Friday, June 24, 2016

Q & A with Steven Gillespie & Tom Squire on "An Evaluation of a Community-Based Psycho-Educational Program for Users of Child Sexual Exploitation Material”.



Gillespie, S. M., Bailey, A., Squire, T., Carey, M. L., Eldridge, H. J., & Beech, A. R. (2016). An Evaluation of a Community-Based Psycho-Educational Program for Users of Child Sexual Exploitation Material. Sexual Abuse: A Journal of Research and Treatment.

Online sexual offenders represent an increasingly large proportion of all sexual offenders. Many of these offenders receive noncustodial sentences, and there is a growing need for community-based interventions. The aim of this study was to evaluate a psycho-educational program for community dwelling users of child sexual exploitation material (CSEM). A total of 92 adult male participants completed self-report measures at pre and post. A subset of participants also completed measures after a follow-up period. Results suggested benefits across depression, anxiety, and stress; social competency, including locus of control and self-esteem; and distorted attitudes. Furthermore, these effects remained 8 to 12 weeks following program completion. Our results suggest that CSEM users are amenable to treatment in the community and that there are beneficial outcomes in affective and interpersonal functioning following psycho-education. These factors represent treatment targets for sexual offenders and are recognized risk factors for contact sexual offense recidivism.


Could you talk us through where the idea for the research came from?

SG/TS: The Lucy Faithfull Foundation has been running the Inform Plus program for nearly ten years now and we were keen to evaluate its effectiveness.  There is an increasing number of men being investigated for child sexual exploitation material (CSEM) offenses, and many of these men want to seek help. However, there are few programs available that offer such help, and limited knowledge on what kind of programs might work with this group.

What kinds of challenges did you face throughout the process?

TS: The biggest challenge was extending the programme from 10 to 11 sessions to enable participants to complete the various measures pre- and post-programme.  This required the content of some sessions to be shifted forwards or backwards by one session, and all staff, working at different sites, had to be appropriately briefed.

SG: The evaluation involved collecting data at various different sites, from ten different groups running at different times within a twelve month period. Data was also collected at three different time points (pre, post, follow-up). Typically I run experimental paradigms so this was a very different project to be involved in. Another difficulty was identifying a suitable control group, and in the end this wasn’t possible. This is one area where our work can be built upon in the future.

What kinds of things did you learn about co-authorship as a result of producing this article?

SG: While my background is purely academic, my co-authors from the LFF have a wealth of practical experience with this client group. During the writing of the report these differing perspectives complemented each other nicely. For example, it would be easy to think that over the course of the program events in the clients’ lives might naturally have started to settle down with time. However, clients might be recalled for interview, receive court dates or appear in court at the same time that they are participating in the program. Set against this background it was interesting that we found reductions in depression, anxiety and stress that might not simply reflect the passing of time.

TS: In terms of producing this article, I am utterly indebted to Steven – without his involvement I wouldn’t be writing this now.  With regard to the actual research, we had some interesting discussions about interpreting the data, and it felt productive to combine the clinical experience of staff at LFF with Steven’s academic insights. 

What do you believe to be to be the main things that you have learnt about treatment for Users of Child Sexual Exploitation Material?

SG: Intervention with low risk offenders can pose various dilemmas, including whether or not intervention will help, or even hinder, the clients. Our findings suggest that short, low intensity psycho-educational programs could prove beneficial with this kind of sample. Our results also suggest that these men are amenable to treatment in the community, which is important given that a large number of CSEM users may not go to prison.

TS: Our research lends weight to the idea that psycho-education, as part of a relatively short intervention, is an effective approach to take with CSEM-only offenders.  In addition, the research is congruent with literature about the benefits of group-based intervention and the importance of the facilitators’ style and approach.  

Now that you’ve published the article, what are some implications for practitioners?

TS: We are at our best when we engage with the whole person and all their needs.  Clients must never be reduced to no more than the embodiment of risk, however that might be classified.  A philosophy of purposeful collaboration and enquiry should be our guide - our clients have much to teach us.

Steven Gillespie, Ph.D, is a Lecturer in Forensic Psychology in the School of Psychology at Newcastle University.

Tom Squire is Clinical Manager at the Lucy Faithfull Foundation.


Friday, June 17, 2016

Alcohol, Vulnerability, and Sex = Rape


“Some people see vulnerability and become exploitive;
others see vulnerability and become protective.  This story saw both.”

On January 17, 2015, Stanford freshman Brock Turner and a young woman both ended up at a college frat party.  The next morning he was in jail, she was in the hospital, and they were both trying to figure out what happened.  This was not the alcohol-infused sexual encounter between consenting young adults, which happens with tragic frequency.   They were both drunk, but didn’t know each other.  There are no crisp laws for when blood alcohol content (BAC) is too high for someone to consent to sex, so let’s agree that when at least one party has reached the not-so-scientific threshold of ‘shitfaced,’ they should not engage in sex.  The limit of BAC to legally drive a car provides a reference point for intoxication.  It’s likely that, at least mechanically, having sex is less complicated than operating a motor vehicle, but in this case, Turner’s BAC was twice the legal limit for driving; her BAC was three times.  Without testing, how can one know if potential sexual partners are shitfaced?   A clue might be when one individual has passed out.

To avoid further victimization, the media has protected her identity, but to try to elevate her above the label of ‘victim’ or a simple pronoun, I’ll offer the small dignity of a capitalized ‘She.’

Sexual abuse is epidemic in the US and pervasive on college campuses; so why did this story catch international attention?  In part because of some classic themes that illustrate disparities in our criminal justice system: the offender was white, attending a prestigious college on an athletic scholarship, and he came from a family of means that afforded him a top legal defense.  But what truly propelled this story into viral status were three other factors: the extraordinary intervention of bystanders, an amazing victim impact statement, and unexpected leniency in sentencing.

When it comes to interpersonal sex, there must be no confusion about consent; but when alcohol is present, consent is always muddied.  Alcohol is not an excuse for rape; it just happens to be a contributing factor in half of all rapes, particularly on college campuses.  When so much about sex happens under the ‘control’ of primitive parts of the brain, it would seem people cannot afford to have any impairment to executive functioning.  An expert at trial testified that one does not have to be unconscious to not remember having sex; they need only be drunk enough to experience a blackout.  This impaired state can facilitate an illusion of consent – with tragic outcomes for both parties.

If She was functioning in a blackout when the sexual encounter began, She was unmistakably unconscious when the sexual assault was interrupted by Stanford graduate students Peter Jonsson and Carl Fredrik Arndt.  As they were riding their bicycles near the frat house at 1 am, they might have ignored two people having sex outside on a Saturday night, but the location by a dumpster seemed odd and when the woman appeared unresponsive, they confronted Turner, who ran.  While Arndt checked on the victim, Jonsson gave chase, tackled Turner, and held him until police arrived.    Some people see vulnerability and become exploitive; others see vulnerability and become protective.  This story saw both.

This contrasting response to vulnerability illustrates curious questions about the flaws and virtues that are ubiquitous in human nature – and typically even found within the same individual.  One treatment target for those who have sexually offended is empathy building.  But a question remains: if when exposed to vulnerability, one is not instinctively protective, can one learn to be protective, or at least not exploitive?  How innate or malleable is this potent, if sometimes unfortunate human characteristic?  

An equally compelling takeaway from this story is how some victims become survivors while others remain victims.  Whether She had the resiliency to tell her story, or found resiliency by telling her story, She undoubtedly has inspired an untold number of victims of sexual abuse to come forward, ask for help, and seek justice.   The world won’t know her name, but millions of people will remember that She wrote a powerful, unfiltered narrative of her journey – from gradually discovering being sexually violated, to enduring the trial of her assailant.  Her full (7,200 word) victim impact statement can be found on the Internet.  There is an edited narrative of her poignant story on YouTube.  Her evocative words drew a heart-felt response from US Vice President Joe Biden.  While the Internet facilitated millions to read her poignant reflections, the Internet will also never forget what Brock Turner did.  His life is in tatters.

A jury found Turner guilty on three felony counts.  He was eligible for 14 years in prisons, prosecutors asked for six years, probation recommended four to six months in county jail.  Turner was sentenced to six months in jail (less with good behavior).  Prison sentences are expected to strike an equitable balance between public safety, punishment, and rehabilitation.  However, by international standards, the US is a leader in both the use of prisons for punishment, and in the length of prison sentences.  Public opinion might be divided on where this sexual assault falls on the heinous scale, but overwhelming public opinion is that six months in jail was a miscarriage of justice. 

Judge Aaron Persky’s effort to spare Turner the “severe impact” of a long prison sentence may have been well intended but might have ultimately backfired.  It fueled an impeachment petition against the judge and probably aggravated public backlash against Turner.  If Turner can avoid rape or assault while incarcerated, any jail time might be the least impactful of the life-changing consequences of his offense.  He is now a convicted felon, subject to lifetime registration as a sex offender, he forfeited a prestigious education, his aspirations for being a world class competitive swimmer are shattered, and any glorious career ambitions are all but over.  Sometimes people can be held accountable for personal violations, outside of the criminal justice system, and without long prison terms.

Sexual assaults and binge drinking on college campuses are rampant.  Reported rapes on college campuses are a fraction of all sexual violations between students.  Some college students are falsely accused of rape, and in one high-profile case the entire Duke Lacrosse Team paid a high price for false allegations.  When so much is at stake for young women and men, we can’t afford to get this wrong.  It’s a bit ironic that college campuses, with their vast educational resources, have not been more effective at reducing the prevalence of sexual violations between students.

According to recent reports, Peter Jonsson and Carl Fredrik Arndt have yet to meet the woman who they rescued.  But She wrote that, “I sleep with two bicycles that I drew taped above my bed to remind myself there are heroes in this story.  That we are looking out for one another.”  Hopefully this compelling story will inspire other bystanders.  Perhaps we will make real progress when we truly understand that justice is neither served when victims remain shamefully silent, nor when offenders can never recover.  Neither victims nor offenders want to be forever remembered for the most regrettable times of their lives.
Jon Brandt, MSW, LICSW
When will our consciences grow so tender that we will act to prevent human misery rather than avenge it?”   Eleanor Roosevelt, February 16, 1946

Friday, June 10, 2016

The Lifelong Damage Labels Carry


Juvenile sex offender — the term abounds in courtrooms, headlines and even among professional treatment and welfare circles. In five syllables, kids go from curious 8-year-olds and teenagers hopped up on hormones to social deviants. It is misguided to define any human by a single action, but when we refer to children as sex offenders the consequences are particularly destructive.

In the United States, federal law mandates that minors adjudicated for sexual offenses be subjected, alongside adults, to “sex-offender” registration and notification requirements. Numerous studies over several decades now have definitely confirmed registration does not deter first time offenses or reduce recidivism — in any instance. Public health officials found in a study published last year that rather than improving public safety, this practice, “communicates constantly and in a variety of ways that [registered] youth are dangerous, feared, worthless and have no real future.”

After leaving my job as a juvenile public defender almost a decade ago, I spent years traveling the country to interview people who had gone on registries for things they did as kids, from playing doctor, streaking or Romeo and Juliet romances to committing serious sexual harm. I sat in their living rooms, with their parents and children of their own, as they described what it’s like to go through the world as “juvenile sex offenders.” They had been physically assaulted, fired from jobs, driven out of schools. One young man I met with would later tell a reporter that I was the first person who told him he wasn’t a sex offender. He’d been on the registry for almost half of his life at that point.

Intended or not, the term sex offender invokes a visceral response in the public. Meanwhile, just the word offender implies that the person intentionally caused harm and offended more than once. Many of these kids were themselves victims of abuse and didn’t even know at the time what they’d done was wrong. And empirical research shows the vast majority — more than 97 percent — have never and will never reoffend sexually.

Even using the term sex-offender treatment is harmful. By framing it as “sex-offender treatment,” we overlook that when it comes to kids their behavior has very little to do with sexual pathologies. Beside, we don’t dismiss people with other psychological symptoms, such as depression or anger, with a single noun; and we shouldn’t in this instance either. In a new study to be published later this year, public health officials surveyed more than 220 kids in treatment for sexually intrusive or abusive behavior. Compared to those who have never been subjected to registration, youth who currently or have previously had to register as a sex offender report significantly higher rates of considering and/or attempting suicide.

As the director of the Center on Youth Registration Reform, my work focuses on youth, my goal is to eliminate the practice of putting minors on registries; but to do that we have to challenge the public narrative around youth sexual behavior. That starts with being more deliberate in conversations on this issue and not using the term sex offender to describe children — under any circumstance. (I normally try to avoid the term sex offender altogether, but I’ve left it in this article so readers can see just how often it creeps in.)

Researcher Sharon Denniston’s recent doctoral dissertation measured the impact juvenile registration has on adult depression. She found that it’s not the legally imposed restrictions but rather the sex-offender label that often has the greatest psychological impact. Interestingly, those on non-public registries suffer from even higher depression rates than those on public registries, which suggests how deeply youth internalize being branded.

In the media, headlines teem: “New therapy proves effective for juvenile sex offenders,” “States Slowly Scale Back Juvenile Sex Offender Registries,” “Are We Properly Dealing with Young Sex Offenders?” What we should be asking is whether we’re properly educating youngsters about sexual boundaries, whether we’re giving child sex abuse survivors the resources they need to heal and whether we’re doing permanent damage because we’re too lazy to say a few extra prepositions. Childhood is about second chances. When we label kids we rob them of identity — and, even worse, hope. We make it is easy for society to demonize and treat them as other.

Moving forward, we must be more vigilant of the words we choose, always careful not to reduce a person to an action or a nuanced behavior to a simplified pathology. And the change must start with us — treatment providers, child welfare experts and juvenile justice professionals. As a body we must pressure the media to reconsider how it uses the term sex offender; if the public discourse can be redirected, eventually sentiments will begin to shift as well. And maybe then we will be able to see our children for what they really are: children.

Nicole Pittman, esq., Director of the Center for Youth Registration Reform at Impact Justice, has been working to remove kids from registries for more than a decade, through legislation, law and creating awareness. Also a juvenile attorney, she is a Stoneleigh and Rosenberg Leading Edge fellow.

Friday, May 27, 2016

The Role of ATSA Members to Bring Our Perspective into Bystanders Intervention Programs

Forty-five years ago, Americans were shocked by the rape and murder of Kitty Genovese.  According to the media at the time, Ms Genovese was attacked multiple times over 30 minutes while 38 men and women saw the assault and did nothing to help. The incident captured the country’s attention and launched a massive public inquiry into how caring people could watch an attack yet remain helplessly inactive.  Last week, her murderer, Winston Moseley died in prison at the age of 81.

After the Genovese case, social scientists Latane and Daley (1969) published their groundbreaking research about “bystander apathy.” They concluded that to take any significant action, a bystander must see what is going on, decide that the situation is serious, and then decide to get involved. The bystander must then choose an action and feel that they can perform it. For many bystanders these five steps present an overwhelming sequence of decisions and the result is doing nothing.

More recent research has shown that the story of people watching the rape and murder and doing nothing is just not true.  If the true story is told, then we can learn more about the factors that led some people to call out the window “Leave that girl alone” and at least temporarily stop the attack.  Or others who called the police, but when the screaming stopped, they had nothing to report.  As Americans, we seem to be fascinated with the story that no one did anything to help.  I can’t help but wonder if our willingness to intervene would be changed if we saw the examples of where someone did reach out to help.

Yet this feeling of helplessness is often echoed in the workshops I have led on this topic.  Someone almost always asks the question, “I saw a young woman being harassed on the bus/subway/street… what should I do?” or “I saw a parent yelling and hitting their child on the playground/supermarket/street… what should I do?”  In every case, I ask, what did you do?  And through that question, I often hear of the myriad of options that occurred – almost all of them meaning that some action was taken.  It might have been to talk with the store manager, or offer some help, or determine that the situation may become violent and call the police or other official in most cases people did take some action.  And if that is the case, then one needs to ask, what actions were effective?

Effectiveness of a bystander approach is currently being evaluated at the college, high school and middle school levels.  Well known programs with promising results include: Bringing in the Bystander, Green Dot, Coaching Boys into Men and many others.  When exploring bystander prevention models, and I encourage everyone to do so, I believe that sex offender treatment providers have invaluable insights and perspectives few people possess.  That perspective includes how to have a conversation with another adult, adolescent or child when there is some concern about their behavior.    While these conversations may be a part of daily treatment programs, how to bring up the topic, how to talk about behaviors without immediate accusations, how to follow-up on the conversations, etc. all are a simple part of a treatment providers work.  But to the general public, confronting behaviors, voicing concerns, holding someone accountable for their behaviors are ALL important skills that treatment providers can teach in their communities.

Joan Tabachnick, MBA



Resources:

Engaging Bystanders in Sexual Abuse Prevention by Joan Tabachnick:


Green Dot Program:  https://www.livethegreendot.com/

The Nationals Sexual Violence Resource Center (NSVRC) developed an excellent overview of programs:  http://www.nsvrc.org/bystander-intervention-campaigns-and-programs

Thursday, May 19, 2016

Q & A with Mark Olver on "Predictive accuracy of Violence Risk Scale-Sexual Offender version risk and change scores in treated Canadian Aboriginal and non-Aboriginal sexual offenders"

Olver, M. E., Sowden, J. N., Kingston, D. A., Nicholaichuk, T. P., Gordon, A., Beggs Christofferson, S. M., & Wong, S. C. P. (2016). Predictive accuracy of Violence Risk Scale-Sexual Offender version risk and change scores in treated Canadian Aboriginal and non-Aboriginal sexual offenders. Sexual Abuse: A Journal of Research and Treatment.

Abstract: The present study examined the predictive properties of Violence Risk Scale–Sexual Offender version (VRS-SO) risk and change scores among Aboriginal and non-Aboriginal sexual offenders in a combined sample of 1,063 Canadian federally incarcerated men. All men participated in sexual offender treatment programming through the Correctional Service of Canada (CSC) at sites across its five regions. The Static-99R was also examined for comparison purposes. In total, 393 of the men were identified as Aboriginal (i.e., First Nations, Métis, Circumpolar) while 670 were non-Aboriginal and primarily White. Aboriginal men scored significantly higher on the Static-99R and VRS-SO and had higher rates of sexual and violent recidivism; however, there were no significant differences between Aboriginal and non-Aboriginal groups on treatment change with both groups demonstrating close to a half-standard deviation of change pre and post treatment. VRS-SO risk and change scores significantly predicted sexual and violent recidivism over fixed 5- and 10-year follow-ups for both racial/ancestral groups. Cox regression survival analyses also demonstrated positive treatment changes to be significantly associated with reductions in sexual and violent recidivism among Aboriginal and non-Aboriginal men after controlling baseline risk. A series of follow-up Cox regression analyses demonstrated that risk and change score information accounted for much of the observed differences between Aboriginal and non-Aboriginal men in rates of sexual recidivism; however, marked group differences persisted in rates of general violent recidivism even after controlling for these covariates. The results support the predictive properties of VRS-SO risk and change scores with treated Canadian Aboriginal sexual offenders.

The full article is available via open access from:

Could you talk us through where the idea for the research came from?

The idea for the research came from a recent Canadian legal decision, Ewert v. Canada, that came out in September 2015. The plaintiff, a man of Métis descent, who had been in custody for more than 30 years on murder and attempted murder (both sexually motivated offenses) had sued the federal government with the contention that actuarial risk assessment tools, and other certain forensic measures, were biased against individuals of Aboriginal ancestry and that he had been caused harm through their use in his case. The tools identified were the Violence Risk Scale-Sexual Offender version (VRS-SO), Static-99, Violence Risk Appraisal Guide, Sex Offender Risk Appraisal Guide, and the Psychopathy Checklist-Revised. In his decision, Justice Phelan ruled that the evidence accumulated thus far had not been sufficient to justify their applications to offenders of Aboriginal descent and strongly cautioned the Correctional Service of Canada (CSC) against using these and related tools with this population until further research supporting their psychometric properties with Aboriginal persons had been conducted. Given the overrepresentation of Aboriginal persons in Canadian corrections, for some time we wished to do such research examining the psychometric properties of the VRS-SO with this population but we didn’t have the sample size to do so. Justice Phelan’s decision was an important call for research and by the time the decision was released we had accumulated sufficient numbers across three CSC-based studies of treated sex offenders to do the work. The decision thus provided an extremely powerful impetus for our group to examine the predictive properties of VRS-SO risk and change scores with Aboriginal offenders.

What kinds of challenges did you face throughout the process?

The decision had issued a challenge to the federal government specifically and to researchers outside the service more generally who may have capacity to explore these questions; but a follow-up decision had yet to be made about whether there may be a formal prohibition issued concerning the use of these tools with Aboriginal offenders in federal corrections. One key issue was time, as my co-authors and I were hoping that the results may assist future decisions on this matter, but it was uncertain when that would be or what the results would be. So I made a mad dash to obtain IRB approval to link the data sets and to conduct these Aboriginal analyses, to do the actual work involved, and then ultimately to get the word out as quickly as possible when we had a good understanding about the findings. As it turns out, a remedy hearing was held the last week of April 2016 to speak to the issues and concerns raised by the judge and to examine future research directions on these tools with Aboriginal offenders. I had the privilege of appearing as an expert witness to give testimony on post-trial research and use of these tools with Aboriginal offenders. The manuscript had been accepted for publication in SAJRT just the week prior to me appearing in court.

What kinds of things did you learn about co-authorship as a result of producing this article?

I have a great team of colleagues who have contributed data, resources, and ideas to support the validation of the VRS-SO. The authorship list, which features a diverse group of VRS-SO contributors is as much a statement of support for the findings generated and the use of the tool to assess risk, identify treatment needs, and track change with adult male Aboriginal sex offenders. 

What do you believe to be to be the main things that you have learnt about Aboriginal sex offenders and/or Risk Assessment?

The results are consistent with past research showing that structured risk assessment tools can predict recidivism outcomes with Aboriginal offenders; in essence the tools do work with Aboriginal offenders. That the predictive accuracy magnitudes were consistently slightly lower for Aboriginal offenders is also consistent with available research. The higher recidivism base rates we see with Aboriginal offenders, however, do not align neatly with the higher risk scores they also receive; base rates can be impacted by other unmeasured variables and identifying these variables is an extremely important area of ongoing research. Perhaps the most encouraging finding for us was to see that the men across ancestral groups made broadly the same amounts of change from sex offender treatment, and these changes showed similar magnitudes in predicting decreased sexual and violent recidivism. The results highlighted to us that a structured dynamic tool, such as the VRS-SO, that can track and measure change can actually be used to help these men in their commitments and efforts to lower their sexual reoffending risk in preparation for reintegration back into the community.

Now that you’ve published the article, what are some implications for practitioners?

The results support the appropriate use of the VRS-SO and the Static-99R with men of Aboriginal ancestry to assess risk, inform treatment programming, and to evaluate changes in risk. Any assessment also needs to take into consideration unique cultural, situational, personal, and historical background factors to contextualize conclusions and risk management recommendations.

Mark Olver, PhD

Friday, May 13, 2016

Complexity and vulnerability in sexual harm more than a ‘zero sum game’

Over the last few weeks I have attended a number of conferences and training sessions related to sexual harm, both national and international, with two things striking me time and time again, complexity and vulnerability. The field of sexual harm is a challenging one filled with a range of complex individuals, complex situations, difficult narratives and vulnerable groups [both perpetrators, victims and at risk populations] which really reinforces the need for reflection, discussion and engagement across the field and society as a whole.

Sexual harm is a complex topic that society does not always want to fully engage with and often downplays its significance on a personal level, we see widespread/meta societal discussions going on around it, policy debates and punitive/rehabilitation arguments. However, when we get to a personal level there is a degree of denial mixed with over reaction, from “not in my backyard” to not discussing healthy sexual relationships at home or in school. To me it is often reminiscent of cancer conversations where people will acknowledge that cancer is real and out there, that they may be at risk but that it will never happen to them; acknowledgement without acceptance. Often when we, individually or socially, discuss sexual harm it is often in a reductionist fashion that only emphasises a one dimensional perspective on perpetrators (from the mad vs evil debate to the “monster label”] and victims/survivors [from rape myths to the vulnerable/incapable victim discussion]; which does neither of them any good. This complexity comes to therefore when we talk about victims/survivors and perpetrators in more depth because they are multi-faceted and not singular.

You can have a perpetrator of sexual harm who has neither a family history of abuse nor significant adverse life experiences, but you can also have a perpetrator who has been a victim of sexual abuse or abuse and neglect more generally. You can have a person who downloads Child Sexual Abuse Imagery who is on the path to committing a contact offence, whereas another Child Sexual Abuse Imagery downloader may not be. You have a range of mental illnesses, anti-social behaviours, learning difficulties and trauma being played out across the perpetrator population as predicating factors; whereas with others it might be a combination of problems with circumstance and decision making. The most challenging thing for most is that the perpetrator, like all of us, can wear different hats, being seen as positive/kind/respectable in one light and abusive/manipulative in another; the complexity of trying to untangle and rationalise these roles poses problems for victims/survivors, friends, family and society. When it comes to perpetrators it is sometimes more comfortable to label them as a “monster”, “mad” or “evil” as opposed to thinking that “here is a person who is a good employee, a talented performer but is anti-social and engages in problematic and abusive behaviours”; however, that is what the Good Lives Model teaches us to do in treatment but it’s not always getting translated into the real world afterwards. It is challenging to see people who commit sexual harm in multi-faceted ways, but they are multi-faceted people and these needs to be recognised for treatment and reintegration to be successful.

In respect to victims/survivors the same logic applies that all victims are in some way vulnerable, unable to overcome what is happened to them and surrounded by rape/sexual harm myths that in some way blames them for what happened to them. That the one discourse in their life that completely frames them is the sexual harm one and its fallout. This is not the reality across the board. Different victims/survivors react to sexual harm in different ways; different victims/survivors disclose at different times, in different ways and for different reasons; victims/survivor’s engage [or not] in treatment in different ways, with some wanting justice and punishment for the perpetrator, whereas others want closure for themselves and an understanding of why this happened to them. The most challenging thing for most is that the victim/survivor is getting past the narrative of “once an victim, always a victim” and that this discourse defines them. The complexity of being a victim/survivor ties in with the realisation that you can be positive, strong, adaptive and whole again; that you may have experienced sexual harm, but that you have accepted it; and that you can move on and embrace other parts of your life. When it comes to victims/survivors it is sometimes more comfortable to label them as a “traumatised” or “broken” as opposed to thinking that “here is a person who has experienced sexual abuse/harm but has moved on got a qualification, become a good parent, developed a positive social relationships is”; however, that is what the counselling, treatment and support teaches them but it is not often translated into the real world afterwards with many not disclosing their experiences, or only disclosing them, for the reaction that they know they will get.

This complexity among perpetrators and victims/survivors needs to be recognised and the one dimensional view of challenged. This is starting to change with different media outlets changing the way that they approach the reporting of sexual harm cases, professionals becoming more involved in the dialogue and us, as a society and individuals, being more open to discussing the realities of sexual harm [especially in terms of identification, prevention, intervention, rehabilitation and reintegration]. The most important thing to remember, and emphasise, is that sexual harm is not a ‘zero-sum game’ where players are simply defined by their experiences and roles and that these factors are not the sole determinates of their future life or progress.

Kieran McCartan PhD

Friday, May 6, 2016

What’s on in Milan: The successes and challenges of a program in Italy


Please note: For those of you who would like to read this in Italian we have the translation below.  Kieran. 


In 2002, Jos Frenken (apparently now retired) gave a presentation to the International Association for the Treatment of Sexual Offenders (IATSO) in Vienna. His mission was to find out what kinds of treatment options were available to people who sexually abused in various corners of the world. During the presentation, he put up a map of Europe showing how few options in Europe there actually were. While this situation has improved considerably during the past 14 years, often there is still too little communication between programs in different countries.

Across the past decade or so, two professionals in Italy, Carla Xella and Paolo Giulini, Centro Italiano per la Promozione della Mediazione, along with their colleagues, have been actively involved in bringing high-quality treatment efforts to Italy. They have authored a book as well as white papers and book chapters, have traveled the world, and overcome remarkable financial challenges in a country that has recognized their pioneering efforts. I had the opportunity to visit them, work with their staff, and meet with many of their clients in April as they intensify their efforts with the Good Lives model.

In some ways, building treatment programs in the prisons around Milan and Rome has presented Xella and Giulini with challenges that will be familiar to many professionals elsewhere. Examples include siting a program safely within a single unit in a larger prison so that the program can develop its own culture and provide safety to inmates who have committed sex crimes. This has been an ongoing challenge in both Rome and Milan. Likewise, while the program in Milan is able to provide individual cells for inmates to live in, the program in Rome houses an average of six inmates per cell. This is very far from ideal, but still better than having no rehabilitation program at all.

Other logistical concerns include the fact that there are only these two programs; many inmates must make difficult decisions about transferring to a prison that may be much farther away from the families with whom they strive to maintain contact. Once they are there, program completion is not guaranteed. Further, every prisoner there can find strong disincentives not to participate in treatment. Many facilities offer employment and educational activities that create scheduling conflicts with treatment sessions, and no centralized scheduling system exists to resolve this issue.

Perhaps most remarkable are the challenges around funding. Xella, Guilini, and their teams have managed to negotiate with complex funding streams and often rely on client self-pay. The staff and clients who take personal risks to attend the programs routinely experience uncertainty as to whether their program will be funded four months down the road.

The structure of the programs will not be surprising. There is an assessment period followed by an introduction to treatment and disclosure of past offending, then a focus on managing risk factors in the here and now. Each program uses art and/or movement therapy, with a strong emphasis on meditation and yoga. The clients have created excellent art, which recently received its own display in a gallery in Milan. As is often the case, much of the clients’ artwork shows remarkable capability and in some cases tragic self-expression. In an era when many professionals interpret the principles of risk, need, and responsivity as being exclusive of adjunctive therapies, the Milan clients’ creations clearly show how therapeutic aspects of treatment participation can be enhanced by these experiences. It seems that this use of adjunctive treatment is at the center of the responsivity principle.

As one might infer from their actions, the clients themselves believe the treatment they receive is important to their continued success. This is not surprising to this author, who assisted in an environmental scan in the republic of Namibia, where inmates who had committed sexual crimes were very clear that they would like to have the opportunity to participate in treatment in order to prevent future crimes. Likewise, Jill Levenson and I found that clients in outpatient treatment and civil commitment programs alike felt that treatment is important.

Meanwhile, the clients themselves were clear that they like working with the Good Lives Model and that their primary wish would be for more individual as well as group therapy. Their greatest concern is the difficulty involved as they reintegrate into a society that largely does not want them back and offers little or no help in managing the transition back into the community. To that end, it was clear that these men wish for more contact with their families. Unfortunately, many of these clients were immigrants to Italy and had left their families far away.

Importantly, the staff of these programs were clear on their mission and the best ways to accomplish it. They value both the work and the clients themselves. Every staff member wants the very best for both their clients and the communities to which their clients will return. 

In the end, the heroes of the story are the professionals working incredibly hard behind the scenes, with no glory and little recognition, except from Xella and Giulini. The moral for all of us comes back to the simple question that each society has to ask itself: Do we want these people to re-offend or not? If the answer is no, isn’t it time to provide support so that these and other programs can continue to exist? With all of the research pointing to the contribution of treatment programs to public safety, it seems unconscionable that there are still so many areas of the world where establishing a credible treatment program should be so difficult. The message from these inmates, and those in other parts of the world, is clear: far more often than not, they want to prevent further sexual violence and need help to do so.

David S. Prescott, LICSW

Accade a Milano: successi e sfide di un programma in Italia


Nel 2002, Jos Franken (oggi in pensione) fece una presentazione all’ International Association for the Treatment of Sexual Offenders (IATSO) a Vienna. Il suo obiettivo era quello di scoprire quali fossero, nei vari angoli del mondo, i trattamenti disponibili per persone che avevano commesso reati sessuali . Durante la presentazione, Franken esibì una carta dell’Europa. che mostrava quanto scarse fossero in realtà le opzioni in quella regione. La situazione è certamente molto migliorata negli ultimi 14 anni, ma spesso sono ancora troppo limitate le comunicazioni tra i programmi di differenti Paesi.

Da circa dieci anni a questa parte, due professionisti italiani, Carla Xella e Paolo Giulini, insieme ai loro colleghi del CIPM (Centro Italiano per la Promozione della Mediazione) si sono attivamente adoperati per portare in Italia trattamenti di alta qualità. Hanno scritto un libro, libri bianchi, capitoli di libri e articoli vari, hanno viaggiato per il mondo e hanno affrontato molte difficoltà finanziarie in un Paese che ha riconosciuto il loro sforzi pioneristici. In aprile di quest’anno, ho avuto l’opportunità di andarli a trovare, di lavorare  con il loro gruppo e di incontrare molti loro utenti, poiché stanno intensificando i loro tentativi di applicare il Good Lives Model.

Per certi versi, il fatto di strutturare programmi trattamentali nelle prigioni di Milano e Roma ha messo Xella e Giulini e i loro gruppi di lavoro davanti a sfide che molti professionisti di altre nazioni troveranno familiari. Ad esempio, organizzare il programma in modo sicuro e protetto all’interno di un singolo reparto di un carcere molto più grande, in modo che il programma stabilisca una propria cultura e dia contenimento ai detenuti che hanno commesso reati sessuali. Questo punto è una sfida continua a Roma e a Milano. Anche perché, mentre il programma di Milano può offrire ai detenuti celle singole in cui vivere, quello di Roma ospita una media di sei detenuti per cella: una situazione molto lontana da ciò che sarebbe ideale, ma meglio comunque di non avere alcun programma di trattamento!

Altri problemi logistici possono essere, ad esempio, il fatto che in Italia ci sono solo questi due programmi trattamentali, e quindi molti detenuti devono prendere la difficile decisione di trasferirsi in un carcere molto lontano dalle loro famiglie, con le quali si sforzano invece di restare in contatto. Una volta là, non è detto che terminino il programma. Inoltre, molti detenuti possono essere fortemente disincentivati a partecipare al trattamento, in quanto il carcere offre occasioni di lavoro e di formazione in orari che entrano in conflitto con quelli dei gruppi trattamentali, e non esiste un’agenda centralizzata per risolvere il problema.

Forse però le sfide più importanti sono quelle legate al reperimento di fondi. Xella, Giulini e i loro gruppi sono riusciti a negoziare con complicate fonti di finanziamento e a volte ricorrono all’autofinanziamento da parte dei pazienti. Gli operatori e gli utenti che si assumono il rischio personale di aderire ai programmi sono costantemente alle prese con il fatto di non sapere mai se i fondi ci saranno o no per i mesi successivi.

La struttura del programma non sarà una sorpresa: c’è un periodo di valutazione, seguito da una introduzione al trattamento e dal racconto del reato commesso, poi il focus si sposta sulla gestione dei fattori di rischio nel qui-e-ora. Ciascuno dei programmi usa l’arteterapia o la musicoterapia,o le terapie motorie, con un forte accento sul movimento, meditazione e lo yoga. Gli utenti hanno creato eccellenti opere, che sono state esposte recentemente in una mostra a Milano. Come spesso succede, il lavoro artistico dei clienti porta alla luce notevoli capacità, e in alcuni casi una tragica espressione di sé. In un periodo in cui molti professionisti interpretano i principi di Rischio-Bisogni-Responsività (RNR, Risk-Need-Responsivity ) come esclusivi di terapie aggiuntive, le creazioni degli utenti milanesi mostrano chiaramente come gli aspetti terapeutici della partecipazione al trattamento possano essere potenziati da queste esperienze. L’uso di trattamenti aggiuntivi è al centro del principio di responsività.

Stando a quanto si può dedurre dalle loro azioni gli stessi utenti pensano che il trattamento che ricevono sia importante per continuare a migliorare. Questo non stupisce chi scrive, che in Namibia ha assistito a un’indagine ambientale durante la quale i detenuti che avevano commesso reati sessuali erano stati molto chiari rispetto al fatto che avrebbero gradito l’opportunità di accedere a un trattamento per prevenire futuri reati. Ugualmente, Jill Levenson e io abbiamo trovato che anche gli utenti dei trattamenti sul territorio e dei programmi di servizio sociale pensavano che il trattamento fosse importante.

Nello stesso tempo, gli utenti stessi hanno detto chiaramente che gradivano lavorare con il Good Lives Model e che il loro maggior desiderio era quello di avere più colloqui individuali oltre alla terapia di gruppo. La loro maggior preoccupazione è la difficoltà di reintegrarsi in una società che in gran parte non li vuole avere indietro e che offre loro ben poco aiuto per gestire il ritorno nella loro comunità. A tal fine, era chiaro che questi uomini desideravano avere un maggior contatto con la propria famiglia. Purtroppo, molti di loro sono immigrati in Italia e hanno lasciato le loro famiglie molto lontano di là.

Cosa molto importante, gli operatori del CIPM hanno chiaro qual è il loro obiettivo e quali sono i modi migliori per raggiungerlo.  Essi valorizzano molto il loro lavoro e i loro utenti. Ogni membro del gruppo vuole davvero il meglio sia per gli utenti che per le comunità in cui questi utenti ritorneranno.


Per finire, gli eroi di questa storia sono i professionisti che lavorano in modo incredibilmente duro dietro le scene, senza nessuna gloria e con poco riconoscimento, se si escludono Xella e Giulini. La morale per tutti noi sta in questa semplice domanda, che ogni società dovrebbe porsi: vogliamo che queste persone tornino a commettere reati oppure no? Con tutte le ricerche che confermano il contributo dei programmi trattamentali alla sicurezza della società, appare addirittura immorale che vi siano ancora così tante aree del globo dove strutturare un programma trattamentale credibile debba essere così difficile. Il messaggio che viene da questi detenuti, e da quelli che si trovano in altre parti del mondo, è chiaro: molto più spesso di quanto si crede, essi vogliono evitare di commettere nuovi reati sessuali e hanno bisogno di aiuto per riuscirci.