Thursday, May 17, 2018

Families of the perpetrator: The hidden victims of online sexual abuse


By Kieran McCartan, PhD

Please note this is a reposting of a NOTA blog post by the same author, the original can be found here – kieran.
Late last week I attended a conference on online perpetrators of sexual abuse hosted by the Lucy Faithful Foundation, the aim of which was to make us reflect upon the reality of downloading and viewing child sexual abuse imagery in the UK (i.e., that is 100,000 individuals downloading material in the UK currently), but especially in the South West of England, as well as how to best respond to it. Although the conference was interesting, informative and worthwhile, it was the questions that were not answered or addressed that had the biggest impact on me. Not the questions about perpetrators, policing or offence characteristics; but rather, the questions about the collateral consequences of downloading and viewing child sexual abuse imagery on the families, friends and communities linked to the perpetrator.

When we talk about sexual abuse we tend to talk about perpetrators and victims. We do not tend to talk about the surrounding family and peers that are indirectly affected by the abuse and its consequences. Often there is an assumption in contact offending that the perpetrator is offending against members of their families, that members of their families are always at risk and that partners are complicit in the abuse; but this is generally not true. If it’s not true for contact offenders, is it also not true for individuals who download and view child sexual abuse imagery? The short answer is that we don’t know!

The conference really highlighted to me that we do not really know, empirically, what the impact of having a parent convicted of online sexual abuse, viewing inappropriate images, grooming children online or networking with other perpetrators on the dark web is. There is a perception that the collateral consequences of being convicted of viewing online child sexual abuse imagery is the same for the perpetrator and their families as being a contact offender, that is

-          That perpetrators receive a prison/community sentence, they go on the sex offenders register, are often being exposed in the press &/or community during their trial, have the  possibility of losing their family, friends, peers, home, job and  have a resultant social stigma;

 
-          That families of perpetrators are too being socially stigmatised because of their relationship to the perpetrator, can be exposed in the press &/or community by default have the possibility of losing a family member/friend, might lose their home, may lose additional income, may lose social standing and suffer from suspicion around complicity (i.e. a feeling that somehow you should have known).

These assumptions are problematic as we do not really know if they are as true in online offending as they are in contact offending. What we do know, which the conference discussed at length, is the recognition that the lives of people related to the online perpetrators have their worlds turned upside down, directly and indirectly, by the behaviour and that they struggle to cope with the related outcomes (i.e., the removal of technology, the police investigation, the re-evaluation of who the perpetrator is and what you really knew about them); but that there is not a lot of support for these indirect victims of online sexual abuse (i.e., they were not abused but they have been impacted by it). Which is problematic because families feel at a loss because of the nature of the offence and that there are many misconceptions about the perpetrators of online sexual abuse, the risk that they pose and the reality of their offences by the public – which includes members of the public misunderstanding what online offending looks like, its level off seriousness (is it as serious as contact offenders?), whether online offending leads to contact offending, whether it is easier to forgive the perpetrator compared to contact offending or who the victim is? All of which means that the families of online offenders can face collateral consequences similar to those of contact offenders, but with less understanding, nuance and (possibly) less sympathy. Over the past 10 or 15 years the level of support and help for the families of individuals who have downloaded and viewed child sexual abuse imagery has grown, but it still not common place and these individuals do not always get the help that they need. Research is starting to be done in this area. Lisa Thornhill presented on her recently concluded research on the impact of having a father or family member that has been arrested on suspicion of downloading and viewing child sexual abuse imagery. This research is important is as it will give us an empirical base to start developing and implementing appropriate services for people directly impacted by having a parent of family member who has child sexual abuse imagery so that they can understand the offences, the consequences of the offences, be helped to process and move past the impact that the offences have on their lives. Sexual abuse, in all its forms, impacts not only the perpetrator and the victims but also the communities in which it happens; therefore the more that we can help these communities understand and move past sexual abuse the more adaptive they will be.

 

Wednesday, May 9, 2018

How do we get better, really? The Achieving Clinical Excellence 2018 Conference in Östersund, Sweden

By David S. Prescott, LICSW

The evidence is in, and there’s no doubt. Psychotherapy works for a wide range of conditions and behaviors. People can and do change, often suddenly and unpredictably. Among the most effective mechanisms for change is the most ancient and fundamental approach: the human conversation. 

Why even mention this? Those working in the fields of violence and trauma (including sexual abuse) too often believe that people who harm others are either unwilling or unable to change, despite decades of evidence. Too many professionals argue over lesser findings or ask the wrong questions. While searching for the randomized controlled trial showing that treatment can reduce risk, we overlook other findings, such as that people who complete programs very commonly have lower rates of re-offense. What can we learn from these studies? And more importantly, from the clients that can inform our approaches? There are entire bodies of research in psychotherapy, criminology, and education that go unnoticed and under-discussed.

The research points to greater differences between the least and most effective therapists within treatment methods than differences between the methods themselves. This uncomfortable truth is that we may be looking in the wrong place for success when we pin our hopes on trainings about the latest technique or model. Instead, we might want to look inward at what we can do to become more effective, one client at a time.

One path to professional development is feedback-informed treatment (FIT), which we have discussed in previous blogs. Critical to understanding FIT is that it is not enough to engage in routine outcome monitoring through the use of measures such as the Outcome Rating Scale (ORS) and Session Rating Scale (SRS). Practitioners don’t always respond with adequate professional self-development based on the feedback they’ve received. This has led to a movement within psychotherapy aimed at focusing on specific steps clinicians can take to become more effective and involves solitary, deliberate practice between sessions.

As revolutionary as much of this information may seem, the ACE 2018 Conference took the discussion to a new level. Routine outcome monitoring cannot result in actual improvement without the clinician actively working to improve performance based on the results. Some measures of outcome (such as the ORS) can provide benchmarks of success in performance, while others (such as the SRS) yield insights for practice aimed at improvement.

At the start of the conference, researchers Bruce Wampold and Scott Miller reviewed the evidence for what works in treatment. Wampold took careful note of emerging evidence that the effects of cognitive-behavioral therapy (CBT) may have declined over the years, and wondered aloud if that isn’t a natural part of the evolution of methods. That is, that the pioneers of CBT had started out as highly trained therapists in general, whereas therapists are now trained more in the methods than in the core conditions of effective therapy. Also significantly, Wampold noted that therapists often overlook the most important therapist skills (e.g., the effective demonstration of empathy) in favor of novel techniques. He emphasized that “basic counseling skills” should be re-framed as “critical counseling skills.”

Birgit Valla, the director of Stangejelpa in Norway, provided a narrative of how her agency became demonstrably more effective in helping clients. She took issue with approaches to mental health agency development based on the traditional medical model. Valla described differences between how successful business and mental health agencies operate in designing actions that will be useful and effective for their customers. Her agency has defined the development of wellbeing as its primary product rather than over-emphasizing diagnoses and focusing exclusively on problems. She further described an agency culture in which “helping people is a team sport” and that before starting employees understand they will be expected to practice deliberately in response to client feedback.

Scott Miller gave a keynote address that reflected his recent provocative article titled “How Psychotherapy Lost its Magick.” In his address, he noted that in recent years, more people have visited psychics than have seen therapists. He concluded that, in part, this was because too often therapists practice within a narrow framework of models and techniques that may look impressive, but are not actually as helpful to clients as they could be.

Ultimately, there is a difference between models and techniques as developed and intended versus how they get applied in actual practice.  Implementation and integration of models can bring many challenges. Perhaps the most heartfelt example of this at the ACE 2018 Conference was Heidi Brattland. In her keynote address, she described going to see a therapist as part of her training to become a psychologist. By her account, the biggest lesson she learned was the resolve never to become the kind of psychologist she had gone to see.

Finally, Daryl Chow urged every professional to develop a broader view of the work we do. He is the first researcher to have published on deliberate practice approaches in psychotherapy.

Where does this leave the rest of us? Take-home messages include:

·    Basic counseling skills are only basic in theory. Combining them in actual practice is an advanced skill.
·       Conversation can be curative.
·     The most effective professionals in our field engage in solitary, often very difficult practice between sessions.
·    Treatment sessions are best thought of as performance that is different from the practice aimed at improving performance.
·       Clinicians in our field can learn from trends happening elsewhere.


I hope that the links provided throughout this post offer ideas for the way forward for readers.

Wednesday, May 2, 2018

Person-first language: Establishing a culture that transcends labels

By Gwenda Willis, PhD, Alissa Ackerman, PhD, & David Prescott, LICSW

The joint MASOC/MATSA conference took place earlier this month in Marlborough, Massachusetts. In a presentation on establishing person-first language across the fields of sexual abuse treatment and prevention, we (Gwen and Alissa) began our session introducing ourselves by several of the labels we hold. Gwen introduced herself as New Zealander, wife, friend, colleague, researcher, clinical psychologist, ATSA member and advocate. Alissa followed with mother, wife, lesbian, friend, colleague, professor, ATSA member, public speaker, advocate, and survivor, among others.

In this interactive presentation, we prompted attendees to explore the labels they use to describe themselves and the people they work with.  Like us, attendees were spouses, parents, clinicians and advocates.  Some were animal lovers and some were music lovers. All participants used positive labels to describe who they are. Next, we asked participants to describe who they work with and we explored which of these might not be self-selected by the very people we work with. Overwhelmingly, the labels we used to describe the individuals we work with were those that our clients might not use to describe themselves. Some of these labels included “victim”, “ex-prisoner”, “sexually violent person” and “offender”.

Importantly, there was agreement that use of such labels in our field is widespread: beyond their use in everyday conversation, such language is rife in the names of treatment programs, agencies, professional organisations and academic publications.  The American Psychological Association (APA), The National Association of Social Workers (NASW) and most professional organizations even tangentially related to our field articulate the need for person-first language in their Codes of Ethics, and yet in our field, we tend not to honor this need. Do we have an ethical dilemma? 

As part of our presentation, we considered core ethical principles of helping professionals including respect for human dignity, professional integrity and beneficence and non-maleficence.  We discussed how the “victim” and “survivor” labels might be self-selected by some people and not others, despite similar lived experiences.  Similarly, we acknowledged that some individuals with pedophilic interests self-identify as “pedophiles” while other individuals with pedophilic interests would find the “pedophile” label repulsive. 

We cannot assume which labels people want to use to describe themselves and if we truly honor human dignity, we must call people by what they prefer to be called. It is a matter of basic respect. For example, in our introductions, Alissa used the label “lesbian” to describe herself, while Gwen did not, despite both of us being married to same-sex spouses.

Discussion turned to the inaccuracies that normative labels such as “offender” and “abuser” portray – that anyone assigned such a label has the same (i.e., high) risk of reoffending.  As professionals working to address misperceptions about sexual abuse we highlighted the importance of communicating accurately about individuals who have abused, in the hope that they will have opportunities to live safe, fulfilling and offense-free lives. We turned to labels with scientific validity, including “psychopath” and “pedophile”, and conversation returned to their potential to stigmatise and ostracise.  Finally, we explored how labels might hinder the work we do to promote desistance from offending as well as healing from sexual abuse: What messages do the “offender” and “victim” labels communicate?  Possibly that this is how we see you. In the criminological literature, labelling theory suggests that the individuals internalize the labels we use to describe them and often live their lives accordingly.

How might we transcend potentially stigmatizing labels?  We introduced person-first language as an alternative to potentially stigmatizing language, which separates the person (e.g., man, woman, young person, individual, child) from a condition, disorder or behavior (e.g., individual adjudicated for a sexual offense, people who have committed crimes of a sexual nature). 

Labels are commonplace in every-day communication, and when self-selected they can aid communication.  However, assigned to us, labels have potential to stigmatise and harm.  As highlighted by Brene Brown (2017):

“The sorting we do to ourselves and to one another is, at best, unintentional and reflexive.  At worst, it is stereotyping that dehumanizes.  The paradox is that we all love the ready-made filing system, so handy when we want to quickly categorize people, but we resent it when we’re the ones getting filed away” (p. 48)

Person-first language avoids making assumptions about how someone wants to be labelled.  Additional exploration of issues raised in this blog and guidance on person-first language can be found in the 6th edition of the APA Publication Manual (American Psychological Association, 2010) and in Willis (in press).

In some quarters, the push towards person-first language has existed for years. It has occurred in other areas of psychology and human service (Willis, in press) as well as the field of treating adolescents who have sexually abused. Although it has long been known that adolescents can change dramatically over time, it is also worth remembering that adults can, and very often do, change as well. Further, the contexts in which they live their lives can change dramatically as well Now that our field knows what it does about building desistance and managing risk, it is clear that the use of labels has now outlived its usefulness. Indeed, it can cause harm.

References

American Psychological Association. (2010). Publication Manual of the American Psychological Association (6th ed.). Washington, D.C.: American Psychological Association.

Brown, B. (2017). Braving the Wilderness. New York, NY: Random House.

Willis, G. M. (in press). Why call someone by what we don’t want them to be? The ethics of labelling in forensic/correctional psychology. Psychology, Crime & Law doi: 10.1080/1068316X.2017.1421640

Thursday, April 26, 2018

The importance of multi-agency working to prevent sexual abuse


By Kieran McCartan, PhD

Yesterday I presented at an event, in London, which examined the role of multi-agency working in child protection across England. The event was framed around new changes being implemented in social work across England as part of the Putting children first agenda and the Children and Social Work Act, 2017. The event had an interesting mix of attendees and presenter’s from across the board including policy makers, members of parliament, police, social work, child protection, academics, survivors/victim charities (including, Barnardo’s, NSPCC), schools and research/policy organizations (incl., Centre of Expertise on Child Sexual Abuse and Internet Watch Foundation).

The day consisted of a series of talks, approximately 10 in total, which focused on how we can protect children better, how we can learn from good and bad practice, as well as how we can work better together to prevent sexual abuse. The talks covered a range of areas, including serious case reviews, local safeguarding boards, child protection investigations, school based education around sexual abuse, the use of materials in the prevention/discussion of child sexual abuse, the role of partnership in supporting victims of abuse, understanding perpetrators and preparation better as well as the role of schools in supporting child protection.

Some of the main themes and issues that arose for me from the event included,

-         A lot of the presenter’s discussed how effective multi-agency working was the best way of responding to sexual abuse and exploitation, a clear example of this came through the discussion of the new Child House that is due to open soon in Camden based on the Icelandic model (Barnahus). In addition, presenters felt that there was a lot to be gained from the multi-agency working that went into serious case reviews, child safeguarding practice reviews and joint targeted area inspections.

 

-         Schools were seen as the lynchpin in effective child protection, but there was recognition that all schools may not have all the resources that they need to be able to facilitate this safeguarding properly. The speakers from schools and with an education viewpoint argued that schools need the resources to deal with the safeguarding issues that they face on a daily basis, suggesting that when social workers and counselors are placed within schools then the establish can effectively respond and the experiences of everyone involved is improved.

 

-         Cassandra Harrison from the Centre for Expertise in Child Sexual abuse discussed their research and ongoing objectives, highlighting that there is still more about the reality and prevalence of child sexual abuse that we need to understand so that we can respond to it as well as prevent it more effectively. Cassandra directed attendees to their research agenda, publications and ongoing collaborations for more information on their work.

 

-         A representative from the Internet Watch Foundation, Michael Tunks, discussed their annual report, emphasizing the increase in child sexual abuse imagery on the internet, the adaptive ways in which it is being embedded online and an increase in reporting of inappropriate material from members of the public. The IWF emphasized the importance of getting men, especially young men, to report child sexual abuse imagery posted on traditional pornography sites or on other forums where they would not expect to find it.

 

-         Jon Brown from the NSPCC called for a national strategy in preventing child sexual abuse, indicating that we needed clearer and more joined up thinking on the issue. The only way that the prevention of sexual abuse was going to happen in practice was through a public and coordinated commitment to it.

 

-        Donna Smalley discussed the work that they have done with victims’ families to create a number of child sexual exploitation films (i.e., Kayleigh’s love story) to use with children when discussing sexual abuse, grooming and online behaviour. This promoted a lot of debate within the audience with some participants suggesting that that these types of material should not be used as they are harmful (referencing the work of Jessica Eaton) or that they should only be used in a certain way, with certain groups with appropriate resources (i.e., counsellors, etc.) on hand.

 

-         The importance of language in preventing and responding to child sexual abuse was discussed with some presenter’s (including myself and Jon Brown) arguing that the way that we frame the issue of sexual abuse has important ramifications for the way that the issue is processed. Which was seen as salient in the way that we talked about perpetrators, the use of terminology (i.e., treatment vs. rehabilitation vs. risk management, etc.) and the differences between exploitation and abuse.

 

-        Across all the presenters, the attendees and the chair’s there was recognition that sexual abuse was a health issue, not simply a criminal justice one.

 

-        The sharing of material, resources and training was a point for discussion across the day with participants questioned how to be access up to date information when there was a lot of varying information coming from a range of sources; how to prioritize? The question was raised, whose responsibility was it to streamline and prioritize this new information so that it could be used effectively.

The event and the presentations across the day really highlighted the importance of working together to prevent as well as respond to child sexual abuse. One of the final statements made by the chair was that change had to come from communities and that if communities saw organizations working effectively together it would enforce that something was being done to tackle child sexual abuse and that they should have trust in, as well as participate with, the system.

Friday, April 13, 2018

Supporting policy to prevent harm: Identifying gaps to support children with sexual behavior problems

By Hannah Laniado (Prevention Program Manager, MNCASA at hlaniado@mncasa.org) & Julie Patrick (National Partners Liaison, Raliance at jpatrick@raliance.org)
 
Recently, the Minnesota Coalition Against Sexual Assault (MNCASA) published, Children with Sexual Behavior Problems: Improving Minnesota’s ability to provide early identification and intervention services through policy and practice recommendations (June 2017), a comprehensive report outlining the data collection, literature review, and formation of recommendations for implementation. This is the first in-depth look at how one state can create change to improve intervention, prevention and response to children with sexual behavior problems.
 
The specific key recommendations are a model for how the system could improve for all children and families. Earlier identification and appropriate response require: specialized training for all professionals working with youth; consistent guidelines and protocols for tracking behavior; clear written policies professionals who work with children can access on how to respond – including when and what to communicate; as well as education and awareness raising to reduce stigma.
 
Methodology
 
MNCASA looked at what’s working and not working in Minnesota’s current systems for identifying children (12 and under) with SBPs through funding from Raliance, a national partnership among leaders in the prevention of sexual harassment, misconduct, and abuse. With seed-funding from the National Football League, Raliance is dedicated to ending sexual violence in one generation and supports an impact grant program with a specific funding category to prevent primary perpetration. 
 
MNCASA utilized ATSA’s definition of SBPs: children ages 12 and younger who initiate behaviors involving sexual body parts (e.g. genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others (Chaffin et al., 2006).
This project collected information and data in multiple forms. To facilitate the process, a set of guiding questions were identified at the outset of the project and then five chosen data collection methods answered the guiding questions (for details refer to Report #1). Exploratory interviews with 19 key informants, a scan of the empirical literature (42 documents published in the last 10 years), a web-based survey of professionals who work with children (1,022 responses total), investigative interviews with professionals who work with children with SBPs, and story gathering were collected between August 2016 and May 2017.
 
Key Findings
The literature review examined the latest research on incidence, identification, assessment, treatment, and policies for children with SBPs to provided an empirical basis for work to better understand how well Minnesota is doing in effectively identifying and intervening with children showing signs of SBPs.
Per the survey of professionals who work with children, parents and colleagues view them as a resource on differentiating between developmentally expected sexual behaviors in youth and concerning or problematic ones. Many professionals expressed interest in training on how to interact with children and their parents about children’s sexual behaviors.
 
Interviews with key informants also showed the lack of a clear process or procedure for where to report a child who is engaging in concerning or harmful sexual behaviors. In fact, many different systems (including social services, law enforcement, medical providers, child protection, probation, and school staff) all come into contact with children with SBPs and yet here is no one system charged with responding to or even tracking reports of children with SBPs. This results in great variations, county by county, to reports of a child with possible SBPs. Professionals who work with children need guidelines for how to treat behaviors as serious, educate about treatment being available, help set up effective supervision, and create protective environments. Without these guidelines, there is a tendency to either over-react or under-react resulting in children not receiving the help they need. There are also disparities across the state in terms of access to effective treatment for children with SBPs. Not all providers have specific training on children with SBPs and not all use evidence based treatment methods. Not all parts of the state have easy access to professionals who specialize in working with children with SBPs.
 
The specific policy recommendations in detail
1.      Make specialized training on best practices for identifying and responding to children’s sexual behaviors readily available to all professionals who work with children and families. This training needs to address the myths about children’s sexual behaviors and share the message of hope that with treatment, children are at no greater risk to grow up to be sexually abusive. A key element of this training should be how to effectively engage parents in discussions of and treatment for their child’s SBPs. Ideally this training would be incorporated into the educational requirements for students as well as offered as part of ongoing professional development or as a requirement for licensure.
 
2.      Develop consistent guidelines and protocols for tracking and responding to children’s sexual behaviors, including sexual behaviors between children. Ideally, all children would receive an assessment by a qualified professional who would make recommendations to address any SBPs and any safety risks the child poses to others.
 
3.      Create written policies professionals who work with children can access on how to respond to a child showing concerning or problematic sexual behaviors, when and what to communicate to parents/caregivers, and how to refer a child for an assessment.
 
 
4.      Develop an educational campaign that can be used to raise awareness about children’s sexual development and SBPs. This could be done by providing resources during well-child doctor visits, sharing handouts at school open houses, etc. This effort would go a long way in reducing the stigma and fear that gets in the way of effective response to children showing early signs of SBPs.
Citations:
Chaffin, M., Berliner, L., Block, R., Johnson, T. C., Friedrich, W., Louis, D.G., Lyon, T., Page, I., Prescott, D., Silovsky, J. (2006). Report of the ATSA Task Force on Children with Sexual Behavior Problems. Association for the Treatment of Sexual Abusers
 
With gratitude:
MNCASA would like to recognize Joan Tabachnick for her guidance throughout this project including reviewing multiple drafts of the literature review as well as Jane Silovsky and Jimmy Widdifield from the National Center on the Sexual Behavior of Youth (NCSBY), part of the Center on Child Abuse and Neglect (CCAN) in the Department of Pediatrics of the University of Oklahoma Health Sciences. Many ATSA members added value to this report.

Tuesday, April 3, 2018

Four Articles for Newcomers


By David S. Prescott, LICSW

Recent discussions in a number of venues have involved which studies and other published papers are essential for people treating clients who have abused. Each offering has been useful, from the basics in risk, need, and responsivity to effective self-care and an understanding of how early adversity influences the lives and treatment of those who abuse. Each of these areas is vital.

Following on previous writings with Gwenda Willis (for example, our only partially tongue-in-cheek call for a “who works doctrine”), it has long seemed to me that our field has overlooked some basics, and that the evidence for these basics has been around for decades. Research continues to find that there is a greater difference between therapists practicing within various methods and models than there is between the methods and models themselves (Wampold & Imel, 2015).

In 2005, Bill Marshall summarized research both in and outside the field of treating sexual violence to ask what qualities make up an exceptional therapist. The four qualities at the center of his analysis, being warm, empathic, rewarding, and directive (guiding and moving the treatment process forward), seem incredibly simple at first. In fact, these four qualities have even produced the acronym WERD, which many practitioners try to live by. Critics have noted that this paper relies on studies outside the field of treating abuse, and yet a recent blog post has highlighted the work of Brandy Blasko and Faye Taxman, who have found that even probation officers who adhere to similar principles have clients who are less likely to return to prison.

Of course, many (likely most) professionals do not view themselves as in need of assistance becoming more “WERD”. Discussions within social media often focus more on scoring items on actuarial measures and what the rules for registration are in various jurisdictions are typically more common than questions about developing these qualities. As research has shown, however, professionals both within and outside our field can overestimate their abilities in a phenomenon known as self-assessment bias.

In one of the most striking studies of self-assessment bias, Steven Walfish and his colleagues found that the average therapist rates themselves at the 80th percentile compared to their peers. 25% rated themselves at the 90th percentile and no one rated themselves below average. Although there are many possible implications of this study, it is entirely possible that one reason that fewer people seek to develop themselves in the above key areas of competency (warmth, empathy, being rewarding and directive) is that they already believe they are as good as or better than their peers in these areas.

The results of these studies beg further questions: If the working alliance and core competencies of effective therapists are so easy to over-estimate and so difficult to excel at meaningfully, are they really the basic skills that many people believe them to be? After years of listening to people who are learning to put collaborative approaches into practice, I’ve concluded that these skills are only “basic” when you are practicing one of them at a time. It’s when one tries to be warm, empathic, rewarding, and directive while staying aligned with what works for each client that these skills become much more advanced and difficult to master. What is the best way forward with this knowledge?

Enter Daryl Chow and his colleagues and their 2015 paper on deliberate practice. Their abstract puts it succinctly: therapist characteristics (e.g., years of experience, gender, age, profession, highest qualification, caseload, degree of theoretical integration) did not significantly predict client-reported outcomes. Consistent with the literature on expertise and expert performance, the amount of time spent targeted at improving therapeutic skills was a significant predictor of client outcomes. Further, highly effective therapists indicated requiring more effort in reviewing therapy recordings alone than did the rest of the cohort.

So what is the take-home message from these four studies?

·         Professionals are often not as effective as they want to believe, but they can become better.
·         This is not to say that average therapy is not good therapy; indeed, people entering treatment typically do considerably better than those who don’t.
·         The most effective therapists attend to the core competencies of therapy and work to improve themselves in these and related areas.
·         Contrary to the practices and beliefs of many professionals, attention to the fundamentals of the working alliance apply to virtually all professionals involved in treating and supervising people who have abused.

If you’re an old master, this all means you can still get better. If you’re a newcomer, it means that many of the skills out there for learning will help you in many areas of your life. I hope you stick around!







Thursday, March 22, 2018

Good things happening in Denmark and Oregon


By David Prescott, LICSW, and Alissa R. Ackerman, Ph.D

Anyone who works with people who sexually abuse knows that human motivation can be multi-faceted. People who are motivated to change their lives for the better may not be motivated to enter treatment programs, and not all who enter treatment programs are truly motivated to change their lives. Likewise, many practitioners find that their clients are more motivated to change some aspects of their lives more than others. It is never as simple as simply going ahead and doing treatment in a purely straightforward or linear fashion.

Two professors at Aarhus University in Copenhagen, Denmark, Charlotte Mathiassen and Morten Nissen recently hosted a two-day conference and public event, also at the university (titled Motivational Interviewing: The Volitional Pragmatics of Conversation). It was an opportunity to explore elements of motivation that may not be apparent to those entering the field of treating abuse. David gave presentations on the nature of motivation and treatment with people who abuse, exploring how the directive and client-centered aspects of treatment in general and motivational interviewing specifically can interact and/or contrast with each other in a given case. For example, some clients in treatment respond well to a more directive approach, even as the clinician seeks to maintain that client’s autonomy and self-efficacy. Questions around roles and power dynamics are rife in the treatment of sexual violence, for example (see Prescott & Levenson, 2010).
Niels Åkerstrøm Andersen came at similar questions from an entirely different angle in his study of the Danish welfare state: How do state systems govern those who are inherently independent? Although this may seem abstract to many professionals, it is nonetheless important to consider when we consider that we are often treating clients who seek to be more autonomous within systems where independence of actions is severely limited. Likewise, in discussing a case, psychologist Morten Halberg described Jacques Derrida’s distinction between a predicted future versus the unpredicted future, leading to questions about how people arrive at their own solutions to challenges when so much of contentment with one’s own life is beyond our ability to predict or plan for?

Finally, E. Summerson Carr gave presentations on the process of motivational interviewing (MI) training in which she described that the process of learning MI can be as motivating as actually practicing it. In this way, she compared MI training to revival meetings of the past. For some who have studied MI deeply over time, her observations will be entirely familiar.

Meanwhile, the Oregon ATSA chapter held its spring retreat March 9-11th. Alissa opened the retreat with a conversation around restorative practices and how they might be useful with clients who have engaged in acts of sexual victimization. Speaking to treatment providers and probation officers provided an important learning experience for everyone. Approximately seventy people attended the training and the knowledge exchange that occurred inspired many of us to rethink our positions and assumptions.

Just as clients’ motivation for change are multifaceted, so too are treatment providers and others who work with those who sexually abuse. Many of us who work in this field are stuck in our ways and find it difficult to change our daily practices. This training provided multiple opportunities for attendees to discern how and whether restorative practices could benefit their clients, even if they entered the retreat unsure of what restorative justice was.

The conversations also affected the way Alissa will approach future trainings. Alissa has traditionally focused on client specific restorative justice. This entails focusing on how such processes can lead to empathy, insight, and understanding for those who have committed sex crimes, while also bringing closure, accountability, and healing to those who have had sexually traumatic experiences. During the training, a probation officer approached Alissa to ask how restorative justice might benefit those in positions like hers. It provided new insight for Alissa to think about how to integrate restorative practices into the larger community of individuals who work with those who have sexually abused.

Another moment of clarity occurred about halfway through the training. Alissa spoke about the current societal discourse around sexual violence and asked attendees what they thought the current discourse was. Several people spoke up about the lives of registered citizens and some of the inherent difficulties with living life on the registry. Interestingly, not a single person mentioned the people who have experienced sexual violence. The room fell silent when Alissa took notice of the lack of acknowledgement of victims of sexual violence.

Perhaps this is because providers who work with those who have offended have little dialogue with those who work with individuals who have been victimized. We remain in our silos, unaware of what others in the field are facing. Restorative practice moves beyond victims and offenders. Open and authentic dialogue is helpful for all of us to make positive changes in the way we work and live.