The importance of the life course in understanding why people commit sexual offences

By Kieran McCartan, PhD & David Prescott, LICSW

We have been spending a lot of time over recent years discussing with professionals, practitioners, and policymakers the importance – as well as impact – of adverse experiences and trauma in the lives of people who go on to commit offences. These discussions have often returned the importance of the life course on offending behaviour. People who commit sexual abuse have often been exposed to adverse experiences, trauma, and problematic life course issues are not that different from the rest of the general offending population. It calls to mind the saying, “What unites us is greater than what divides us.” The implications of these findings include that we need to start thinking, across the board, about the role of trauma and adversity in people’s lives (see Levenson, Willis, & Prescott [2018] for example). Just as importantly, we have an opportunity to focus on how a trauma-informed approach can help us prevent, as well as respond, to sexual abuse.

One of the most significant criminological research in the last 40 years has been Professor David Farrington’s “Cambridge study”, a longitudinal study which looked at the impact of environment and development on criminogenic behaviour. In a nutshell, Farrington found that life course, environment, adverse experiences had an impact on an individual’s behaviour; especially in terms of anti-social or illegal activities. Farrington was talking about prevention, multi-agency collaboration, adverse childhood experiences, and trauma before any of these became buzzwords. Research into human development across the lifespan highlights the importance of understanding what happened to people to get them to the point where they have committed an offence. Commonly, professionals in our field often think about preventing re-offending rather than preventing first time offending. If we are to change our prevention paradigm, we need to re-conceptualise the way that we frame these dialogues. The reality of using life course approaches in the prevention of sexual abuse means that we must use more individual, institutional, and community-based multi-agency approaches; we must move our focus to the front end. One way to change our outlook and practice is to frame it within the model of trauma-informed practice.

Trauma-informed practices emphasise the need for practitioners, institutions, and organisations to be aware of the traumatic events, or experiences, that the people that they work with have gone through. Being trauma-informed means asking, “what happened to you?” as well as “what motivated you to do that?” It also involves exploring what’s right with someone and not simply what’s wrong with them; What strengths, positive goals, and protective factors (or “promotive” factors, as Farrington has called them) do this client have that can help them to prevent offending?

Having a trauma-informed approach further involves looking at the life course of the individual and how it has shaped them so that professionals can identify how to help them in moving forward with their lives, building an overarching sense of wellbeing and developing a lifestyle in which offending would be unwanted and unnecessary. It might also involve helping others in similar situations to prevent offending.  As trauma and adversity are central to the lives of people who commit offences, particularly sexual offences, being trauma-informed is a critical part of the foundation to our work with these populations; the correlation between victimization and perpetration is closer than we recognize or, sometimes, that like to consider. Therefore, we need to consider where trauma-informed practice fits in the training of professionals, in media coverage of, and the way that we engage with the public around sexual abuse. 

The collateral consequences of sexual abuse

By Kieran McCartan, PhD, & David Prescott, LICSW

With this post, we have hit a milestone. This is our 300th posting, and the blog has had 375,000 individual “hits” since the blog’s inception eight years ago in February 2010. Over the past eight years, the blog has had several contributors outside of the main blogging team (which has included Alissa Ackerman, Jon Brandt and original blogger/founder Robin Wilson) some infrequent and others more sustained (like the ATSA Prevention committee). All of this has happened with the support of ATSA and its Journal, Sexual Abuse. We are grateful to everyone who has been involved as well as to all of you who read the blog and keep coming back each week!

This blog has addressed diverse issues throughout its existence, so with this post, we focus on the idea of “collateral consequences” in the area of sexual abuse. Primarily an American term, collateral consequences are the unintended outcomes – generally negative – of certain policies and practices. The field of sexual abuse is littered with policies and practices that have negative unintended outcomes. Either separately or in combination, these collateral consequences include barriers to community reintegration of people who have committed sexual offences, horrific experiences for those who have been abused, and the capability of professionals to provide a meaningful service.

For example, in the time that this blog has existed, we question whether there has been any improvement in the collateral consequences, particularly in the USA, in four over-arching areas:

• People who have committed sexual offences: Despite strong evidence that measures such as public registries and residency restrictions don’t work to reduce risk or prevent re-offence and can easily make matters worse, they remain in effect. There is little indication that these measures will be re-examined at any time in the future, except for the registration and notification policies linked to juveniles which are being examined. Interestingly, other countries have learnt from the USA’S experience and not replicated the registration and/or community notification policies in the same way; the American version has acted as a cautionary tale in other contexts. Sadly, it seems that in society’s rush to punish, the extant research into what works has gone largely ignored.

• Those who have been victimized: For all of the recent media attention on survivors of sexual abuse, including in the #metoo movement, it is difficult to discern whether any lasting changes are being made that will actually improve the lives of those who have survived abuse. On one hand, the international dialogue is welcome and timely. Indeed, rates of reported sexual abuse have gone down across the past few decades. On the other hand, we can find no broad evidence that the experience of survivors has improved across the board in recent years and in some instances, there has been a greater societal backlash as a consequence of the increased societal awareness of sexual abuse.

• Friends, families and colleagues: The silent anguish of the family, friends, and colleagues of those who have abused remains an under-acknowledged area of harm. These people have few places to turn for support, particularly when the person who has abused returns to the community. We generally think about the collateral consequences of criminal justice sanctions on families and networks, but we are starting to see and hear of the collateral consequences of supporting non-offending or at-risk individuals too.

• Professionals who work in the field of sexual abuse: Finally, although anecdotal, the stories of those who research and treat people who have abused often illustrate that there can be little gratitude for the work they do in building healthier lives and safer communities. Indeed, the work itself can have cumulative effects and can often result in secondary traumatization, which reinforces the need for effective and ongoing staff development. This is particularly important in developing resilience and preventing burn out.

One of the main ways that we can combat the collateral consequences linked to sexual abuse is through better joined up, multiagency and long-term policy and practice. It’s important to recognise all the potential outcomes from sentencing, treatment, management, integration and support services related to sexual abuse to make sure that problems are not compounded or result in adverse (problematic) outcomes.

In the end, we continue to know what does and doesn’t work to reduce the harm of sexual abuse. The question remains as to whether society and its policymakers are willing to examine our practices and their many consequences.

Hearing the narrative, seeing the person: Considering the appropriate research methodology

By Kieran McCartan, PhD, and David Prescott, LICSW

A memorable case discussion attended by the second author featured a consultant recommending multi-systemic treatment (MST) for an adolescent who had been acting out aggressively ever since his father’s death. The case manager was concerned about his behaviour and had just overseen an unsuccessful course of MST with this client. Despite the fact that MST hadn’t worked, the consultant recommended that it be repeated, not because it was the correct intervention for that particular individual (for whom grief counselling might also have been appropriate), but because of the strength and quality of the MST research. The situation calls to mind words from a UK practitioner during a conference in 2012: Are we personalizing our manuals or manualizing our persons?

It often seems that our field is governed by large-scale studies and quantitative evidence indicating that a particular treatment, intervention, or process either works or doesn’t work. Understandably, we look at the broader outcomes of re-offense and risk reduction to drive future processes. We (the authors) are not saying that this is wrong, but rather that practitioners should remember the individual in the process, as well as the greater cohort. Sexual abuse (and treatment for sexual abuse) is as much about personal narratives and context as it is about processes and outcomes. Sadly, our most sacred studies don’t always take into account the experiences of those who have lived through the interventions.

The prevention, treatment, and management of people who have committed, or may commit, sexual offences include features that range from the individual through to the social and cultural. One implication is that we must use multiple research methodologies to answer a range of questions that include the “service user”, the “service provider” and the facilitating institution; their “voices”. A single research methodology, epistemology, ontology, or form of data analysis will not work in all circumstances; especially given that research and practice linked to sexual abuse cross many social (politics, law, policy, sociology, criminology, psychology) and physical (chemistry, biology, psychology) disciplines, and everything in between (public health). We need quantitative studies to look at large cross-population samples and answer broad-based questions. However, is a quantitative approach the best one for small-scale, small-cohort, individualised, practice-based, policy-based or process-driven questions? No, it isn’t. We often need to consider case studies or qualitative research methods to answer these more personalised, individualized, and small cohort questions. The research question, who is asking it and why they are asking it are central drivers as different disciplines and different groups have different agendas; which is fine, as long as its transparent and clear!

We need to use the research (and treatment) method that enables us to answer the question that we are asking. We can’t fit a particular research question into a certain methodology for artificial reasons because, in reality, it will fail and jeopardise the outcome.  Certain research questions linked to prevention, treatment, management, and community integration need to be qualitative so that we can capture the appropriate narrative and understand whether the process or intervention is working at a ground level. We need a qualitative, or case-focused, approach to hear and understand the “service user” experience, or the expert voice, within the cohort sample and larger outcome. This is essential, because we need to connect research and treatment in a coherent way that does not create paradigm extremes (quantitative being the choice of “research” and qualitative being the choice of “treatment”). This happy medium incorporates multi-stage, multi-methodology, and multi-disciplinary studies in order to focus on the larger research questions as well as capturing the personal narrative. A multi-methodology approach enables us to explore treatment, research, and policy questions and facilitates a more holistic response.

Working in a politically, socially, and personally sensitive area demands that we think ethically about the research that we do and the way that we do it. Often times we need to do the complex, expensive research study that allows us to understand the reality of the situation. Unfortunately, this type of research does not happen as much, or in as much of a nuanced way, as it should. 

Understanding the Obstacles to Help-Seeking for Minor-Attracted Persons

By Jill Levenson, PhD,  Barry University, Inc. at JLevenson@barry.edu; Melissa Grady, Ph.D, The Catholic University of America at grady@cua.edu; and Julie Patrick with RALIANCE at jpatrick@raliance.org

 

W. Edwards Deming once famously said, “In God we trust, all others must bring data.” Designing effective primary prevention services starts with collecting good data. Yet this proves challenging for many stigmatized populations who remain “in the shadows.”

The scholarly literature, for instance, about non-offending minor attracted persons (MAPs) is in a nascent stage. Though they remain an under-studied and somewhat misunderstood population, we are learning more about individuals who have sexual interests in children (Cantor & McPhail, 2016). Studies have revealed that most MAPs become aware of their unusual sexual interests in early adolescence (B4UAct, 2011b; Buckman, Ruzicka, & Shields, 2016), and that among MAPs, about 42% report a primary attraction to pre-pubescent youngsters (Mitchell & Galupo, 2016; Piché, Mathesius, Lussier, & Schweighofer, 2016).

Due to stigma, fear, and shame, and many other factors, many MAPs have not sought help from professionals, and others have been discouraged by the services they received (Jahnke, 2018). Some MAPs who did seek services but did not receive them reported that failure to obtain adequate help resulted in negative ramifications. These include an exacerbation of mental health symptoms such as depression, suicidality, withdrawal and isolation, lost productivity, fear and anxiety, hopelessness, and substance abuse (B4UAct, 2011a). Furthermore, a small group (3-4%) said that after being unable to obtain counseling, their attraction to youngsters continued or escalated and that they were later convicted of a sexual crime (B4UAct, 2011a). MAPs in non-forensic samples tend to have higher education and socio-economic status than those convicted of sex crimes, and may have greater willingness and opportunity to engage in formal and informal help-seeking through various professional or online resources.

Thanks to an impact grant by nonprofit leadership collaborative RALIANCE, Dr. Jill Levenson at Barry University and Dr. Melissa Grady at Catholic University surveyed minor-attracted persons (MAPs)​ ​to better understand the obstacles they faced when seeking help[JP1] .

The project complemented information gained from the “Help Wanted” project developed by Dr. Elizabeth Letourneau [described in Buckman, Ruzicka & Shields (2016)] by collecting data from a larger sample with a greater age range. The quantitative survey for more robust data analyses including group comparisons and associations between variables.

Good data and collaborations

The researchers built relationships to partner with consumer groups that provide online support, resources, education, and information for MAPs who are concerned about their sexual interest in children. With the help of organizations like Stop It Now! and VirPed, the project was able to collect a non-random, purposive sample of MAPs (n = 293; 154 completed all questions). The on-line survey included quantitative questions to gather information about their histories, help-seeking experiences and behaviors, as well as 10 open-ended prompts designed to capture their lived experiences of seeking counseling for minor-attraction.

Overcoming challenges

Confidentiality and anonymity concerns were addressed by building in protections in the survey platform. Many MAPs have worked to separate the constructs of minor-attraction or pedophilia from “sex offender.” The conflation of these terms perpetuates the stigma and shame felt by MAPs. For this reason, some MAPs did not want to be part of a study focused on the prevention of sexual abuse, arguing that many MAPs are not at risk for abuse.

Implications for service delivery

The participants reported that stigma was the primary barrier to seeking help from others. Although stigma was reported as a stand-alone theme, it overlapped with many of the other themes, such as fear of being judged or being reported to authorities even though they had never acted on their attractions. They also reported high levels of shame, which focused on internal views of themselves as a “bad person,” which was sometimes reinforced by mental health professionals. To counter these negative experiences, many noted the importance of building a community with other non-offending MAPs (either in person or online). To learn more about the implications for practice and policy, please review: “I can’t talk about that”: Stigma and fear as barriers to preventive services for minor-attracted persons [JP2] [Original Journal article in Stigma & Health] and Preventing Sexual Abuse: Perspectives of Minor-Attracted Persons About Seeking Help [JP3] [Original Research Article in Sexual Abuse].

This project promotes the idea that we can make communities safer when we provide compassionate, relevant, ethical, and effective psychotherapy services accessible and available for non-offending MAPs who wish to maintain an emotionally healthy and non-victimizing lifestyle.

References

B4UAct. (2011a). Mental Health Care and Professional Literature Survey Results. Retrieved from http://www.b4uact.org/research/survey-results/spring-2011-survey/

B4UAct. (2011b). Youth, suicidality, and seeking care. Retrieved from http://www.b4uact.org/research/survey-results/youth-suicidality-and-seeking-care/

Buckman, C., Ruzicka, A., & Shields, R. T. (2016). Help Wanted: Lessons on prevention from non-offending young adult pedophiles. ATSA Forum Newsletter, 28(2).

Cantor, J. M., & McPhail, I. V. (2016). Non-offending Pedophiles. Current Sexual Health Reports, 8(3), 121-128. doi:DOI 10.1007/s11930-016-0076-z

Jahnke, S. (2018). The stigma of pedophilia: Clinical and forensic implications. European Psychologist, 23(2), 144-153. doi:10.1027/1016-9040/a000325

Mitchell, R. C., & Galupo, M. P. (2016). The role of forensic factors and potential harm to the child in the decision not to act among men sexually attracted to children. Journal of Interpersonal Violence, 0886260515624211.

Piché, L., Mathesius, J., Lussier, P., & Schweighofer, A. (2016). Preventative Services for Sexual Offenders. Sexual abuse: a journal of research and treatment. doi:10.1177/1079063216630749

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 [JP1]http://www.raliance.org/grant-program/grant/understanding-obstacles-help-seeking-minor-attracted-persons

 

 [JP2]http://psycnet.apa.org/doiLanding?doi=10.1037%2Fsah0000154

 [JP3]https://journals.sagepub.com/doi/full/10.1177/1079063218797713

We never know where the next innovation will come from

By David S. Prescott, LICSW

I recently had the opportunity to provide training on the Good Lives Model and Feedback-Informed Treatment in a secure treatment center for adolescents. The program has been able to accomplish what others only dream of with kids deemed by the courts to need this intensive level of supervision and structure. After the training, I had the privilege of meeting with a number of treatment graduates as well as their student advisory board, an independent collection of students currently in treatment. I also toured the facility, observed people and situations, often beyond their full awareness, etc. Just imagine:

·   In a program that serves well over 100 adolescents, they have not had to engage in physical management in over 560 days.

·   As a part of eliminating physical management, they also reduced the number of staff injuries significantly.

·    They present at national conferences on the methods they used to accomplish this remarkable feat. The short version is that it involves strong leadership, a philosophy of trusting kids to do the right thing under the right circumstances, and intensive in-house training on how to have a conversation with a distressed teenager and how to prevent appearing threatening.

·    The program was an early adopter of trauma-informed care and has used trauma-focused cognitive behavioral therapy for the better part of a decade.

·    They incorporate client feedback in a number of areas through the use of anonymous surveys. The process itself is further anonymized through the way staff members handle each survey.

·    The student advisory board takes an active role in the hiring of staff and has actually contributed substantively, including accurately identifying candidates who were unfit to hire.

·    Taken in sum, the program has worked like very few others to develop a “culture of feedback” in which its students are free to speak with staff at all levels about their doubts and concerns. They are able to do so without fear of retribution and with confidence that they will be taken seriously. In a large institution, this is itself a  major accomplishment.

·     The program tracks outcomes and finds that only a small number of its clients return to a similar or higher level of care. They break this data down further to identify which clinicians are more and less successful in this regard so that all can improve the services they deliver.

Although there are good and not-so-good youth-serving programs all around North America, what makes one of the biggest differences? This program uses the polygraph. Those familiar with my work know that I have long been sceptical of the polygraph with adolescents. As just one example, consider this post by myself, Kieran McCartan, and Alissa Ackerman from last year, in which we discussed how the success of an intervention can rise and fall on its implementation.

To a sceptic such as myself, this implementation comes as a refreshing surprise. From internal data collected, it is clear that the majority of clients are not only comfortable with the polygraph as it is implemented but endorse its use wholeheartedly. Comments from students who had nothing to gain or lose by being honest in interviews focused on how the process of using the polygraph helped them to be honest with themselves about their treatment needs. Inconclusive results were as likely to activate discussions in treatment as to the possible role of adversity and trauma in the backgrounds of the students as anything else. Policies are in place that firmly establishes its use as a treatment tool. In fact, to an outside observer like myself, it appeared that the program had worked to wrest polygraph processes away from professionals outside the program in order to implement its use in the context of the client-centered values described above.

Of course, some aspects of this program’s polygraph use are clearly at variance with other implementations and deserve comment. I have personally worked with some polygraph examiners who should probably never work with adolescents. That is a fair enough statement, as I have also spoken with examiners who don’t want to work with this population. Likewise, this program has no expectation that the polygraph will do anything except help teens to demonstrate to themselves or others that they are giving treatment, honesty, and meaningful personal change their best shot. Importantly, in the context in which these young people find themselves (entangled in the legal system and often at odds with their families), they are grateful for anything that helps them to get back on track quickly.

In addition to their consumer satisfaction and feedback measures, the program further uses these approaches to ensure that the polygraph is helping and not hurting any of the kids or their futures. Questions related to how comforting the examiner was to the child are at the forefront of questionnaires and clinical discussions; indeed, the students give specific feedback on the examiners themselves. Just as importantly, the polygraph is billed as something that confirms students’ statements rather than catching them lying. Ultimately, there is no over-selling or misrepresentation of the polygraph; the students are aware that it is far from perfect, and this is evidenced in their feedback.

Ultimately, any intervention can do harm when misapplied. This is why we have practice guidelines and codes of ethics. I have personally witnessed polygraph examinations that were anything but helpful. Unfortunately, as with other agency settings, it is a very difficult process to obtain approval for research from the court system involved. For the time, it is limited to its own practice-based evidence. At the present time, the program is continuing to work to improve. For example, while a very considerable majority felt that the polygraph process had helped them to forge better relationships with others, a majority also felt that they could have been better prepared.

In all, I left the experience feeling that the real question is not whether the polygraph should be used or not, but rather how programs can best focus on all of the myriad elements that make up a solid, youth-guided intervention. Although I have no plans to change my own practice, this experience points to the obvious need for professionals to keep an open mind and not simply assume that any other professional is either wrong or in need of instruction.

The challenge for practitioners in the field ultimately has to do with balancing the promise of better futures with minimal risk of harm. Like many other aspects of treatment (e.g., disclosing past abuse without the polygraph, focusing on victim empathy), it can take years of teamwork to accomplish this.

Again, one never knows where the next innovation will come from.