Thursday, September 13, 2018

Good Things Happening in Poland and Italy

By David S. Prescott, LICSW

I had the honor of spending several days training in Wroclaw, Poland, last week. Two days went into a Master Class series training trainers and supervisors in their various areas related to Motivational Interviewing (MI), two days at a conference on MI and trauma, and three other days providing consultation on the use of the Good Lives Model (GLM) and MI for private organizations interested in implementing these approaches in Poland and Italy.

The real heroes of the story are people who work days, nights, and weekends to ensure the best possible services in the areas of trauma and addictions in their various countries. Iga Jaraczewska is a clinician who has worked diligently for over ten years to bring MI into Poland to replace older status-quo approaches to addictions. This has brought an increase in understanding how clinicians and other professionals can best respond to trauma. Iga has organized trainings all over Poland, as well as international conferences in Krakow, Warsaw, Torun, and other locations to bring in outside voices. These often involve a progression of introductory and advanced trainings with consult and supervision. Similar efforts are rising in Estonia, with the work of Inga Karton. Following along the same basic path as Iga Jaraczewska in Warsaw, is Domink Meinhart, located in the area surrounding Wroclaw. He has worked to ensure training, master classes, and supervision circles to put these methods into place with fidelity.

Their efforts are remarkable. Around the world, an ongoing phenomenon shows people like these working incredibly hard, often with little reward, to ensure that treatment services to marginalized people are as effective as can be. Among other areas of focus, Iga and Dominik have each taken a great interest in how MI and the GLM can be used to treat people with a variety of problematic sexual behaviors. Both approaches are inherently collaborative and strengths-based, an important consideration in light of research finding that the more coercive the treatment experience the less effective it likely it is to be and that low therapist empathy can be toxic. Iga produced an edited volume focusing in these areas, while Dominik has recently collected articles for the Polish Terapia. Each have built well-received organizations that focus on disseminating these methods with fidelity across a spectrum of professional disciplines.

Equally encouraging are the efforts of the students and other participants in these trainings. People routinely travel from around the country in order to attend various trainings and supervision sessions, often with little incentive beyond becoming a better therapist. As in the implementation of various models and methods in North America, these therapists submit recordings of their sessions to be reviewed by a supervisor, transcribed, and discussed in a group session with other therapists. I had the opportunity to sit in on a day of feedback sessions and felt fortunate to see just how supportive these groups can be.

Similar efforts are bringing these approaches into more areas of the criminal justice system in Italy. Previously, this blog focused on a group in Milan (https://sajrt.blogspot.com/2016/05/whats-on-in-milan-successes-and.html) including pioneers Carla Xella and Paolo Giulini. Now, a group led by Giacomo Salvanelli is working to expand these methods into other areas within Italy.

Most impressive of all is how all these people work to secure funding for their efforts. Very few people enter the human services with an eye on developing expertise in fundraising in challenging times. And yet, this is often what makes or breaks their efforts to ensure high-quality services for people who often have no voice in the systems that order their lives. Of course, much of the same happens around North America.  There are any number of people doing amazing things with unreasonably scant resources. Having had the great privilege of visiting many programs, it is always an honor to witness the efforts of people working behind the scenes to make trainings, conferences, and other forms of professional development happen.


Taken together, the efforts of these professionals show that therapeutic services improve when like-minded professionals get together with a common goal and purpose to exchange resources and ideas.

Friday, September 7, 2018

Integration into the community of people who have committed sexual abuse

By Kieran McCartan, PhD, David Prescott, LICSW, & Alissa Ackerman, PhD.
Over the years, our field has talked a lot about the use of language and the power of narratives in the field of sexual abuse. Words have impact. Words matter.  We often discuss whether we should use “victim” or “survivor” to discuss people whom have been directly impacted by sexual abuse and whether we should use labels at all. We have also discussed terms such as “sex offender” or the broad array of first person language that has emerged over recent years to describe the individuals that have committed sexual abuse. Likewise, there is the question of whether therapeutic activities should be called “treatment” or “management”. However, the one thing that we have not really discussed (and possibly one of the most important) is “reintegration” vs “integration”. This may seem like a minor semantic difference, but it’s more than that. It is an important debate, especially in terms of the experience of those who have victimized and those who have experienced sexual violence. This language can affect society’s view of each as well as the work that professionals do in the field. It is a conversation about transition and desistence.

The issue with reintegration is the addition of the prefix “re”. It indicates a return or a re-entry—this poses a problem? It assumes that they have been integrated into the community to begin with. In talking with anyone who works in the field of sexual abuse, it is common to hear them discussing their work in terms of changing people, changing attitudes and, most importantly, changing behaviors. The common thread that winds through discussion among police, probation, parole, treatment providers, and counsellors who work in the field of sexual abuse is that the person who has committed the abuse comes out of their service (i.e., prison, counselling, treatment, etc.) different, that they are a changed person. Herein lays the problem with the “re” in reintegration: We are not returning the person to the point that they were at pre-offence or pre-sentence, because that is a problematic and potentially harmful place. We are trying to integrate people who have committed sexual abuse into society, to successfully integrate many of them for the first time. What we see with these men (it’s mostly men that we are talking about) is that their lack of integration (whether socially, culturally, personally, psychologically or emotionally) contributed to their sexually abusive behavior in the first place. We are trying to help them move forward into a positive, productive, and engaging life, not back to the lifestyle that they had before.  


Thinking about integration versus reintegration enables us to view integration as being about the society, community, and individual’s social network working together to support the person. In contrast, reintegration too rarely looks beyond a return managed by professionals to similar circumstances. Therefore, we propose a view of integration that includes professionals playing a role, but that they are not alone in doing it. Integration is everyone’s responsibility, were as reintegration is often seen as the responsibility professional services. Past blogs have focused on the language that we use, what it means, and what its outcomes are. If we want people to take responsibility for their behavior and change we need to use language that reflects this goal.