Hence, such incidents occur and have a tremendous impact on the victim(s) and all those involved. Less often however, we hear about staff members mistreating or (sexually) abusing patients. Unfortunately, such cases occur as well. Without minimizing the seriousness of patients’ violent behaviors towards staff, we want to focus for a moment on sexually transgressive and violent behaviors caused by practitioners. We start from a recent case in the Netherlands.

In September of this year, it became known that an employee of a high-security forensic psychiatric clinic had been fired after sexually assaulting a patient. This employee had forced a patient to perform sexual acts. In April, this came to light during an interview with the woman in question. The employee was a sociotherapist who helps patients train pro-social behaviour and learn to cope with their mental health problems. When this came to light, the man was suspended and later eventually fired. On top of that, other problems came to light. At the same clinic, a staff member was fired for having a sexual relationship with a patient and an internship was stopped because the intern had started a relationship with a patient.

Especially the first case, but certainly also the other cases raise a lot of questions and concerns, first and foremost with respect to the patients. The patients that are admitted to such clinics have committed serious offences, but often also have a very traumatic past. Frequently, they have been mistreated, neglected and/or abused by those they should have been able to trust. These patients do not only struggle with their own often- extensive criminal past but also with their own repeated victimization. During their stay in the clinic, we try to teach them a prosocial lifestyle, which also means that they have to learn to trust others and to get attached again. This is anything but obvious to them and requires considerable work. Attachment problems and a deep distrust of others are characteristic of this population. It then almost speaks for itself, when the (little) trust they finally gained, is damaged, especially by someone to entrusted with their care. It leaves very deep wounds, Not to mention the psychological and physical damage they suffer from the sexual violence. The house of cards, being the new prosocial life, that staff and the patient have tried to build on often very weak foundations, then threatens to fall apart or just collapses at once.

The reach of this cannot be underestimated. Not only is the direct victim seriously affected, but also fellow patients. The questions then become whether their trust and faith in staff, and broader, in others, are still recoverable and how we, professionals, best try to restore it. And the third group we should not lose sight of is the staff. They, too, are badly affected by such incidents. They struggle with questions like “how did I not see this?”, “couldn’t I have prevented this?”, and “what now?”. Moreover, as was observed in this specific case, staff members were also confronted with stigmatizing remarks from the public. For instance, when the abuse was disclosed, staff members were confronted with condemning remarks in the vein of “You’re all the same,” and “you’re all rotten apples.” Also notable was the ripple effect: Staff from other clinics were very concerned, scared, and angry, and clearly felt the need to talk at length about this with colleagues, among others. Hence, the consequences of such violent and transgressive incidents are thus not limited to the setting where the incident took place but are felt far beyond.

Protocols for violent incidents by patients are in place in most, if not all forensic clinics. But do we have a protocol ready for situations when a staff member exhibits transgressive behavior? How can we best respond to this as a patient, as colleague, as manager, as society?

It is not our aim to propose specific guidelines here. However, we would like to point out some points of importance. As in other cases of (sexual) violence, we should start with the beginning and that is acknowledging the violence and the suffering it has caused. Abuse is abuse, no matter who the perpetrator is, no matter what status he/she has, no matter what position he/she holds, and no matter who the victim is. When you observe that the Dutch media described the abuse not as abuse but as 'sexual acts', you realize that this seemingly obvious starting point is already not obvious to many.

In addition, we need to have difficult conversations with our colleagues, within forensic clinics or in any workplace. Thinking that such cases certainly can't happen in your department implies closing your eyes to the fact that sexual violence can happen anywhere and that several characteristics of our work, e.g., relationships that are disproportionate in terms of power, are risk factors for (sexual) abuse. Increasing awareness and daring to ask difficult questions and engaging in not obvious conversations about prevention and identification of (sexual) abuse by professionals, (bystander) strategies when such abuse occurs, and rehabilitation after the abuse of all those involved, are already key starting points.

Another important question is how to involve patients and clients? Asking for help after a violent incident as a victim or a bystander is not easy, let alone when you are in a dependency relationship and vulnerable. Some organisations, for example, have started to develop guidelines for clients and patients. It would be useful to reflect within our field on this as well; to make suggestions available to our patients and to explore how we can make them more resilient within clinics or other settings.

So let’s have these conversations now, and let’s not wait until a complaint of abuse by a professional arrives at your own doorstep.