Tuesday, January 31, 2017

Holland and Belgium Are Getting It Right: The 2017 ATSA-NL conference

This week we attended and spoke at the ATSA-NL conference in Utrecht in the Netherlands with Bill Lindsey and a range of Dutch as well as Belgian practitioners.  It was a great opportunity to see and hear about some of the work, research, policy and practice which is going on across the Netherlands and Belgium. The theme of the conference was on the responsivity principle and the current state of public policy and awareness. Kieran spoke on public policy and communication; David spoke about building responsivity and therapeutic engagement.

The conference is vitally important on a number of levels, as it reminds that our field is a truly international one in which the main policy, practice and research issues, as well as our successes and challenges are transferable to other locations. The conference explored the issue of responsivity in the field of sexual abuse deeply. It discussed the role of responsivity in treatment outcome, in the client/practitioner relationship and in how we reintegrate the offender back into the community. The issues raised could have been applied to any sex offender conference, particularly, any ATSA related conference international, including how we get clients to engage, practitioners to be responsivity, policy makers to be realistic and society to support us in our work.

Perhaps most importantly, the professionals of Belgium and the Netherlands demonstrate true grit in making high-quality assessment and treatment happen. Outside the region, these countries have an excellent reputation in research and practice. Once there, we quickly realized how much hard work goes into making excellent services happen.

The conference was held at the Van der Hoeven Kliniek in Utrecht. Many world-famous practitioners have worked there, from ATSA’s own Wineke Smid to Corrine de Ruiter, Vivienne de Vogel, and others too numerous to mention. One of the highlights of the day was having a tour of the facility, meeting the staff, the patients and seeing the work that they do there. To this end, we have to acknowledge the psychiatrist, Jelle Toelstra, who described the incredibly hard work, over many years, that it takes to build a world-class facility and let us interview a number of patients without limitation. The Netherlands and Belgium may have an excellent reputation in our field, but they came by it honestly and in an environment where things can always change.

The Van der Hoeven Kliniek is a therapeutic community and seeing some of the approaches that they use [especially “rock and water”, which we will have an upcoming blog about], the facilities that they have, the training/work based practice that they can offer and the way that they engage with the families of their patients are an important model to follow. The approaches they use, the latitude that they have in their therapy and the trust that is placed in them by the state is impressive. They are an example of good practice that needs to be recognised and shared.

The ATSA-NL conference reinforced the importance of sharing good practice, international collaboration and recognising that sexual harm is a global problem that has local, national and international responses. ATSA-NL grew out of earlier conference/organization work and are bringing practitioners together in a time when budgets are tight and time away from the office is more difficult than ever. The real question is what we (who live elsewhere) need to do to live up to their example.

Kieran McCartan, Ph.D., & David Prescott, LICSW

Wednesday, January 18, 2017

What Matters is What’s Missing: The Non-Persistence of Memory

Experts have often commented on the fallibility of memory, from Daniel Schachter’s classic book, The Seven Sins of Memory to Elizabeth Loftus’ TED Talk on the subject. Most of us are aware, at least intellectually, that memory can be flawed. Unfortunately, the discussion seems to end at the point where the fascination fades. Loftus’ showing us that we can’t identify which of the coins that are similar in appearance is the real penny, the convincing memory of your father driving on the right side of the road while vacationing in the UK when you were six — these are easy for us to get our minds around.

A recent internet cascade brought the problems of memory into a different perspective. This time, Reddit readers got into an extended discussion of a 1990s movie called Shazaam in which the celebrity Sinbad had played a genie. The New Statesman produced the story, which was then picked up by other media outlets. The opening of the article is where the implications for the field of assessing and treating sexual violence begin:

In the early Nineties, roughly around 1994, a now 52-year-old man named Don ordered two copies of a brand new video for the rental store his uncle owned and he helped to run. “I had to handle the two copies we owned dozens of times over the years,” says Don (who wishes to give his first name only). “And I had to watch it multiple times to look for reported damages to the tape, rewind it and check it in, rent it out, and put the boxes out on display for rental.”

Don is describing the movie that doesn’t actually exist. What is amazing is not the falsity of the memories, but the extent to which to which people cling to them:
“It feels like a part of my childhood has now been stolen from me. How does a movie simply vanish from our history?” This isn’t Don speaking, but another man – who he has never met – named Carl*. Carl, whose name has been changed because he wishes to remain anonymous, recalls watching a movie called Shazaam with his sister in the early Nineties, and has fond memories of discussing it with her over the last 20 years. 

The discussion of this movie apparently began in 2009 on the Reddit web site and escalated to the point where Sinbad had to comment repeatedly that he had not starred in the movie and had never even played a genie. Still, readers cling to the belief that he did, with confidence and vigor. This is where professionals in our field should sit up and take notice.

People providing treatment to those who have abused frequently accept nothing less than a complete accounting of a person’s sexual history. In many cases, this extends into accepting only those accounts that match the story of the person they abused. I personally watched as entire teams of clinicians insisted that a client in treatment should not move forward in treatment because his version had not matched the “findings of fact” issued by the court that had convicted him. The concern was not that he was minimizing his behavior and therefore was participating in treatment only superficially; it was that the minutiae of his story did not match those of the person he acknowledged he abused, as filtered through legal documents.

Holding someone back in treatment for the above reason is worrisome given what we know about memory; it simply doesn’t comport with the research. Also concerning is the confidence with which we professionals can assume that a client is actively lying or purposefully downplaying his or her actions. It is worth asking whether it isn’t more important to us to be confident in our certainty than it is to accept the limitations of our knowledge. In other words, no one wants to appear ambivalent or wishy-washy about their conclusions and opinions. Ironically, second-rate reports overflow with confidence, while first-rate forensic reports are written with confidence and openly acknowledge their limitations.

It is worth noting that many professionals in the US (and some other jurisdictions) also rely on the polygraph to verify their clients’ accounts, despite the scientific problems associated with it. Although polygraph advocates rightly point out its ability to elicit more information from clients, we still lack research to conclude that this information is always as accurate or useful as we would like. The fact that there is still no evidence to support the idea that polygraph examinations reduce subsequent abuse is beyond the scope of this blog post.

My point in raising these issues is not to discount the polygraph or the processes it entails. Rather, it seems important to note the many ways in which “the truth” can get lost along the way. People who are abused don’t necessarily remember every detail correctly (we’ll come back to this). People who abuse don’t necessarily recall every detail correctly. People who have been traumatized frequently have problems with memory; it’s a diagnostic criterion for the diagnosis of Post-Traumatic Stress Disorder. People writing the accounts of those who abuse and those who have been abused are not without memory fallibility either, and neither are the people who review those reports, often recycled over the course of years through evaluations and re-evaluations.

On the other hand, the accounts of traumatized people aren’t necessarily wrong either.  Memories of abuse can be vivid and profound. There may be no greater insult to a person who has been traumatized than to distrust their memories. In his recent book, The Body Keeps the Score, trauma researcher and clinician Bessel van der Kolk discusses these facts at length. Professionals who doubt the memories of abuse survivors do their clients no service. After all, many aspects of the memories indeed may be perfectly accurate, or their memory might become fragmented, with some parts dissipating while others linger on, sometimes causing decades of distress the person who lived them.

Adding further insult to injury, Shane O’Mara recently published a review of the many ways that memory fails under high-stress circumstances in his book, Why Torture Doesn’t Work: The Neuroscience of Interrogation. While this may seem out of place, O’Mara draws on findings from diverse areas, including the effects of stress, sleep deprivation, anxiety, and other experiences that are common among clients in and around the criminal-justice system. Taken together, all of these points should raise concern among professionals.

As a final point, it is worth noting that my colleagues, Jill Levenson, Gwenda Willis, and I found that males and females who have sexually abused often have a higher rate of adverse childhood experiences in their histories, raising further questions about the effects of their lives on their memories.

It may be time to acknowledge once and for all that, while we are quite certain that abuse poses an unacceptable risk of harm to those who experience it, the research shows how much noise there is in our systems as we try to retrieve and understand the details. What’s missing (i.e. understanding the fluidity of memory) from our understanding of clients matters, and sometimes the most confident answer is that we don’t know the complete picture.

David Prescott, LISCW

Friday, January 13, 2017

Q & A with Sandy Jung on “Sexual Violence Risk Prediction in a Police Context”

Jung, S. (2016). Sexual Violence Risk Prediction in a Police Context. Sexual Abuse: A Journal of Research and Treatment. Available from: http://journals.sagepub.com/doi/full/10.1177/1079063216681563

Adoption of evidence-based approaches by police services offers a practical and scientific solution to ensure public safety and proper allocation of resources. Advances in the field of sexual violence risk prediction have the potential to inform policing practices. The present study examines the validity of existing actuarial measures to predict the future sexual violence behavior of 290 identified male perpetrators of sexual assault against adult victims (ages 16 and older). The Static-99R and Static-2002R were coded from police documentation, and the sample was followed up for at least 1 year with an average of 3.6 years. Both measures showed large effects for predicting any offending, violent offending, and sexual offending in the form of charges and convictions. The findings suggest that existing sex offender research can extend to police practice, and criminogenic factors used to predict recidivism among convicted offenders may apply to assessing the risk posed by perpetrators of police-reported sexual assaults.

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

A few years ago, I was fortunate to be asked by the Edmonton Police Service to examine their homicide cases. In working with them, I was able to establish a mutually respectful and trusting working relationship with them. A year later, given the increased calls they received regarding intimate partner violence and sexual assault over the years, they contacted me again to carry out more research. Although their interest was focused more on examining the profile of reported cases, I was very much interested in examining the application of risk assessment in the police context, as I was already collaborating with a provincial law enforcement agency. When I pitched this idea, they became quite interested as well, and I was given the opportunity to access their police database to carry out the research.

What kinds of challenges did you face throughout the process?

I’m more familiar with correctional and outpatient forensic settings, so one of the things I found challenging was learning about the policies and politics in the police context—in essence, I had to immerse in the police culture at the service. I was lucky as I was eligible for a sabbatical leave and applied for one with the goal of conducting research at the Edmonton Police Service. The learning curve was huge and it was critical for me to understand how the police organization worked in order for me to truly do meaningful and impactful research.

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

It was an interesting experience for me, as I collaborate a lot with other researchers who are often friends or become good friends, or else I work very closely with my students. I greatly enjoy the collaborative process, and I also find that collaborating provides a nice safety net because I can bounce things off my collaborators or my students to ensure I’m doing the right thing or I haven’t missed something. But this particular research started as a solo project during my sabbatical leave. I was able to dedicate a lot of time to it, but I was mostly on my own in developing the coding strategy I would end up using to collect and code the data.

The fortunate thing was that the research was focused in an area that I was already familiar with. Given my research on threat and risk assessment in policing (I currently collaborate with Drs. Ennis, Hilton, and Nunes), this was an easy application to the sexual violence risk field, with which I was more familiar.

What do you believe to be to be the main things that you have learnt about Sexual Violence Risk Prediction in a Policing?

Prioritizing police-reported cases of sexual violence is necessary given the finite resources available to police. Taking from the RNR principles used in correctional psychology, it makes sense to use evidence-based practices, such as validated risk assessment tools, to prioritize resources to sexual assault cases where there is an identifiable perpetrator. The risk principles highlights that we should be aware of who should receive the most resources and such tools can be invaluable to police in their service-intensive work to reduce further sexual victimization. This research supports the use of these tools at the front line where early intervention responses can prevent further assaults committed by the same perpetrator.

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

In this case, practitioners are law enforcement. Borrowing from intimate partner violence research, we know that police are capable of reliably using actuarial measures of risk in their work. So the implications from this research suggests that police officers can use evidenced-based practices, that are extracted from sexual violence research conducted in correctional and forensic settings, in their work to both efficiently use their resources and make defensible daily decisions with the goal of preventing further sexual assaults.

Sandy Jung, PhD, RPsych

Friday, January 6, 2017

Reflecting back on 2016 & moving forward into 2017

Welcome to the first blog of 2017 where we are going to reflect upon our favourite articles from 2016, and consider the impact that they may have, on us personal or the sexual harm field, in moving forward into 2017.
Kieran McCartan, PhD
At ATSA 2013 I saw Nicole Pittman talk, she was discussing her report “Raised on the Registry” which highlighted the impact of disclosing juvenile sex offender information in the USA. Nicole’s report struck me as it highlighted a very punitive practice with massive societal community and individual impacts; particularly as we do not publically disclosure the information of sex offenders, especially that of youths,  in the UK in the same way as the USA. I thought that the recently published article by Harris, Walfield, Shields and Latourneau entitled “Collateral Consequences of Juvenile Sex Offender Registration and Notification: Results from a survey of treatment providers” (Sexual Abuse: A Journal of Research and Treatment, 28, 770-790) was a good counterpoint to Nicole’s report. The article by Harris et al highlighted, again, the negative impact that community notification of juvenile sex offender information has on the person in question as well as their community but this time from treatment providers. The insight that that treatment providers brings to this argument is important as it can help shape policy and practice in this arena, with policy makers hopefully being more inclined to listen and support change. The Harris et al paper also reinforces the importance, as well as negative consequences, of language, social policy, risk management and politics in how we deal with sexual harm (“sex offender”, “Juvenile sex offender” etc), which was also highlighted in other 2016 SAJRT papers ( Zgoba et al; Harris& Socia; Hoing, Bogaerts & Vogelvang). The Harris et al paper refocused me for 2017, it remaindered be that there is still a distance to be travelled in getting realistic sexual harm policy and practice across the board for high profile  offenders (i.e., middle aged, white child sexual abusers), never mind  what may be considered  by sections of society as “fringe” offenders (i.e., juveniles, females, learning  disabled).
David Prescott, LISCW
For this year, I am going well outside the usual scope of our “best of” series. It may seem off topic, but I think this study by Goldberg, Miller, Nielsen, Rousmaniere, Whipple & Hoyt called Do Psychotherapists Improve with Time and Experience?”  (Journal of Counseling Psychology, 63,1-11) is very important to know about. Here’s why:
Goldberg and his colleagues studied whether therapist experience is linked to improved outcomes for clients in general psychotherapy (i.e. not abuse-related). They followed 6,591 patients seen in individual psychotherapy by 170 therapists over nearly five years. To date, no large-scale longitudinal study has assessed whether the amount of professional experience of the therapist would improve outcomes over time.
The study found that psychotherapy was effective overall. Unfortunately, therapists did not improve with experience. In fact, therapists became slightly less effective over time (although the authors note that the level of this decrease was extremely small). The authors also note that these results contrast with clinician self-reported experiences with clients. In short, therapists believe they become more effective over time; these results suggest otherwise.
Clearly, effective treatment of people who sexually abuse is a matter of public safety as well as a means to help individual clients manage their lives. This study should serve as a warning that practitioners can easily be lulled into a sense of complacency about their effectiveness; confidence can improve across one’s career, competence may not. In our work, we should always remember that getting better at avoiding mistakes is not the same as becoming more effective at developing the clinical skills that lead to successful treatment completion for our clients.
Jon Brandt, LISCW
This year, my pick for the most noteworthy journal article of 2016 is an easy one: “Quantifying the Decline in Juvenile Sexual Recidivism Rates,” (Psychology, Public Policy, and Law; July 18, 2016).  Michael Caldwell (University of Wisconsin, Madison) reviewed 106 international recidivism studies involving more than 33,000 juveniles who have sexually offended, and determined the mean five-year sexual recidivism rate for offenses committed over the last 30 years is less than 5%.  Looking at the most recent 33 studies, since 2000, Caldwell determined a mean sexual recidivism rate of 2.75%, and, “This suggests that the most current sexual recidivism rate is likely to be below 3%.”  Another important finding was that follow-up periods beyond 36 months did not significantly increase recidivism rates.  The implications of this study are significant and are the subject of a SAJRT blog 8/12/16.
Current policies and practices driving the assessment, treatment, and management of juveniles with sexual offenses are still predicated on beliefs that they are likely to sexually reoffend.  If, as a group, 97% of juveniles don’t sexually reoffend, what’s the takeaway from this research?
Caldwell’s research also indicates that general delinquency IS positively correlated to sexual reoffending, and even with sexual recidivism below 3%, the Risk-Needs-Responsivity model is still useful in determining NEEDS and RESPONSIVITY.  It is likely, that a small percentage of juvenile offenders have high needs, however, perhaps the seven out of ten juveniles who do not have concurring general delinquency, might benefit from some psycho-sexual education, and otherwise deserve a speedy exit from the juvenile court system.  For the majority of juveniles with sex offenses, intensive treatment, long periods of supervision, and onerous conditions of probation, are essentially unwarranted, and may even set them up to fail, e.g. sex offender registration and notification laws are not only unfounded, they are profoundly counterproductive.  Public perceptions and engrained practices die hard, but hopefully, professionals throughout the juvenile justice system will use this conclusive research to guide sound dispositions.