“Victim”: Reflections on autonomy, choice, and the power of language

By David S. Prescott, LICSW

You are never more than a stone’s throw from someone who has survived sexual violence.”

-          Alissa Ackerman, Ph.D.

For years, I’ve puzzled over the American Psychological Association’s definition of trauma:

Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives. Psychologists can help these individuals find constructive ways of managing their emotions.

There is a number of ways to read this definition, starting with the idea that trauma is an “emotional response.” This seems strange given that victimization can have devastating effects on how people view themselves and the world around them (for example, cognitive schemas that the world is a dangerous place where one has to see risk everywhere in order to survive). Being victimized is about a lot more than simply emotional responses. This is evident even in the criteria of our diagnostic manuals.

Looking deeper, however, it seems odd that the definition concludes with the idea that “psychologists can help these individuals find constructive ways to manage their emotions.” While the statement is not untrue, there is an implication that psychologists may be more exclusively qualified than others to assist those who have been traumatized. There is an implication that those who have been traumatized likely need professional help. Of course, there is no evidence to support either of those statements and no evidence that the APA intended to imply these things. Nonetheless, I have found myself wondering whether this isn’t where a curious kind of colonization begins. After all, close friends can also be helpful to those who have been victimized. By what right does any profession claim, even implicitly, that they have the best answers?

History has shown that colonization can start with good intentions – actions taken “for your own good.” For professionals, it can begin with implicit beliefs about our clients, often beyond our awareness. For example, “This person clearly needs treatment…” can morph into “… and I am the right person to provide that treatment.” Others may simply imply that they speak for all who have been victimized and that they know what these people need or want. Meanwhile, anyone who has worked with people who have survived sexual abuse knows that no two people have the same experiences as they re-build their lives. The fundamental question becomes how we know that we speak for others without first confirming with them that we’ve heard and respected their voices? It may seem petty, but if we are not allowing them to frame their own experiences, how can we know that we are not causing further harm by, in essence, colonizing their experiences to meet our own agendas?

How we frame these issues matters. Over many years of practice, I’ve spoken to a number of practitioners. One interaction has haunted me. This practitioner described how “victims” often believe that they are “damaged goods” and therefore need long-term treatment to learn that they are not. This person then went on to describe clients returning to treatment decades later after re-traumatizing experiences. On the one hand, these situations are not unusual. On the other hand, this practitioner appeared to derive a sense of professional identity and intrinsic gratification at being the one to whom these people would turn. It was as though she needed her clients to desire her continuing care more than they need to be back in treatment. Most professionals in our field are proud to be helpful to others, myself included. Where we cross the line into the beginnings of colonization can be difficult to discern, however.

While the broader discussions could fill a book or multi-day conference, this post focuses primarily on words. I’ve come to wonder whether phrases such as “damaged goods” (as in “You may feel like you are damaged goods. Rest assured that you are not, and many other people have felt this way”) may actually cause harm to those that don’t feel that way but start to wonder if they should. Why put our linguistic focus on “damaged goods” first when we can just as easily say truthfully that many survivors go on to reclaim their bodies or their lives despite sometimes wondering if they would ever get over the harm they’ve experienced. Post-traumatic growth receives far less attention than post-traumatic stress disorder in our education and research. While no one can realistically argue that the harm caused by abuse can last a lifetime, studies continue to find that life-long harm is far from inevitable. As Kieran McCartan and I have argued, it should not be left up to others how someone survives.

Where does this leave us? One place to start is in reconsidering the word “victim”. Many who have victimized have been quite vocal that they don’t want to be defined by the worst thing that has happened to them. Many prefer the term “survivor,” although having worked with a number of extremely violent men, I’ve learned all too well that not all who are abused actually survive. Three years ago, ATSA issued a statement regarding person-first language. Perhaps it is time to extend the same courtesy to those who have experienced victimization. Of course, just as important is that we explore with clients how they want to define themselves – for the moment and in the future.

Ultimately, it can be easy to forget that language is sometimes intervention in itself, and not just one part of treatment. The words we use can have a profound impact on others as well as ourselves. Given how often mental health practitioners worry that stigma interferes with people seeking our services, it makes sense that we do what we can to abandon stigmatizing language. It may also be the case that thinking in person-first terms (for example, “person who has been victimized” rather than “victim”) will help all professionals to better understand that people who abuse are themselves often people who have also been victimized.

In the end, Judith Herman may have captured it best in the early 1990s when she said that no intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it may appear to be in her own best interest. One place we can start is with our assumptions about who we are in others’ lives and how our language (as well as our actions) can bring about assistance or cause further harm.

The author is grateful to Kasia Uzieblo, Jill Levenson, Alissa Ackerman, Danielle Harris, and Kieran McCartan for their review of an earlier draft of this post.

The evolution of the ATSA 2020 Conference: ATSA from home

By Kieran McCartan, Ph.D.

This year has been difficult and challenging in many ways, with all of us having to change our lifestyle and working practices. Currently, large amounts of us are working from home and only thinking of our next trip to the food shop, never mind moving further afield. This means that trips and experiences that would be a normal, regular part of our professional and personal calendar either are not happening or have significantly changed. One example of this is conference attendance. We are often told, especially in academia, that conferences are a luxury and that we should take the hit this year with everything else that is going on. I would counter that argument as the core root of evidence-based practice is research and the function of a conference is to create an environment that enables free, frank, and critical engagement with colleagues on research and practice. Conferences, therefore, are an important part of the lifeblood of our field, they are where we hear cutting edge research, network with colleagues, and generate new ideas. The Covid-19 pandemic has impacted the viability of the conference circuit with some organizations suspending their conference to 2021 (IATSO, NOTA), putting on a reduced conference program in the form of webinars (NOTA), however, ATSA has decided to continue with their conference albeit in a different way. 

ATSA has had an annual conference each year for 38 years and 2020 will have an ATSA conference as well, but this year rather than it being in person (it was supposed to be in San Antonio) it will be online and “from home”. ATSA has embraced the recently necessitated technological and online move predicated by Covid-19 and moved the conference to be completely online. The conference will run from October 21-23, 2020, with the first day being a series of pre-conference training and the next two days being traditional conference presentations and workshops. 

The 2020 conference theme – Blending Voices. Strengthening Lives. – is particularly meaningful at a time when so many people feel isolated and vulnerable due to the ongoing pandemic. As I have noted in this blog and we have seen in many media reports, there is an increased risk of sexual abuse when individuals are isolated without the normal access to support structures that can help prevent and address that abuse.

The 2020 ATSA from home the conference has a strong line up with plenaries from Shannon Moroney and Michael Seto, with more than 40 educational sessions (all with CEUs at no additional cost), 30 poster sessions, several chat rooms, and many other opportunities to hear from and interact with experts in the field of sexual abuse prevention. Speakers and attendees, at this year’s event, will be international in nature and the research and practice discussed will be of the same standard as previous conferences.

While ATSA from home will be different format, layout, and approach to the traditional in-person conference it does allow us to meet, talking, and learn from each other. In person, conferences seem like a long way off and quite alien at the minute. Has Covid-19 changed the nature of conference attendance, especially international conference attendance, permanently, or is this only a bump on the road? Who knows! To me, it shows that ATSA is moving with the times to support researchers and practitioners to prevent sexual abuse.

Not so cute after all? The controversy over “Cuties”

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

In recent days, a controversy arose over a Netflix-produced movie titled, “Cuties”. Its marketing campaign featured young girls dressed provocatively. It drew instant criticism in social media with some claiming it is a movie for pedophiles; others even stated it will elicit pedophilia. The topic has also become politicized, with politicians apparently fueling the idea that the movie is evidence of an underage child sex trafficking cabal in Hollywood. The furor over risqué art is nothing new, but the speed with which Netflix was chastened and responded was impressive: Netflix apologized, canceled the marketing campaign and in some countries has seemingly removed the award-winning movie from its platform. Ironically, most agree that the marketing campaign did not reflect the actual content of the movie effectively. The film was about a girl caught between the cultures of her French schoolmates and her Senegalese Muslim family and reflected the director’s story. Still, opinions of the content have been sharply divided within our field.

 

So, did we judge too soon? Most probably. Many judged the metaphorical book by its cover, without having seen the actual movie. The experience shows us the many perils of social media. Although social media has its merits, it tends to ignite polarized discussions with little room for nuance and reflection. Social media encourages the rapid browsing of headlines and elevates provocative items. Users are rewarded for (re)posting provocative, splashy items by giving them more followers and retweets, even if the story is untrue. Hence, social media focuses our attention on the number of likes and distracts people from accuracy. This is a dangerous evolution that is increasingly misused and abused by certain people and groups in society to mislead people on political, economic, health, and climate issues, to name a few. All of this is important for those us who spend much of our careers attempting to dispel inaccurate, seemingly mythical information about sexual abuse.

 

Will people change their judgment on the movie? Some might, and many will not, even when they hear what the story is really about. Information that is initially accepted but later corrected, is found to have a persistent influence on people’s memory and reasoning. New information will always be weighted and interpreted in light of information already received (Ecker, Lewandowsky, Pin Chang, & Pillai, 2014). In addition, people are more likely to accept (mis)information when it is consistent with their believes and attitudes (see for a review, Lewandowsky, Ecker, Seifert, Schwarz, & Cook, 2012). Thus, the danger in this story also lies in the fact that this controversy will fuel wrong conceptions on pedophilia and facilitate child trafficking conspiracy theories.

 

Will the movie ‘elicit’ pedophilia, as some have argued? There are two possible questions within this idea. With media willing to sexualize children in high supply everywhere in western society, perhaps we should be engaged in a broader discussion about this topic. On the other hand, questions regarding whether this film will create pedophilia where none existed before might best be answered with the question of whether watching films about gay people have ever changed anyone’s sexuality at a fundamental level. While there is always the possibility that any media will move people into some kind of action, people’s fundamental sexuality is simply not that subject to change.

 

Further, while there are provocative images and content within Cuties that some will view as confirming their existing offense-related attitudes and beliefs, the film is best understood in context. The ongoing debate reinforces the point that problematic content is always available and easy to access for our clients. This means we need to respond to this with our clients. It is not that different from the times before the Internet, when our clients would commonly use non-pornographic child sexual abuse imagery. Those who are interested in children will always find this content, with the difference here being that it was given directly to them. 

 

The main issue remains that these headlines and social media attacks divert from the important discussion that the director intended to have with the audience. She wanted to ignite a discussion on the sexualization of children. As the directors stated, “I wanted to open people’s eyes to what’s truly happening in schools and on social media, forcing them to confront images of young girls made up, dressed up and dancing suggestively to imitate their favorite pop icon.” This is the discussion that should get our attention. When I (Kasia) bring this topic up in my classes – which I have been doing over almost the last 10 years - many students argue that I’m not a feminist. Girls and women have the right to dress how they want; an argument that many pop icons promote as well. But isn’t the pressure that these girls feel to dress provocatively so that they can be part of the current pop culture not also a sign of oppression? And isn’t this form of oppression also worthy of close examination? Perhaps our rush to judgment precludes other, more important discussions, including those regarding where oppression begins and ends?

“But they must have known”: Am I getting this wrong?

 This blog was written by an individual from the UK who wanted their story heard but wishes to remain anonymous.

This is a blog in a continuing series about the impact of the arrest & prosecution of individuals convicted of having Indecent Images of Children on their families (please see a previous blog by a professional and a family member). The author of this blog has wished to remain nameless, but please be aware that the individuals who contribute to these blogs, while anonymous, are different individuals. Kieran

The “But, they must have known!” blog presented the story of an ex-partner of an IIOC and her experience and emotions in the five years since ‘the knock’. My situation is almost identical, just five years on, and I wanted to highlight how the focus on the event and the immediate aftermath is not enough, and how the situation continues to evolve, and even heighten, as the year's progress. I am an ex-partner of a man arrested for IIOC offences 10 years ago. He received a community sentence and 5 years on the SOR. My children do not know. 

On the night that my ex-husband was arrested, my 2 sons (3 and 6) were playing in the living room. We had a great family, the kids loved their dad, and contrary to what people may imagine, there were no signs, we were very happy, and for the children, that meant an unexpected decimation of the family. Ten years on they still don’t know about their Dad, but this is what I imagine THEY FEEL.

Confused

Every day after the knock my eldest asked me: “What did Dad do wrong?” Every day I distracted him with: “Look what your brother just did”. One day, about a year after the arrest, he asked me: “Did Dad kill someone?” and I vowed that the next time he asked I would tell him the truth. He never asked again! I struggle to imagine another situation where what appears to be a happy and stable family unit would be terminated without the permission to grieve or to talk about the trauma. I told my children (and friends and family) that we decided to separate because we weren’t making each other happy. When people say: “The children will be better not hearing the arguments, or living with the tension”, I envy those families because my children were not better without the arguments or tension because there were no arguments and there was no tension. Is it akin to the death of a parent? I imagine in that situation there is permission to talk about Dad and how great he was. The children don’t have to see their Dad unemployed and broken, but silent as to why this has happened. It’s a world based on lies, deception and, ultimately, a disengagement, because the topic cannot be discussed. I hope that they are too young to dwell on the inaccuracies and the contradictions, but I fear that may be false hope.

Scared

I think my children feel scared. When your world falls apart in an instant, one of the outcomes is hyper-vigilance. Within a day their mum turned from a laid back, happy person to someone who panics at the sound of the phone or knock at the door, who over-reacts when school phone to tell her you have done something wrong, and who often breaks down at things she never did before – without explaining why. While mum used to have lots of friends, enjoy a glass of wine and relish the chance to mix with other adults, she makes excuses to avoid seeing people, she rarely goes out and she doesn’t talk much anymore. For the (ex)partners of IIOC offenders, the crime has a life sentence – the lies, the deceit, the fear,  it consumes you to a point where the safest option is to retreat, and for my children, that overnight transformation must be terrifying.

Do they know?

I think that one of the hardest parts of being the remaining safeguarding parent is projecting every emotion you feel onto how your children might feel. Are they scared or is that my emotion? Are they confused, or does this all wash over them? And feeling the intense and unrelenting desire to tell them why their life changed so dramatically, but all the time knowing that, once said, that cannot be unsaid. These are thoughts, emotions, and behaviours that are not recognised or supported by agencies set up to deal with offenders, victims, or children of prisoners (the overwhelming majority of IIOC offenders receive a community sentence). For my children, and for me trying to parent them, there is no guidance or support, and the overwhelming feeling I have is: “Am I getting this wrong”.

Community Violence and Individual Anguish

 By David S. Prescott, LICSW

The news across cities in the US has once again been horrifying. We, professionals, have found ourselves at our wits’ end trying to figure out what we might do. Watching the news is a harrowing experience. Ignoring it is irresponsible. While some details of each incident may be debatable, the overall trends couldn’t possibly be clearer. People of color have died under circumstances that are questionable at best (and this is an attempt to express it diplomatically). All of this comes against a backdrop since the start of the summer of documented, nationwide increases in anxiety, depression, substance use, and suicidal ideation. Why mention this topic in a blog that typically focuses on issues relevant to sexual violence prevention?

First, most of this blog’s readers have in one way or another made life as well as a living in trying to help build healthy lives and safer communities. For the most part, we all have skin in this game. Yet for all of our specialized efforts anxiety, depression, illness of all sorts, and overt violence – including overt racialized violence – are on the rise. We still don’t have a clear picture of what has been happening with family violence behind closed doors. Where will we want to focus our next efforts? With what resources?

I was recently on a call with colleagues discussing work with at-risk children and adolescents. The question arose about whether any kids in the current era are not at risk, given their exposure to so many horrific events. While, on average, kids from minority backgrounds and marginalized communities are at much higher risk for every kind of bad outcome, it is an interesting question. The challenge of how best to form connections with kids who have been abused was once front and center in our minds, but it may be more realistic now to ask whether we can possibly understand their current realities and emerging world view. How should we change our assessments and treatment in response to the gruesome realities of daily life in 2020?

It’s sad, but not unsurprising, that here at the end of the summer social media for professionals has been quiet on these issues. An earlier draft of this blog post shared with listservs for clinicians of various backgrounds prompted almost no response in some quarters, despite it specifically asking what readers were doing in response to these events. Certainly, there are questions about the boundaries of listserv discussions when the pandemic and our current community violence is so intertwined with politics, economics, and other topics that have been historically off-limits, often for good reason. On one listserv for solution-focused practitioners around the world, there was no response at all. On a US-based listserv for over 2,000 psychotherapists, there was only one response -- a reminder to vote in November.

Nonetheless, there is no way that this same silence goes unnoticed when those of us providing treatment don’t acknowledge the deep, life-altering anguish surrounding us in discussions with clients and co-workers. In just one example, a colleague related how an academic dean sent around an email in sympathy for those affected by Hurricane Laura and the wildfires but never mentioned the numerous instances of civil unrest or their tragic causes. Some professionals feel that it’s important to get the conditions just right before having discussions about race. Meanwhile, professionals of color observe that they have been waiting for centuries for those conditions to become “right.” Some professionals have correctly noted that participating in social media can present a high risk of being misunderstood. On the other hand, practitioners frequently participate in uncomfortable discussions about everything from the sensitive details of victimization to the nuances of sexuality; perhaps it’s time to work on our communication skills?

Further, it seems that all too often our discussions of trauma-informed care are easier when the trauma is clearly of someone else’s doing rather than our own. It’s easier to look at overt violence at an individual level than to look at cultural trauma boiling over -- a trauma that we may well have contributed to, whether actively or passively. Every now and then we discuss clinical approaches to clarification, reconciliation, and reunification for individuals on this list, and yet we’ve been absent from any discussions about how we might apply these ideas to ourselves in a larger social context.

What can we do?

Perhaps the most effective response we’ve heard in recent weeks was from programs in the Southeastern US, where the director asked for data to be reviewed. This involved data about the length of treatment, number of sessions, treatment outcomes, etc. To quote the director, “Across the board, we found that we were not practicing in an equitable way. Our clients of color were less successful, (had) longer lengths of treatment, (had) more disruptions in treatment . . . It initiated a process that we are in the middle of to make changes, with consultation from some folks that are much more astute about equitable systems, in creating a more equitable and culturally responsive practice.” In a subsequent private email exchange, this person emphasized that it was the staff members who had done the heavy lifting to make these changes possible.

In another case, the editorial board of a journal outside of our field engaged in a lengthy self-assessment process in order to completely revamp their procedures. Yet another set of circumstances prompted a lawyer involved in the field of therapeutic jurisprudence to describe how so much of her work had focused on justice with individual cases that she had to re-think how she views community responses to violence. Still, another described, with some grief, how she had changed her legal practice because she could no longer justify her practice in family law to herself.

At the front lines of our work, however, direct questions remain. For example, a young black man is arrested after a brief chase. In his assessment interview, he states that he does not trust people in authority. When asked for clarification, he says, “Just look at the news!” Where are the bounds of our judgment in describing his attitudes and/or behavior as “antisocial?” Where do objectivity and subjectivity begin and end under these circumstances? To what extent do we say that circumstances are “different in the current era” when the primary difference is the ease of access to a video recording? After all, the statistics and concerns have not actually changed much over the years, although the possibility of documenting violence has.

Clearly, addressing issues around race; the backdrop of violence, anxiety, fear; and in some cases suicidal ideation will require efforts at the individual and community levels (and by the community, we mean the full range that the word implies, from professional organizations such as ATSA to our society beyond). This will have to include deep soul-searching and difficult conversations as well as educational approaches, policy reviews, and the like.

As Martin Luther King, Jr., famously asked: “Where do we go from here? Chaos or community”?

Note: The individual communications noted in this blog are shared with the permission of those who communicated them.

 

“The Train Keeps a’Rollin” … 10 Years Later

 By Kieran McCartan, Ph.D., David Prescott, LISCW, & Kasia Uzieblo, Ph.D.

In the UK we do not have high school reunions, they seem to be something quite American or reserved for 80’s movies; but if this blog had a reunion, this post might be it.

 

Ten years ago, in July 2010, Robin Wilson started the blog with the blessing of Maia Christopher and James Cantor as a way of continuing the public and professional outreach of ATSA and its Journal, Sexual Abuse. The blog was to be a platform for discussing, via concise messaging, the main issues, challenges, and progress of the sexual abuse research and treatment field. The aim of the blog was to be informative but critical in an accessible way. Whether the blog has accomplished that is for its readership to decide and comment on. What the blog has done is provide a commentary on the reality of sexual abuse for professionals and the public for 10 years. Just to give a behind-the-curtain snapshot: over this period we have produced 372 posts, averaging between 30 – 45 annually, with approximately half a million individual hits across the life of the blog, means that we average 200-250 hits per day, from across the world (although westernized, anglophone countries are where most off our readers come from).

 

Over the last 10 years, the blog has had a number of in-house writers (Robin Wilson, David Prescott, Jon Brandt, Kieran McCartan, Alissa Ackerman, and Kasia Uzieblo). We have also had a number of external writers, some invited and others who volunteered themselves or ideas (including Norbert Ralph, Michael Seto, Danielle Harris, Jill Levenson, Don Grubin, Tyffani Dent, Franca Cortoni, Joan Tabachnick, and Cordelia Anderson, to name a few as we have had over 30 contributors please do have a look at the back catalog to see who else has contributed ). In sum, the blog has had strong influences of practice, academic, and international approaches to it. Over the course of this period, we have covered topics, including risk assessment, treatment, polygraphy, residence restrictions, the (non-)impact of Halloween, myth-busting, desistence, re-offending, community reintegration, professional practice, prevention, individual and systematic issues (i.e., gender, race, vulnerability, etc), and policy. The blog has often reacted to current affairs, as well as discussed ongoing debates in the field and society; we have never shied away from touchstone issues and won’t going forward either.

 

So, as this is our anniversary, what has changed and what has not? We believe the public policy landscape in the USA and internationally has shifted somewhat We also believe our field now discusses sexual abuse prevention even more than in the past. We have seen beginning increases in the use of person-first language in our communications, just as the field has started to take more of a client-centered approach. Finally, we are starting to see more nuanced public discussion in the media.

 

However, not everything has changed: we still see punitive policies, a fractured use of the evidence base, and emotion/ideology clouding the development of realistic policy and practice. Budgets are cut routinely, and professionals are expected to do more with less. Ten years on it feels like the deckchairs have been re-arranged when a wholesale redecoration is what has been needed.

 

This is not to say that there are no signs of hope for the future. The advent of the #metoo movement, increases in bystander intervention, corporate “wokeness”, the rise in awareness brought about by movements such as Black Lives Matter, increased victim advocacy, the debate surrounding the best ways to help people who are attracted to children and to prevent offending, and an increasing realization that sexual abuse is a (public) health issue, as well as a criminal justice one, mean that a new vision for the future is underway.

 

Change takes time and ours and related fields have a long way to go. On balance, it seems we are on the right path. Professionals need to keep emphasizing the importance of using the available evidence and making our knowledge and experience available to others as a concrete means of preventing as well as responding to sexual abuse. We also need to keep an open mind to new perspectives and learn from our colleagues in both westernized and non-westernized countries.

 

In ten years, the biggest strength to the blog has been the voice of contributors, both in-house and external, and to that end, we encourage anyone, and everyone from all around the world, to contribute. We are always open to new voices and perspectives. Here is to another 10 years, it’s not an ending rather a marker on a never-ending journey!

Developmental perspectives on "lying and manipulation" in juveniles who sexually offended.

By Norbert Ralph, PhD, MPH, private practice, San Leandro, CA.

As a clinician working with juveniles who sexually offended (JwSO) I find that these youth are frequently described as "lying and manipulative" which is presumed to be part of the pattern of behaviors that led to sustained criminal charges. Such behaviors might include things like denying or minimizing harmful behaviors and the effects on victims, for example. A developmental perspective can be useful to understand these behaviors from the youth's point of view, and importantly also adult reactions to them, and the interaction between the two. It can help in developing strategies and interventions to avoid future harmful behaviors and develop prosocial behavioral patterns in the youth.

The ethical and moral framework of professionals involved with juvenile justice youth is an important factor in the probation process. Sexual violence, whether by adults or juveniles, is among the most serious crimes, a cultural taboo, and significant harm is often done to victims. Societal and personal ethical reactions to sexual crimes by juveniles often becomes part of the legal and probation process and evoke strong negative emotional reactions. This moral view of juvenile transgressions may also resonate with the psychiatric categorization of juvenile delinquency. For example, DSM 5 criteria for Conduct disorder includes, "Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)" (American Psychiatric Association, 2013).

Evidence-based models contrast with these personal moral attitudes regarding sexual crimes. For example, the How I Think Questionnaire (Barriga, Gibbs, Potter, & Liau, 2001) assesses offense-related thinking patterns based in part on Kohlberg's theory of moral development. For example, the instrument has scales which assess developmental immaturity and egocentricity, sometimes described as thinking errors, such as Lying, Self-Centered, Blaming Others, and Minimizing/Mislabeling. These thought patterns are viewed as part of developmental immaturity using Kohlberg's framework for moral development and not fixed and presumably untreatable traits.

A complementary model is Hy and Loevinger's (1996) work on ego development which provides an evidence-based theory of psychosocial development throughout the lifespan. Adolescence is a period of rapid psychosocial development. Most older teens and young adults score at the I-4 or Conformist level which reflects an internalized sense of socially appropriate behavior, rules, and laws. The next lower level, the I-3 Self-Protective level is most prevalent in pre- and early adolescence, from age 10 to age 13. In one study of JwSO, 92.5% were either classified at the I-2 Impulsive or I-3 Self-Protective (relatively lower levels of ego functioning), compared to 43% of a non-clinical 14-year-old sample (Ralph, 2017a). Similar to Europeans in the Middle Ages who viewed the Earth as the center of the universe, youth at the I-2 or I-3 level view their own needs and goals as paramount, and don't have a differentiated model of external rules, laws, and rights of others that facilitate prosocial and "win-win" interactions as might be present in higher developmental levels found more frequently in adults. For these youth, rules, or facts (e.g., you missed your appointment) that get in the way of things the youth wants to do, are seen as something to deny or avoid, unfair so they can be ignored, not true, wrong, mistaken, etc., rather than youth at a higher level than see "facts are facts" and "rules are rules", and like it or not, they are just there.

Ralph (2017b) describes factors and treatment methods that promote psychosocial maturity for the general juvenile probation population, and specifically for JwSO. These interventions view deficits in prosocial reasoning as a modifiable risk factor for delinquent and harmful behaviors that are treatable. These methods help the youth "up their game" to use more effective and mature methods of social-emotional reasoning about the choices they make. Complementary literature described in Ralph (2019) reports that incarcerated youth who psychosocially mature in detention have improved the frequency and severity of recidivism. More psychosocially mature youth have more sophisticated internal models or paradigms of "how the world works" and can do the "cost-benefit" analysis to avoid future problems. For example, Ezinga, Weerman, Westenberg, and Bijleveld (2008) in a community sample found more delinquent behaviors in youth at the I-2 or I-3 level in contrast to higher levels.

A developmental perspective on harmful behaviors by youth may help explain adults’ reactions to JwSO. Adults who are at the I-4 Conformist level, higher than the I-2 and I-3 levels have an internalized sense of rules, laws, and expectations, different from one's own wishes. People are either "good" and moral, or "bad" and immoral. The assumption of adults in this stage is that teenagers involved in harmful behavior know right from wrong and are deciding to be "bad" because they think they might get away with it. In my experience, this perspective often dictates that the most effective approach with youth with moral immaturities include verbal criticisms and severe sanctions. Such measures, while in some circumstances appropriate, if over-utilized may further traumatize youth where trauma itself had been a factor in offending, and also there is evidence that "get tough" approaches are not effective (Lipsey, 2009). This "get tough" view of JwSO and appropriate interventions may "bump up" against a developmental perspective. This disparity in perspectives may account for conflicts regarding disposition planning advocated by treatment providers on the one hand, and judges, probation officers, and district attorneys on the other.

In summary, risk factors, and treatment interventions for JwSO optimally should include developmental considerations, among other approaches. It is useful not only in designing more effective treatments and disposition planning for JwSO, but also in every day clinical work with these youth and consultation with the probation and legal system. In real-life clinical work these behaviors when can provide a useful framework for considering therapeutic "next steps" for youth in therapy and treatment planning.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Publisher.

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Ezinga, M. A. J., Weerman, F. M., Westenberg, P. M. and Bijleveld, C. C. J. H.(2008). Early adolescence and delinquency: Levels of psychosocial development and self-control as an explanation of misbehavior and delinquency. Psychology, Crime & Law,14(4), 339-356.

Lipsey, M. W. (2009). The primary factors that characterize effective interventions with juvenile offenders: A meta-analytic overview. Victims and Offenders, 4, 124-147.

Ralph N. (2017a). Moral Reasoning in Juveniles Who Sexually Offend. ATSA Forum, XXIX(2).

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Ralph N. (2019). Neuropsychological and Developmental Factors in Juvenile Transfer Hearings: Prosocial Perspectives. Journal of Juvenile Law & Policy, 23(1), 1-24.