Thursday, February 27, 2014

CoSA Funding Threatened (Again) in Canada

Last week, all Circles of Support and Accountability (CoSA) projects in Canada were informed by the Correctional Service of Canada (CSC) that their contracts would be terminated at the end of the current fiscal year, which in Canada means end of March 2014. The finality and implications of that decision are still being reviewed, but it is clear that CoSA funding in Canada is again under threat.

CoSA began in Southern Ontario in the summer of 1994, but it wasn’t called that then. Repeat child molester Charlie Taylor was being released from Warkworth Institution (a medium security federal penitentiary). Although most offenders receiving determinate sentences in Canada are eligible for conditional release (i.e., day parole, full parole, or statutory release at the two-thirds point) before the end of their sentences, it was not uncommon in those days for a high risk sexual offender to be detained by the National Parole Board. In such circumstances, the offender is held until the very end of his sentence (known in Canada as the Warrant Expiry Date, or WED). This is equivalent to the US experience of “maxing out”.

On the surface, the practice of detention appears to make sense. High risk sexual offenders who have refused treatment or have been otherwise problematic while incarcerated are held past their release eligibility dates, thereby delaying their release to the community until the last possible moment. But, when one looks a little deeper, the practice is fraught with potential pitfalls for the community. The Correctional Service of Canada provides an array of treatment and other reintegration services for sexual offenders on conditional release, including problem-solving skills training, substance abuse treatment, job search, and psychiatric services, among others. The key point in this, however, is the phrase “on conditional release”. Offenders released at the end of their sentences are not eligible for such reintegration assistance, on the basis that they are no longer under the umbrella of CSC or the federal government’s responsibilities for offender reintegration. This was the situation facing Charlie in 1994, and the many WED sexual offenders who have since followed.

Charlie’s release was an incident waiting to happen – a repeat sexual offender with dozens of prior victims released to the community with no formal aftercare or link to the community in any meaningful way. Understandably, the citizens of the city to which Charlie was released were incensed. However, prior to his release, efforts were undertaken to establish some aspect of social support for him, which was principally in the form of a group of volunteers from a local Mennonite church under the direction of the Rev. Harry Nigh. That small group of volunteers pioneered what we now know as Circles of Support and Accountability, a model of professionally supported volunteerism that has proliferated across Canada and into the United Kingdom, Europe, and the United States. There are presently over 30 individual CoSA projects worldwide, all based in part on the innovative model developed over the past 20 years in Canada. Indeed, US-based evaluability research has assessed projects in terms of how much fidelity they show to the original Canadian model.

Funding for CoSA projects in Canada has always been tenuous. When delegates from CSC and the Mennonite Central Committee of Ontario (MCCO) traveled to Ottawa to discuss funding with then-Solicitor General Herb Gray in 1996, they were initially turned down. Mr. Gray asserted that the Government of Canada had no legal responsibility for providing services to offenders no longer serving sentences. However, he was persuaded that while no legal responsibility existed, there was a moral responsibility to assist in protecting citizens from harm that might be committed by known at-risk offenders. On that basis, a funding structure was established that has seen CoSA projects receive federal government funding over the ensuing 18 years. Once again, this funding relationship is under threat.

To be fair, the government (via CSC) may maintain some funding for CoSA projects; however, reports are that this funding will be limited to work with only certain types of offenders. Since Charlie’s WED release in 1994, Canada has legislatively attempted to address the problem of WED releases with no aftercare. At the time of sentencing, sexual offenders with prior histories and who present particular challenges may now be declared Long Term Offenders and have post-sentence periods of community supervision appended to their regular sentences, known as a Long Term Supervision Order (LTSO). LTSOs are managed by CSC and offenders may be supervised in a parole/probation hybrid for up to 10 years post-sentence. It appears that CSC is, at least in principle, okay with CoSA projects working with LTSO offenders, who are still under CSC’s risk management umbrella. The offenders they no longer want to support are those who didn’t get an LTSO at sentencing and who are therefore released at WED. It’s déjà vu all over again. The public has been clear for decades that they expect their communities to be safe and that they want the government to provide protections; as such, the continued policy of WED release with no provisions for support or accountability raises ethical as well as moral questions.

CoSA was founded as a grass roots, community based response to what amounted to a failure of the government to protect the people. High risk sexual offenders were being knowingly released into the community with no aftercare, no supervision, and no attempts at linking them to social supports or other risk management frameworks. Courageous citizens like Rev. Nigh and more than 750 socially conscious Canadians have since stepped up to the plate to help cover that risk, often without much in the way of thanks or accolades. Despite its clear legal responsibility for managing sexual offenders on LTSO, CSC seems to be looking to outsource a substantial portion of this work back to the community to whom it is accountable. However, CSC doesn’t appear willing to assist the community in managing the risk of offenders for whom they (CSC) are trying to divest responsibility. There’s an issue of fairness here.

Realistically, the only pats on the back CoSA volunteers ever get are from the offenders they help or via research published showing the successes of their efforts and the model. To date, four controlled studies demonstrating the effectiveness of the model have been published in prestigious peer-reviewed journals (one of which was founded in Canada). Two of these studies are from Canada (1 and 2), the others coming from the UK and the USA. All four studies show the same outcome – dramatically different rates of sexual and other reoffending in groups of CoSA participants when compared to matched or randomly assigned samples who did not participate in a CoSA. These findings have been encouraging enough for the US federal government to support CoSA project development in various places in the US; the same being the case in the UK and ever more so in other international jurisdictions. Even behind the scenes, the most skeptical researchers have been impressed by CoSA findings.

Yet, in defending their decision to defund CoSA in Canada, CSC officials have declared CoSA research to be seriously flawed (surprisingly, two of these studies were originally published by CSC’s own Research Branch). To be truthful, there is something to this assessment. Four studies with small sample sizes and relatively short follow-up times – there is clearly a need for more research before we can definitively declare CoSA to be a truly evidence based initiative. Of course, virtually all scientific studies have flaws. But, really, the evidence comes from researchers in three different countries, all of whom found the same thing. Further, the decision to defund CoSA comes as Canada wraps up its participation in a 5-year national demonstration project funded by the National Crime Prevention Center, a federal agency affiliated with Public Safety Canada, ostensibly the same government ministry that wants to cut the funding. What’s the rush? Why not wait and see what the ongoing national research project finds?

In many ways, attacking the CoSA research base is disingenuous. This can be seen as a standard governmental and corporate tactic employed when one wants to close down something that touts empirical research as a basis for its existence. The great Canadian criminologist Paul Gendreau warns us of this sort of thing in his many publications regarding correctional quackery and “fart-catching”. Such attempts to selectively dismiss or promote research findings can also be seen as “ideologically and professionally convenient” (Andrews & Wormith, 1989):
"Knowledge destruction" refers to the uncritical acceptance of null findings, while findings of covariation are contaminated or dismissed through the mere suggestion of errors of conceptualization or measurement (Gottfredson 1979). "Knowledge construction" involves exploring the implications of identified threats to the validity of research-based conclusions and recognizing that the effect of threats is not always the production of inflated estimates of validity. Rather, "threats to validity" sometimes may have the effect of masking covariation or producing underestimates of the magnitude of covariation. In summary, an objective of the psychology of crime is to understand personal covariates of criminal activity, whereas an objective of major portions of mainstream criminology is to discredit such an understanding.
The current government in Canada remains convinced that it must implement criminal justice reforms that are, as a group, poorly supported by research. Mandatory minimum sentences, efforts to limit or deny conditional release, longer sentences for sexual offenders, and other get-tough-on-crime measures, which the government calls their “Safer Streets and Communities Act,” have been or are about to be implemented in Canada in the near future. Some of these changes are already being challenged – some successfully – in the courts. It is disquieting that the current government agenda is at times diametrically opposed to findings in decades of peer-reviewed research, most of it published by Canadians funded or working directly for the same government agencies that now seek to ignore those findings. As one volunteer observer commented after hearing of the impending defunding of CoSA, “My first reaction to this news is that communities are less safe this week than they were last week.”

To summarize, the Correctional Service of Canada (on the recommendations of the National Parole Board) used to release high risk sexual offenders into the community without aftercare or other follow-up services. This forced community members to take matters into their own hands through development of grass roots projects intended to provide support for offenders while ensuring a means by which offenders can be accountable for their behavior once released. Convinced that a moral responsibility existed to assist these community volunteers in their efforts, government funding has been provided to established CoSA projects coast to coast in Canada for nearly 20 years. This partnership in risk management between the correctional service and the community has become a best practice model for jurisdictions worldwide. Now, the Government of Canada seeks to cease that partnership in risk management with the community, one end result being that vulnerable citizens will be at increased risk for harm from offenders the government was so concerned about that those offenders were detained until the very last day of their sentences. This situation will no doubt be exacerbated by the fact that the government plans to spend millions of dollars on get-tough-on-crime measures that a quick review of the science will reveal are unlikely to work, while defunding an initiative that many people internationally are convinced is exactly the sort of approach most likely to work. Ultimately, the Government of Canada’s plan amounts to bad policy based on ignoring good science. And, given Canada's prominence in the "what works with offenders" world  including sexual offenders  that’s a shame.

Robin J. Wilson, Ph.D., ABPP
Wilson Psychological Services LLC, Sarasota, FL
McMaster University, Hamilton, ON

References:

Andrews, D.A. & Wormith, J.S. (1989). Personality and crime: Knowledge destruction and construction in criminology. Justice Quarterly, 6, 289-309.
Bates, A., Williams, D., Wilson, C., & Wilson, R.J. (2013). Circles South-East: The first ten years 2002-2012. Published online first April 24, 2013, International Journal of Offender Therapy and Comparative Criminology. doi:10.1177/0306624X13485362
Duwe, G. (2012). Can Circles of Support and Accountability work in the United States? Preliminary results from a randomized experiment in Minnesota. Sexual Abuse: A Journal of Research and Treatment. 24, 1-23.
Elliott, I.A., Zajac, G., & Meyer, C.A. (2013). Evaluability assessments of the Circles of Support and Accountability (COSA) model: Cross-site report. Washington, DC: Department of Justice.
Gendreau, P. (2009). Chaos theory and correctional treatment: Common sense, correctional quackery, and the law of fartcatchers. Journal of Contemporary Criminal Justice, 25, 384-396.
Wilson, R.J., Cortoni, F., & McWhinnie, A.J. (2009). Circles of Support & Accountability: A Canadian national replication of outcome findings. Sexual Abuse: A Journal of Research & Treatment, 21, 412-430.
Wilson, R.J., Cortoni, F., Picheca, J.E., Stirpe, T.S., & Nunes, K. (2009). Community-based sexual offender maintenance treatment programming: An evaluation. [Research Report R-188] Ottawa, ON: Correctional Service of Canada.
Wilson, R.J., Cortoni, F., & Vermani, M. (2007). Circles of Support & Accountability: A national replication of outcome findings. [Research Report R-185] Ottawa, ON: Correctional Service of Canada.
Wilson, R.J., Picheca, J.E., & Prinzo, M. (2005). Circles of Support & Accountability: An evaluation of the pilot project in South-Central Ontario. [Research Report R-168] Ottawa, ON: Correctional Service of Canada.
Wilson, R.J., Picheca, J.E., & Prinzo, M. (2007). Evaluating the effectiveness of professionally-facilitated volunteerism in the community-based management of high risk sexual offenders: Part two—A comparison of recidivism rates. Howard Journal of Criminal Justice, 46, 327-337.

Wednesday, February 19, 2014

The Promise and Peril of Role-Play in Experiential Treatment

A member of the Association for the Treatment of Sexual Abusers (ATSA) recently asked for others’ thoughts on having adolescents re-enact their sexual offenses as a part of group treatment. Of course, there is some question as to whether group treatment is the preferred modality for work with juveniles, but that is another matter for another post.

For those who may be unfamiliar, some adult programs have indeed used role-play re-enactments of sexual crimes as a means to explore the issues and harm of sexual abuse, although this practice has diminished. At the time, it certainly seemed like a good idea to many professionals.  There are probably many reasons for its decreased use, including research attention turned toward cognitive-behavioral therapy.

Experiential work in treatment can certainly deepen its impact. In an era when so much focus is on building clients’ responsiveness to treatment, experiential work seems a natural part a larger program that adheres to the principles of effective treatment. Among the helpful resources, John Bergman and Saul Hewish’s book, Challenging Experience (2004), offers many excellent ideas, and Bergman has recently summarized the fascinating history of experiential techniques in a 2012 book chapter. I incorporate many of these techniques into my own work. Of course, none of these resources advocates real re-enacting of the client’s own crime. Still, experiential techniques can be very powerful tools that only skilled therapists should use.

That said, there are many reasons not to have young people re-enact offense scenes in treatment. In fact, I would be extremely careful about going anywhere near it. Here are a few perspectives:

The first is a clinician’s perspective: Young people in trouble with the law often have far more complex/developmental trauma in their backgrounds than we realize. No matter how one looks at it, acting out offense scenes is a high-dose/high-intensity activity that is rife with opportunities for increasing shame instead of understanding. There is no doubt that some kids will gain some genuine understanding from it; however, my concern is that many more will simply acquiesce to it and say that it was an important experience for them while never sharing what they really went through doing it. Many is the young person victimized by an adult who came away saying it was not so bad or that they deserved it. To what extent are these kids truly consenting to experiential treatment activities that may a very public expectation of the provider or the program? When treatment completion is largely dependent on participation – and the adolescent knows that their peers are participating – how easily can they (and their families) weigh the risks against the benefits? Where does pressure offset consent? To what extent are we replicating abuse and abusive environments?

The net result for adolescents is more likely to be “I’m a bad person” than “I’ve done something harmful.” Further, the highly fragmented experience that results from past trauma makes it far more likely that kids will see this as one more bad experience brought down on them by adults. Many readers might look at this as a challenging experience brought about by caring people who have their best interests at heart. Not so in the world of traumatized teens. Professionals must build, re-build, and maintain must a positive alliance with them every day.

Obviously, it’s not helpful to criticize without offering an alternative. Instead of thinking “let’s give them an experience, so that they will understand the harm of their actions”, why not think in terms of “this is a young man capable of understanding the harm of his actions, and that understanding is in there somewhere. How can I elicit, invoke, or invite that part of this kid to talk to me, thereby having him provide his own experience of understanding? This way, any epiphany is more likely to occur in the way that works for him and on his timetable, rather than through my methods or in accordance with my schedule.

The second is a clinical supervisor’s perspective: Supervisors should ask themselves how confident they are that their clinicians can manage this kind of activity without difficulty? For inpatient settings (which is where these activities typically take place), how will they manage it when their young clients return to their units shaken and upset, experiencing shame and at greater risk for self-harm? It might not happen today or tomorrow, but something will happen eventually. Then there is the “Lord of the Flies” problem, in that many of the kids might feel shame, anxiety, or even gratification from acting out others’ experiences. How certain is the supervisor that he or she knows what the clinician is doing with this high-stakes activity? How will the supervisor respond to complaints by families? After all, in their minds, they signed consent for their child to enter treatment, not another world.

The third perspective is that of an administrator: This is a media event waiting to happen. Eventually, there will be a bad experience and it will make the newspapers. In fact, this has happened in at least one adult treatment program some years ago. Inmates complained that they were being told to re-enact abuse situations. The complaints received all sorts of coverage and there were complaints about tax dollars supporting this, etc. More recently, there was a juvenile program’s use of the penile plethysmograph that led to complaints that appeared in the newspapers across Canada (Turpel-Lafond, 2011). There are many ways to use experiential exercises, but re-enacting offenses is generally not such a great idea.

Humanitarian perspective: We often have no idea how much power we hold over our clients of all ages. It may be the easiest element to forget when working with people who have sexually abused. We need to be extremely careful how we use it.

David S. Prescott

References

Bergman, J. (2012). The theatre of meeting: The history of drama and other experiential therapies as neurological analogs. In R.E. Longo, D.S. Prescott, J. Bergman, & K. Creeden (Eds.), Current perspectives and applications in neurobiology: Working with people who are victims and perpetrators of sexual abuse (pp. 317-344). Holyoke, MA: NEARI Press).

Bergman, J. & Hewish, S. (2003) Challenging experience: An experiential approach to the treatment of serious offenders. Oklahoma City, OK: Wood’N’Barnes.

Turpel-Lafond, M.E. (2011). Phallometric testing and B.C.’s Youth Justice system. Report to the Legislative Assembly. Retrieved February 18, 2014 from http://www.rcybc.ca/Images/PDFs/Reports/PPG%20Report%20FINAL%20Updated%20April%2014.pdf.  

Thursday, February 6, 2014

Treatment Providers: Born or Made?

On the listserv of the Association for the Treatment of Sexual Abusers (ATSA), a member recently observed that, in his experience, great therapists are born more than made. Indeed, many professionals who have worked in larger agencies have had the experience of working with someone who just didn’t seem to “get it.” The underlying assumption is that some of us are simply better than others. Is that true?

The stakes are high for professionals treating people who have sexually abused; don’t we all want to be the most effective we can be? Early pioneers stated that treatment must be confrontational (e.g., Salter, 1988, p. 93). More recently, Marshall (2005) summarized a number of studies showing that the most effective therapists are those who are warm, empathic, and rewarding, while providing clear direction. What seems to be the case is that no matter the therapy, agreement between therapist and client on the goals and tasks of treatment, as well as on the nature of the relationship itself (these factors being referred to as the therapeutic alliance), is vital (Wampold, 2001).

At first, Marshall’s findings seem encouraging. Warm, empathic, rewarding – that’s me, right? Until we ask others, including our clients. A major problem is that almost everyone considers themselves warm, empathic, and directive in one way or another. Do you know anyone who says they are cold and not particularly empathic? It’s now been 16 years since Beech and Fordham (1997) found that people treating men who had sexually abused believed themselves to be more helpful than their clients do. Have we gotten more effective since then? Or, does our faith in ourselves actually prevent us from becoming the best therapist we can be?

Research by Scott Baldwin and his colleagues (Baldwin, Imel, & Wampold, 2007) and by Bruce Wampold (2001) has found that there may be fewer differences between therapeutic approaches in psychotherapy, overall, than there are between therapists. Does this mean that who professionals are is more important than what we actually do?

A couple of recent publications should give us pause to consider our practice. The first is by Helene Nissen-Lie and her colleagues in Norway. The second is a review of research by Theresa Moyers and Bill Miller.

Helene Nissen-Lie and her colleagues (Nissen-Lie, Havik, Høglend, Monsen, & Rønnestad, 2013) examined an international sample of 70 therapists and 227 clients. The authors used measures that explored the personal satisfaction and personal burdens of each therapist. They next examined the therapist’s and the client’s experience of the alliance. They found that therapists with high levels of personal satisfaction rated their alliance to be higher than their clients did. The therapists’ self-reported level of personal burdens was strongly and inversely correlated with the client’s rating of the alliance. In other words, therapist’s experiences of their own problems seemed to have a greater effect on their alliance than their experiences of satisfaction. Important to recall is that it is the client’s experience of the alliance that predicts the success of treatment, and not the therapist’s.

Clearly, this was not a study of recidivism rates of sexual offenders, but instead yields important clues as to how therapists can build alliances that will help their methods become most effective. In this writer’s experience, many people who have sexually abused have described a sense of knowing when the time or situation was right to commit a crime. Why shouldn’t they also know when their therapist is on their game… and not?

In his early years, Bill Miller, then only beginning to develop motivational interviewing, decided to run a simple experiment. He looked at therapists providing substance abuse treatment, expecting to find that their clients relapsed less than people with addictions who read self-help books. He was wrong; there was no difference. Perplexed, he repeated the study and realized that those therapists who were judged by their peers to be more empathic did indeed produce clients who abused substances less. Therapists who demonstrated less empathy produced clients who would have done better with a good book. These findings are deeply frightening, but necessary to address if our field is ever to improve.

Since then, Theresa Moyers and Bill Miller (2013) have come to believe that although empathy levels differ between therapists, an important element of treatment provision is to screen for it during employment interviews and teach it to clinicians wherever possible. They also remind us of the body of research showing that it is the client’s perception of empathy that is more important than the therapist’s self-assessment. Further, they clarify that what is important is the actual demonstration and expression of “accurate empathy,” which they define as a:

… commitment to understanding the client's personal frame of reference and the ability to convey this heard meaning back to the client via reflective listening … the process encompasses the accurate understanding of both cognitive and emotional aspects of the client's experience as well as attunement to the unfolding experience of a client during a treatment session.

It can be a common refrain among treatment providers to say that people who have sexually abused are different or more challenging than other clients. Of course, Moyers and Miller are describing work with people who suffer from addictions – another population with a reputation for being deceptive and manipulative over time before entering treatment.

So where does this leave us?

Certainly, some therapists enter the field with higher levels of demonstrated empathy than others. Those of us committed to becoming better therapists can likely become more effective by deliberately practicing our skills in accurate empathy. However, our own self-assessment of our empathy – and for that matter our satisfaction with our lives – will probably predict very little of our actual effectiveness. Nissen-Lie and her colleagues have also shown that our personal burdens may have more of an effect on our clients than we realize. In the end, even if some of us have greater advantages in some areas, the best therapists may well be the ones who make themselves better… with the help of their clients.

David S. Prescott, LICSW

References

Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842.

Marshall , W. L. (2005). Therapist style in sexual offender treatment: Influence on indices of change. Sexual Abuse:  A Journal of Research & Treatment, 17(2), 109-116.

Moyers, T.B., & Miller, W.R., (2012). Is low therapist empathy toxic? Psychology of Addictive Behaviors, 27, 878-884.

Nissen-Lie H.A., Havik, O.E, Høglend, P.A., Monsen, J.T., & Rønnestad, M.H. (2013). The contribution of the quality of therapists' personal lives to the development of the working alliance. Journal of Counseling Psychology, 60, 483-95.

Salter, A. (1988). Treating child sex offenders and their victims. Thousand Oaks, CA: Sage.


Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings.  Routledge.

Monday, December 23, 2013

A note about sajrt.blogspot.com, Minnesota Sex Offender Program (MSOP), and Robin Wilson

As many sajrt.blogspot.com readers may be aware, class action lawsuit proceedings are ongoing regarding Minnesota's civil commitment program, known as the Minnesota Sex Offender Program (or MSOP). In the past, sajrt.blogspot.com has included posts about both sexual offender civil commitment, generally, and the MSOP, specifically.

Civil proceedings in Minnesota continue to evolve, and Federal Judge Donovan Frank recently announced the appointment of four sexual offender treatment experts retained to guide the court in the weeks and months ahead. The experts are Naomi Freeman, Deb McCulloch, Mike Miner, and Robin Wilson. 

As our readers are aware, Robin Wilson is the Chief Blogger for sajrt.blogspot.com. Given his new role, and in the interest of limiting potential conflict of interest concerns, no policy-related posts will be made on this site regarding sexual offender civil commitment or the MSOP until such time as Robin's retainer to the court has been terminated. Posts on these topics of a more purely research nature will be managed by SAJRT Editor-in-Chief Dr. James Cantor.

Thursday, December 19, 2013

Age of Consent in the UK: A guest post by Dr. Kieran McCartan

The issue of what the age of consent to sexual activity should be was recently raised in the UK. On this occasion it was not in the context of an offence, nor was it in the context of punishment. Rather, it was raised in the context of prevention, as well as public health. It was suggested that the age of consent in the UK (which is 16) should be reviewed, reportedly in an attempt to prevent teenage pregnancy, poor and problematic teenage sexual relationships, and to allow for appropriate and realistic engagement between practitioners and children.

Ideas around consent, puberty, sexual engagement, child protection, and public health are at the heart of work with persons who have sexually offended. Indeed, we only have to look at James Cantor’s talk at the November 2013 annual conference of the Association for the Treatment of Sexual Abusers. So, when Professor John Ashton called for a national debate on lowering the age of consent from 16, it was clear that we really need to consider the implications of this proposal. Professor Ashton suggested that lowering the age of consent would help better educate children about engagement in sexual behaviour and, therefore, protect them more fully. He cited as examples of best practice other European countries with a lower consent age, indicating that these countries generally have lower teenage pregnancy rates, lower infant mortality, and lower levels of sexual transmitted diseases. Professor Ashton’s suggestion was dismissed out of hand by UK Prime Minister David Cameron as damaging, irresponsible, and insulting.

Age of Consent varies internationally, and sometimes nationally, as demonstrated in the following table:


Regardless of your opinion as to what the age of consent should be, there are real issues relating to sexual abuse and child protection caught up in this debate, including:
  • What impact would a change in age of consent have on children below the current age of consent who are having sexual relations? It would hopefully open up possibilities for more education on sex, a greater discussion of appropriate age related sexual interactions; open up more possibilities for greater sexual health help (e.g., condoms, protection, counselling, etc.), potentially reduced use of the internet for sexual advice and, perhaps, less use of pornography. However there is a counter-agreement that lower the age of consent will lead to more teenage/adolescent sexual behaviour, increased victimisation, and a weakening of the state’s ability to prosecute inappropriate offenders as well as offences.
  • Experimentation vs. abuse? Often the reason why certain persons engage in certain activities is not as simple as simply considering issues of age. For example, we may need to distinguish between children and childlike behaviour. In the cases of both perpetrators and victims learning difficulties (e.g., Intellectual Disability) and/or mental illness, how do we evaluate the impact that their condition has on consent, especially when those conditions cause them to understand things on a level pertinent to age of consent in non-disabled persons? This also highlights the balancing act we must be mindful of when distinguishing between child-on-child sexual abuse versus childhood experimentation, a distinction that is not always easy to make (Human Rights Watch’s 2013 publication Raised on the Registry is pertinent to this discussion).
  • What is consent? Age of consent is based on the notion that there is a line of best fit (and, a socially constructed and morally defined line at that) that indicates a point at which we are best able to appropriately understand sexual relations and their impact. This raises many questions, especially regarding who determines this and how? Additionally, how does this relate to persons with special needs (intellectual or cognitive disabilities, mental health conditions)? How are people educated about consent and does this match up to their peer interactions and life experiences? This argument is also confused by the fact that some countries have the equivalent of statutory rape laws, meaning that below a certain age you cannot legally give consent. For instance, in the UK all sexual relationships with anyone under 13 are automatically considered to be rape because teens below that age are not thought of as being able to give consent. However, there is a odd 3-year gap in the middle between the statutory rape age and the age of consent. How do we explain the three years teens will have to wait before they can give the informed consent that the law seems to think is possible post-13? As you can see, the idea of consent is difficult in a legal, moral and psychological sense, which means that consent laws are the product of historical compromise.
  • Social and Cultural practices relating to sex and consent? With all modern western societies being so culturally diverse, this means that additional cultural practices have to be incorporated into policy (for example, how do we manage immigrants coming from nations with such practices as forced marriage, child brides, female genital mutilation). Similarly, do we need to revisit some currently established practices in light of this new cultural integration? Even though age of consent may be different internationally, new immigrants and members of minorities will have to fall in line with policies in their host country and not their country of origin. However, has enough be done to educate newcomers on such issues?
  • Technology, new media and old media? We have started to see an increase in sexting and image sharing between children. In public health terms, this has got to the point where we are on the verge of calling it an epidemic. However, contextually, all these devices, technologies, and formats are new; therefore, can we really compare them to 20 years ago when they did not exist? On one level, children are potentially no more sexualised and sexually active than previously, we just have more ways of uncovering it now. Previously, children may have shown each other their bodies, been sexually engaged, or looked at images offline and in private. Now, they are doing it online and in public. This is further complicated by children’s (lack of?) understanding of what it means to engage in such sexually charged activities in online interactions (e.g., sexting, sending inappropriate images, etc.). A recent study of young adults showed that their understanding of sexual politics and legalities are often quite limited (Fenton et al., 2013, ATSA Forum, available via the Comments section).
So, should the age of consent be lowered? I’m not sure anyone has a good or conclusive answer to that question, and I am no different. Should changes to age of consent and their implications be debated?  On this, I would say “yes”. Consent and understanding of sexual behaviour should be framed as an issue important in child protection, over and above how they pertain to  childhood development and sexual exploration. Maybe the place to start is in considering the social harms versus social benefits that may result from different standards of age of consent. Further, it will be important to assess the impact of age of consent on child vulnerability and the sometimes inevitable negative social consequences that come with breaking the “social contract” of the age of consent, which appears to be different from the actual “social norm” of childhood sexuality. This suggests that Professor Ashton is correct, in that childhood sexual behaviour is a public health issue that needs to be framed in a preventive/educational dialogue that helps protect children. Community engagement is at the forefront of this perspective.

Dr. Kieran McCartan
Associate Professor in Criminology
Programme Manager in Criminology
University of the West of England, Bristol UK
kieran.mccartan@uwe.ac.uk

Monday, November 25, 2013

Variance in Sexual Violence Definitions: How These Differences Impact Our Work

It has long been recognized that the true rate of sexual violence is unknown due to difficulties arising from underreporting to law enforcement; inconsistencies in the investigation, prosecution, and follow-up of the incidents that are reported to the authorities; and societal stigmas related to attitudes and beliefs about sexual abuse.  In an attempt to address this issue, the National Academy of Sciences released a 2013 report on Estimating the Incidence of Rape and Sexual Assault (http://www.nap.edu/catalog.php?record_id=18605&utm_source=Twitter&utm_medium=napsm&utm_campaign=Hootsuite). This report addresses the current measurement of victimization rates by the National Crime Victimization Survey (NCVS), as well as concerns that the NCVS appears to be undercounting rape and sexual assault. The NCVS was first developed to provide another source of crime statistics beyond law enforcement data. It is a national household survey that collects information on a broad set of criminal victimizations (including rape and sexual assault) from victims rather than law enforcement. As users of the NCVS data expressed concern about potential underestimation of rape and sexual assault on the NCVS, the current report was requested by the Bureau of Justice Statics (BJS) to identify the reasons for this possible underestimation and provide best practice recommendations for measuring rape and sexual assault in the future.

While the report encompasses an intensive exploration of the strengths and weaknesses of the current structure of the NCVS, it begins by identifying numerous definitional problems when discussing rape and sexual assault as there are two quite different perspectives on the measurement of these behaviors – the criminal justice perspective, which focuses on “point-in-time” events that are judged to be criminal, and the public health perspective, which looks at victimization as a condition that endures over a period of time and may not necessarily be criminal.  Additional issues identified were the considerable differences on the legal definitions of rape, sexual assault, force, lack of consent, etc., as well as variance in the manner in which measurement of rape and sexual assault is implemented, across different jurisdictions.  These differences were also reflected on the existing body of independent surveys investigating rape and sexual violence (i.e., National Women’s Study [1989-1991], National Violence Against Women Study [1995-1996], National College Women Sexual Victimization Study [1996], National Intimate Partner and Sexual Violence Study [2010]).

These definitional differences caught my attention, especially due to recent dialogue in the media and on several professional listservs related to refining or changing the label of “child pornography” to “child sexual abuse images” (see http://sajrt.blogspot.com/2013/11/bearing-witness-to-child-sexual-abuse_19.html).  There are many different disciplines involved in the prevention of sexual violence (e.g., law enforcement, victim advocates, parole/probation officers, sexual offender treatment providers, community groups) and we frequently work collaboratively on varying issues related to offender management, victim safety, and policy development.  Yet, when we engage in cross-disciplinary discussion, how often do we begin these discussions with a conversation about how we each define rape, sexual abuse, sexual violence, and other related topics? 

I would assert that we often engage in these discussions with the assumption that everyone involved is coming from the same definitional understanding.  This likely occurs because we view each other as partners working on the same issues, but it may also occur because it can be difficult to step outside one’s own discipline or area of expertise.  We may sometimes forget that there are varying theories about the etiology of sexual violence, varying disciplines involved in addressing sexual abuse, and varying perspectives about how to effectively target the myriad of resulting issues stemming from sexual violence.  When we approach the table with only our own perspective in mind, this may inhibit or limit our ability to engage effectively in these multi-disciplinary discussions, as well as limit our ability to provide educational information to our communities.

A lack of common definitions about sexual violence is also readily apparent in our communities, as demonstrated by the recent debates in the media and popular culture about sexual assault on college campuses, whether or not “rape culture” exists (http://www.huffingtonpost.com/2013/11/07/rape-culture-exists-david-hookstead_n_4235955.html), the development of strategies like “anti-rape underwear” (What Are We to Make of This "Anti-Rape" Underwear?), and similar topics.  A stark light has also been focused on the struggles experienced internationally with respect to sexual violence prevention and the oppression of women, with frequent contradictory views regarding the definitions within these cultures (girl whose rape changed a country; Child Sex Abuse Steps Out Of The Shadows In Pakistan; 'Statutory rape isn't romantic,' says rape crisis centers head; South Africa's rape problem: why the crime remains under-reported).

There are many factors involved in the development and prevention of sexual violence that are reflected by the numerous disciplines who address this public health issue. I do not propose that we will solve all of these issues by reaching unilateral definitions about the different types of sexual abuse.  I am proposing, however, that it is imperative for us to remember that our own perspectives and disciplines are exactly that…our own…and when we sometimes forget that, we potentially obstruct or impede the beneficial work that can be accomplished through the respectful multi-disciplinary collaboration and community engagement that would otherwise occur.  Although we may work with different populations, have different ideas or philosophies about the etiology of sexual violence, or provide different types of services from direct treatment to policy development, when we approach these discussions and collaborations with an open mind and acknowledgement of our differences, we only become stronger and more effective in aspiring to our shared goal of No More Victims.

Katie Gotch, M.A.
Coordinator of Public Affairs 
Association for the Treatment of Sexual Abusers

Tuesday, November 19, 2013

Bearing witness to child sexual abuse: What do we call it? How should we understand it?

A recent sting operation resulting in hundreds of arrests on child pornography charges around the world has been in the news in recent days. At the center of an investigation that involved 90 countries was a distributor of “naturist” pictures of children that were not – on the face of it – illegal. Over time, however, it turned out that he was also distributing images of child sexual abuse.

This and related events have been discussed in various social media, including listservs of professionals and interested parties. One sexologist took offense to a recent situation in which a man was arrested for pre-offense behaviors involving a girl who was actually an FBI agent. The logic was apparently that since no one was abused, no one should be punished. Another professional decried that many jurisdictions in the US consider possession of child pornography to be a violent offense. In opposition to this judgment, they stated, “LOOKING at pictures is not violent,” and “Calling it such belongs in some Orwellian ‘1984’ scenario.” Indeed, those of us over a certain age are accustomed to describing violence as overt activity of a hands-on or weapons-based nature. The Internet has caused many to reconsider what stalking, violence, and similar crimes are and how they might be defined. On the other hand, prosecutors can be called “soft on crime” if they elect to prosecute only the most egregious of cases. So what’s violent? What constitutes child pornography (legal definition) and child sexual abuse images?

One place to start might be with definitions of violence. Here’s what the World Health Organization has to say:
Violence is "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.
My belief is that we should strive to be accurate and truthful in our use of language; I’m sure no one disagrees. Obviously, not all images of children and child sexual abuse are created equal. Elsewhere in the thread there has been discussion of the often-cumbersome nature of language in our field. My hope is that professionals will err on the side of accurate, precise language; they may be “sex offenders” in the eyes of the law, but whenever possible we should still remember and express that they are people who have sexually abused. As humans, they are more than the sum of their worst behaviors. Ultimately, terms like “sex offender” and “child pornography” are heterogeneous and legal, not diagnostic. Likewise, “violent crime” is its own sort of catch-all and, indeed, there are some overtly violent child sexual abuse images on the Internet.

Some friends of mine (who live in Eastern Europe) recently showed off pictures of their toddler-age daughter taking some of her first steps, as captured on an iPhone. No one in their right mind would consider parents taking that picture an act of violence, even though it can and does get classified that way in many jurisdictions. To our knowledge, it would not have been against the law in the country in which the images were taken. Further, one member of the Association for the Treatment of Sexual Abusers also observed privately that just because they downloaded pictures of Nazi war crimes does not make them a Nazi war criminal. This point is well taken.

But at what point in our attempts to counter legal over-reach are we missing more fundamental issues? When people say that a broad category of activities is either violent or non-violent, isn’t that a particularly black-and-white way of thinking? Are these really our only options? Without meaning to cause offense to some of those in this discussion, isn’t trying to “classify” a broad range of heterogeneous images (images of child sexual abuse as well as pictures of naked children in bathtubs) an exercise in futility? Can’t we do better?

Whatever lawmakers and prosecutors use to classify crimes (e.g., violent/nonviolent), where does our professional obligation to tell the truth begin and end? Prosecutors are obviously not going to classify “child pornography” as a drug offense or moving violation. The problem isn’t that looking at images of child sexual abuse has nothing to do with violent acts, it has to do with the legal definitions … and lawmakers are typically less concerned with the precise nature of language than we typically are.

However, there is a real question about how much masturbating to images of violence against children actually does become an act of violence in itself. I don’t have the answers, but I do have some questions:
  • At what point does watching images of children being sexually abused become an act of violence regardless of legal definitions? To use some analogies, at what point is receiving stolen goods akin to the actual theft? And, at a time when we can buy goods made by American corporations in countries where they may exploit child labor, at what point do we all need to consider our actions?
  • Isn’t the act of looking at pictures on the internet somehow different from how violent someone might be elsewhere in their lives? Or their risk to become violent? Do we minimize peoples’ actions because they’re less likely to be violent in the future?
  • Setting aside looking at imagery on computers, how would we understand someone who is present at a sexual crime, observes, and perhaps masturbates during it, and does nothing? 
  • Before we assume that it is or is not its own form of violence, abuse, etc., maybe we should ask the young people in the images themselves? Or their caregivers and guardians?
  • Maybe we should consider that the notions of many interested persons about what is and isn’t violence came about before the current state of electronic communications and social media?
  • Given that society has changed (e.g., social media and its prevalence in the lives of people) is it time to revise our definitions of what is and isn’t an act of violence? Or is it time for us as professionals to be more aware of the potential for violence within communications?
  • At what point do silent observers become collaborators in violent processes? Isn’t this a question that western societies have asked many times since the start of World War II?
  • Are we as professionals simply asking the wrong questions when we rely on legal definitions to shape our language? Granted, most of us need to work within legal frameworks and understand the relevant terminology. Should we have higher standards in our own reports? In other words, whether an images “meets criteria” for a legal standard or not, shouldn’t we be clear in our communications about what we do and don’t know about the clinical implications? 
  • If we say that laws considering it are “Orwellian” and make comparisons to the fantasy writings of Lewis Carroll, are we not engaging in the same kind of overstatement that we’re accusing our lawmakers of?
  • There is a saying that “all that is necessary for evil to triumph is that good men do nothing.” Personally, I have little use for the word “evil.” Just the same, how might that phrase apply to people who view images of child sexual abuse? Is it possible that lawmakers are recognizing the harm to children and using the first words that come to mind? Is that really “Orwellian”?
David S. Prescott, LICSW