Thursday, April 13, 2017

Risk and those who experience harm

A friend of one of the authors was a forensic psychologist in a European country and gave permission to share her story. The short version is that she was on her way to meet her son and took a shortcut through a park. There, she was raped by a stranger. It was a nasty assault that could have ended much worse due to a health condition. Thanks to her quick thinking and smartphone, her son helped the police to apprehend the person before he left the park. He apparently had a lengthy criminal record, including similar assaults. There is little question that he was a high-risk, high-velocity person in need of outside forces to stop him.

To hear her tell the story, it seems that the most devastating effects of this life-threatening experience actually occurred in its aftermath. The nature of the local police department, and her work at the intersection of law and psychology, meant that all of her colleagues had access to every detail of her experience, and were unafraid to express judgment about her circumstances. This serious breach of privacy was a primary motivator in her leaving her country and relocating elsewhere. Once resettled, her primary concerns for getting on with her life typically had more to do with her children and pets. Any lingering bitterness had more to do with the response from the legal system than the assault itself. It’s quite possible that the presence and actions of her son prevented years of more serious problems. 

On the other hand, a pioneer in the field of prevention (no longer active) used to publicly describe how her father molested her growing up, and the devastating after-effects that lasted across the rest of her life. She was a force of nature as she described how the only thing she ever wanted was for the abuse to end. As one might imagine, she had few places to go, and fewer people to whom she could turn to make her father stop. By all appearances, had her father come to the attention of the legal system, his risk would have been low in accordance with actuarial risk measures. For that matter, so would many famous people who have abused, including Jeffrey Dahmer, Jimmy Savile, and Jerry Sandusky; and yet the harm in their wake has been horrific. 

The narratives that we hear from people who have experienced sexual abuse reflects these experiences. Often we hear that they did not report as they felt that they would not be believed or that nothing would be done. Often, they believed that they type of abuse perpetrated, their relationship with the perpetrator or the context of the abuse [in their eyes or their beliefs around the perceptions others] mitigated the abuse. In some cases, people don’t report because they are afraid that it will lead someone to cause harm to the person who abused. All of this highlights the complexity in experiencing and living with sexual abuse, especially if the individuals involved are in close proximity to each other and therefore have to come into contact frequently; in that sense no risk is low risk to the victim, more a constant low-level trauma.

All too often, it seems that in our rush to improve risk classification, we also create an appearance of uncaring and benign neglect of the experiences of those who are abused. What is striking is how the harm of abuse was mitigated by family relationships in the first case and aggravated in the second. And yet from a purely risk-based perspective, the second case involved a lower-risk abuser.

This, in turn, creates terrible dilemmas. As the saying goes, bad cases can result in bad laws, and the authors certainly advocate for reserving the most intensive interventions who pose the highest risk. At the same time, however, our field creates risks of its own at those moments when we appear disconnected from the relational harm of trauma.

At a time when we advocate person-first language for people who have abused, it’s vital that we have the same consideration for those who have been harmed. Not everyone who has experienced abuse wishes to be called a “survivor” or “victim”. Taking this further, however, the above vignettes who how important it is that all professionals communicate in a way that demonstrates respect for all who have experienced sexual abuse, without creating the appearance of being dismissive of harm or of overstating risk for future abuse. In the end, skills for demonstrating respect, understanding, and effective communication are intertwined.

David Prescott, LISCW, and Kieran McCartan, Ph.D.

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