ATSA - The Forum Newsletter

It feels like I was just writing to you with well wishes for summer, and here we are embracing the autumn with already falling leaves in this part of the world. While summer is often a time of relaxation, this did not appear to be the case for the contributors to our fall issue of the Forum. They were busy reflecting and writing so that they could share their clinical wisdom with you, ATSA members. I’m sure you will find this issue full of helpful and practical resources just in time for “back to school”.

Our editor emeritus, Robin Wilson, reminds us of the impact of doing our work and how to take care so we can keep doing it. He provides a succinct summary of some of the key points from the literature on vicarious/secondary trauma, and includes references to resources and reading to facilitate the process of self-care, which for many clinicians, falls to the wayside after the multitude of other work and life demands.

Two other feature articles provide very practical clinical advice and direction for domains of practice and intervention that we know relatively little about. David Delmonico and Elizabeth Griffith share their clinical expertise working with individuals who have engaged in online offending. Specifically, they highlight the importance of addressing technology directly within treatment approaches and offer insight and helpful exercises to facilitate self-awareness, challenge thinking, and navigate the web in a healthy way.

I was also very excited to read the article by Christin Santiago-Calling, in which the benefits of therapeutic recreation for adolescents was introduced as a novel and innovative means of intervention. The article makes a compelling case for the integration of this mode of work into multidisciplinary team approaches for residential treatment. Christin includes excellent examples of activities and their potential mechanisms of change, making it easy for readers to try them out in their own practice.

Staying with adolescents, following the new guidelines, many members wondered about the guidance offered surrounding polygraph for youth. In this issue our FAQ column was jointly authored by Phil Rich and Danielle Harris (Adolescent and Research Committee Chairs, respectively) to provide the rationale and additional clarification regarding this issue. Continue to send me your questions regarding research translation or clinical practice so we can get you the answers you need.

Other committees have been busy updating materials and gearing up for the conference. From the Ethics committee, Becky Palmer provides a helpful summary of some of the major changes to the revised and updated ATSA Professional Code of Ethics. Thanks to Becky for helping members to wade through this document by signalling some of the pertinent additions and changes. The student body of ATSA is looking forward to welcoming student conference attendees and showcasing their significant contributions at the conference. Committee chair Andrew Brankley provides a helpful guide and schedule that will prepare returning and new student attendees alike. For non-student members this piece is a summary of the impressive work our students do and all they contribute to the conference. Many events are not just for students (e.g. data blitz), and a review of all the events and advice will benefit many first time conference attendees. As an example of the quality of the work produced by ATSA students, our student article by John Michael Falligant, summarizes his exciting work looking at novel behavioral assessment procedures for the assessment of deviant sexual preferences.

I hope you enjoy the fall issue of the Forum and find it as interesting and exciting as I did. As always, I look forward to reading your articles and I am happy to work with you on developing ideas for a Forum piece.

President's Message

As summer fades into fall, the ATSA staff is preparing for the Annual Research and Treatment Conference, this year in Kansas City, Missouri. The conference committee, co-chaired by Amanda Faniff and Marc Schlosberg, has put together what promises to be an engaging and enlightening program. Plenary speakers included Patty Wetterling, who is always inspiring and provides an astonishing perspective given her personal loss. On Saturday, Pamela Mojia from the Berkeley Media Study Group and Nicole Pittman from the Center on Youth Registration Reform discuss their on-going work designed to shift the public narrative around prevention of sexual offending. In addition, there are the usual range of pre-conference workshops and concurrent session with speakers both familiar and new. Following up on last year’s successful pre-conference workshop aimed specifically for researchers, Tony Beech will lead an interactive workshop, “Challenges and Debates in Risk Assessment: Moving the Field Forward or Not?” Our theme, Creating Balance, highlights the many competing interests, orientations, and perspectives that must be balanced in moving the mission of ATSA forward and making this a better world for everyone.

There are a number of new things at this year’s conference. For the first time, continuing medical education credits will be offered. There are also some exciting new activities. The day before the conference, all conference attendees are invited to participate in a Giving Back to our host community by joining ATSA staff and other colleagues in volunteering at Sunflower House, an organization that assists children who have been physically and sexually abused. We will be performing a range of services, so there should be a project for everyone’s interests. Also new this year is the Public Policy Reception, which provides an informal gathering for those interested in ATSA’s public policy activities and influencing public policy. I hope to see all of you there.

ATSA’s Board has moved forward with the implementation of our strategic plan, with all committees developing goals and objectives for the next year. We had some changes on the Board. Andy Harris and Pamela Yates resigned their positions. So, we welcome Katie Gotch as the Public Policy Chair and Anita Schlank as the Adult Clinical Representative.

A final important initiative that the Board has been working on is the development of a funds development plan. The Board has adopted a plan that provides a framework for developing a more diverse set of funding streams and looking for mechanism for philanthropic giving. More information will be forthcoming as this plan takes shape and more specific activities are designed.

In closing, I hope to see you all in Kansas City this October. I thank you all for supporting ATSA and its mission, and I applaud all the important work you do every day to prevent sexual abuse.

Why is Juvenile Polygraph Not Recommended by ATSA?

Phil Rich, Ed.D., LICSW
ATSA Executive Board Juvenile Practice Representative

Danielle Harris, Ph.D.
ATSA Executive Board, Research Committee Chair

ATSA’s new adolescent practice guidelines, available to ATSA members through the ATSA website, do not recommend the use of the polygraph for adolescents. As a body wishing to support and emphasize evidence-informed and evidence-based practice, ATSA has assumed this position because there is a lack of evidence to support the use of polygraph examination practice with juveniles. Further, ATSA’s position reflects our priority to “first do no harm,” as well as concerns voiced by some that the polygraph may be harmful to the wellbeing of the juvenile (for instance, Chaffin, 2011). ATSA both supports the importance of client wellbeing in treatment and avoiding treatments that may be coercive whenever possible, as well as building treatment upon evidence, rather than using treatments that have no known established treatment effects. As with all professional guidelines the recommendation is meant to be aspirational with respect to practice, and does not reflect or replace local and/or applicable statutes, provisions, requirements, and other standards that may govern or shape practice. Recognizing this, the guidelines are designed to simply encourage practitioners “to take steps to achieve an appropriate resolution in cases where a conflict between these guidelines and legal and professional obligations occur.”

The polygraph is somewhat unusual in that, in this case, ATSA’s recommendation is not based on evidence that juvenile polygraphs are harmful or ineffective. The position was neither taken with respect to whether or not sexually abusive youth acknowledge more victims or sexual behaviors than they might otherwise have acknowledged, nor with respect to the discovery of additional victims of sexual abuse, who may then themselves get additional help. ATSA’s recommendation is instead based on a lack of evidence for treatment effect or efficacy, as well as the possibility that using the polygraph to engage the young person in greater honesty and less dissimulation, or to get to the “truth,” may in fact be a harmful process, and/or simply ineffective at further increasing the effect of treatment on the young person.

In many, cases it is safe to say that we have treatments and approaches to treatment that are informed by available and consistent research, even if not empirically validated, in which empirical validation is the surest and most concrete form of evidence. However, it must be acknowledged that that level of surety is rare in our field. Nevertheless, we do have treatments that are supported and informed by research into effective and central aspects of treatment and rehabilitation, improved mental health, desistance from antisocial behaviors, and engaging in the treatment process itself. Indeed, this research forms the foundation upon which much of the adolescent practice guidelines is built. In the case of the polygraph, there is, at best, only inconsistent evidence that it is effective in accurately distinguishing between truth and dishonesty (American Psychological Association, 2004; National Research Council, 2003). There is still less evidence about its use with juveniles and there is an absence of empirical evidence that demonstrates its value as a treatment intervention (Jensen, Shafer, Roby, & Roby, 2015). Finally, it remains unknown whether the use of polygraph examination is associated with either gains in treatment or the further reduction of recidivism in individual clients (Rosky, 2012).

Chaffin, M. (2011).The case of juvenile polygraphy as a clinical ethics dilemma.Sexual Abuse: Journal of Research and Treatment, 23, 314-328.

Jensen, T. M., Shafer, K., Roby, C. Y., &Roby, J. L. (2015).Sexual history disclosurepolygraph outcomes: Dojuvenile and adult sexoffenders differ?Journal of Interpersonal Violence, 30,928 –944.

National Research Council (2003).The polygraph and lie detection.Committee to Review the Scientific Evidence on the Polygraph.Division ofBehavioral and Social Sciences and Education. Washington, DC: The NationalAcademies Press.

Rosky, J. W. (2012). The (f)utility of post-conviction polygraph testing. Sexual Abuse: A Journal of Research and Treatment, 25, 259-281.

Responding to Problematic Technology Use:
Creating a Therapeutic Toolbox

David L. Delmonico, Ph.D.
Duquesne University
Pittsburgh, Pennsylvania

Elizabeth J. Griffin, MA, LMFT
Internet Behavior Consulting, LLC
Minneapolis, Minnesota

Correspondence: David Delmonico; Duquesne University; Canevin Hall; Pittsburgh, PA 15236; (412) 396-4032; delmonico@duq.edu

There is a growing body of research related to individuals who use digital technology to commit their sexual offense. Much of the focus in the field has been on understanding the characteristics of online sex offenders, and the risk they pose to the community; however, little has been written about treatment of the individuals who commit an online sexual offense. A number of models specific to working with sex offenders have been applied to the treatment of online sex offenders. One model that has been found to be useful is the Risk-Need-Responsivity model. The Risk-Need-Responsivity (RNR) model suggests treatment providers think in terms of identifying the level of risk to the community, identifying the criminogenic needs, and developing treatment strategies based on specific client needs (Andrews & Bonta, 2010).

The risk principle states that the intensity of treatment should be matched to the level of risk with the most intensive levels of intervention reserved for higher risk offenders, and lower intensity or no intervention applied to lower risk offenders. Research regarding individuals who commit their sexual offenses using technology suggests that many are low risk for sexual recidivism (Seto, 2013). Online-only sex offenders have been found to have recidivism rates nearly one‑half (approximately 7%) (Faust, Renaud, & Bickart, 2009; Seto, 2011) of their contact counterparts (approximately 13%) (Hanson & Morton-Bourgon, 2005). Given this low recidivism rate, it has been suggested that online sex offenders, with no history of a past contact sexual offense, need little to no treatment. However, initial research has identified potential dynamic risk factors to address online sex offenders who are in treatment.

The need principle states the most effective interventions are those that target a client’s criminogenic needs, or dynamic risk factors. Dynamic risk factors are those factors associated with risk for re-offending, but which can be changed through intervention, thereby reducing risk and recidivism. Given the limited research regarding online sex offenders, the specific dynamic risk factors that lead to risk reduction have yet to be identified (Henshaw, Ogloff, & Clough, 2017; Seto, 2013). The research has identified several psychological problems and behaviors associated with online sex offending. These include (1) emotional regulation (Beech & Elliott, 2009); (2) social skills/intimacy (Beech & Elliott, 2009); (3) deviant arousal (Beech & Elliott, 2009); (4) online hypersexuality (Krueger, Kaplan, & First, 2009) and (5) problematic Internet use (Beech & Elliott, 2009; Taylor & Quayle, 2003).

Problematic Internet use is often an overlooked area of intervention in sex offender treatment programs. There is little information in the literature on how best to intervene with problematic technology use among online sex offenders, and how to assist them in developing healthy technology alternatives. The need for this information has become increasingly important as courts are recognizing that broad restrictions against sex offenders, regardless of the nature of the sex offense, or how technology was used in the commission of the offense, are overgeneralized and violate an individual’s freedom of association, speech, and privacy protections (Chan, McNiel, & Binder, 2016). The courts are recognizing that access to technology is necessary for the tasks of everyday living, and denying access is likely to be unconstitutional. Additionally, a literature review by Chan, McNiel, and Binder (2016) found there was no evidence that restrictions or bans on individuals from the Internet and/or social media were successful in reducing sexual offense behavior. Given the evolving technological landscape, and the recognition of constitutional rights of individuals who commit sexual offenses, most sex offenders will have access to technology and the Internet with some limitations or monitoring.

When courts deny Internet access there is little opportunity for individuals who committed their sexual offense in the online world to learn healthy technology habits. Additionally, there is no opportunity to practice and experiment with re‑integrating technology use while under the guidance and support of community supervision and treatment. It is important to remember that clients will eventually have access to technology; therefore, addressing problematic Internet use and developing healthy technology habits while under supervision is crucial. This article provides treatment activities that address both problematic Internet use and the development of healthy technology habits.

The treatment activities in this article will incorporate elements of responsivity from the Risk-Need-Responsivity model. The responsivity principle states that interventions should be delivered in a manner consistent with a client’s learning style, abilities, and personal circumstances. Important considerations in the responsivity principle include motivation to change, cognitive abilities, cultural considerations, mental disorders, etc. In addition, it is important to consider adult learning theory, which suggests information retention by adults is improved when paired with multiple modalities (e.g., visual, kinesthetic, auditory, etc.) (Aivio, 1971; International Learning Styles of Australia, 2010).

Six practical treatment activities addressing problematic Internet use are described below. While problematic “Internet” use is the term in the literature, it is important to consider this behavior more broadly given advancements in technology, therefore this article will use the term problematic “technology” use. These activities encompass the spirit of responsivity through their creativity and multiple modalities for teaching information. A webpage has been established where the complete treatment activities, along with instructions on using each activity are provided. This webpage is the start of a “Therapeutic Toolbox” that can be used to address problematic technology use for online sex offenders. In addition, the webpage lists other resources that may be useful when addressing problematic technology use. The URL for the webpage is: http://www.internetbehavior.com/therapeutictoolbox2017

The Psychology of Technology - This treatment activity is a three-part activity designed to assist clients in understanding the influence of technology on their behavior. It teaches concepts such as the Online Disinhibition Effect (Suler, 2004) and The CyberHex (Delmonico, Griffin, & Moriarity, 2001). These concepts assists the client in understanding that online behavior can be influenced by various features of technology. The hope is that clients will gain a better understanding of the influence of technology on their behavior. In doing so, clients will develop skills that are effective in managing the Psychology of Technology in the online world.

Digital Footprints – Every individual that uses technology leaves a Digital Footprint of the places he/she has been and the things he/she has done. This exercise explains the concept of the Digital Footprint, and the impact of digital footprints when using technology. Clients are provided with a copy of footprints printed on paper as a metaphor for their Digital Footprint. They are then asked to do several activities with the footprints to assist them in understanding and visualizing how their use of technology may impact their Digital Footprint. The exercise ends with a reflection of the client’s “online reputation” and how he/she can more positively influence that reputation.

The “Lawyer” - In this treatment activity The “Lawyer” character is used as a metaphor to assist clients with understanding the cognitive distortions/thinking errors that may blame, justify, deny, or minimize their online sexual offense behavior. The treatment activity includes a picture of an action figure that looks like a lawyer. For many clients, their online sexual offense feels ego dystonic – that is, they do not fully understand how or why they would allow such behavior to occur. Their internal “Lawyer” comes to their aid by defending their behavior and reducing the need to take full ownership and responsibility for their actions. The goal of this exercise is to assist clients by teaching them to become aware of their internal “Lawyer”, “own” and take responsibility for the role their “Lawyer” has played in their online sexual offense behavior, and finally, to learn to manage their “Lawyer” to the point that he/she is not interfering with their treatment progress. In order to take full advantage of this exercise, clinicians should consider purchasing an action figure that looks like the “Lawyer”. The “Lawyer” can be purchased through the website http://www.hermesweb.com. (No actual lawyers were harmed in the creation of this treatment activity and apologies are offered in advance if any lawyers are offended by the use of this metaphor).

Word Webs – This treatment activity is focused on individuals who have viewed child sexual abuse (child pornography) images online. Due to the Psychology of Technology, individuals can often frame the viewing of online child sexual abuse images as a victimless crime. Those who possess/view/distribute child sexual abuse images can minimize their behavior, and often feel they are different from individuals who commit contact sexual offenses. The Word Webs can assist clients in understanding that possessing/viewing/distributing child sexual abuse images is problematic and not a victimless crime. In this treatment activity a “foundation” world is placed in a center circle on a piece of paper (in this case we have used the term child pornography on one word web, and the phrase child sexual abuse images on another word web). Clients are then asked to place associated words in empty circles around the page. When processing this activity, clinicians should focus on comparing the two Word Webs with the goal of helping the client understand that viewing child sexual abuse images is not a victimless crime. This treatment activity can be used with variety of “foundation” words and may be helpful to the individuals who have committed an online sexual offense. Examples include sexting, BDSM, sting operations, etc.

The Technology Health Plan – This treatment activity is used to differentiate between technological behaviors that are off limits from those that are healthy, safe, and therapeutic. The activity uses three concentric circles – one red, one yellow, and one green. What makes this treatment exercise effective is the inclusion of a green zone that focuses on determining positive and healthy technology-based behaviors. This activity is designed to develop client awareness, and assist in setting set boundaries for healthy technology use. The Technology Health Plan may be modified at various points in treatment since clients will gain new awareness regarding their technology behaviors, and will need to shift items between zones, delete items, or develop new items. The reality is, regardless of technology restrictions, clients will be exposed to technology and should be prepared in advance to deal with such exposure. The Technology Health Plan accomplishes this goal.

The Technology Toolbox – The purpose of The Technology Toolbox is to remind clients (and clinicians) that technology can be an asset in the treatment process. While it is easy to focus on the negative aspects of technology, eventually, clients will need to learn healthy ways to use technology in their daily lives. Clinicians should work towards equipping clients with a Technology Toolbox in order to explore healthy and safe technological resources. The treatment activity suggests several areas of technology (e.g., webpages, chatting, social media, streaming, podcasts, online universities, etc.) that can assist clients in understanding the healthy use of technology and to provide alternatives to problematic technology use. The client is encouraged to explore and find additional technologies that may be helpful to continued healthy use of technology. Clients are reminded throughout this activity that they need to seek permission and guidance from their treatment provider, probation officer, and support group before exploring positive and healthy technology behavior.

This article highlights the needs posed by clients who use technology to commit online sexual offenses, addresses the problematic use of technology, and provides practical treatment activities encompassing the spirit of the responsivity principle. Clinicians typically understand that problematic technology use needs to be addressed in treatment; however, they are often at a loss for how best to address this issue. The treatment activities in this article provide clinicians with an opportunity to discuss with clients both problematic and healthy use of technology. These treatment activities are the start of creating a “Therapeutic Toolbox” that will assist clients in developing positive and healthy technology habits. Visit http://www.internetbehavior.com/therapeutictoolbox2017/ for more information on the activities described in this article and other resources related to problematic technology use.

Aivio, A. (1971). Imagery and verbal processes. New York: Holt, Rinehart, and Winston.

Andrews, D. A., & Bonta, J. (2010). The psychology of criminal conduct. Routledge.

Beech, A. R., & Elliot, I. A. (2009). Understanding online child pornography use: Applying sexual offense theory to Internet offenders. Aggression and Violent Behavior, 14, 180-193.

Chan, E.J., McNiel, D.E., & Binder, R.L. (2016). Sex offenders in the digital age. The Journal of the American Academy of Psychiatry and the Law, 44, 368-375.

Delmonico, D., Griffin, E., & Moriarity, J. (2001). Cybersex unhooked: A workbook for breaking free of compulsive online sexual behavior. Gentle Path Press.

Faust, E., Renaud, C., & Bickart, W. (2009, October). Predictors of re-offense among a sample of federally convicted child pornography offenders. Paper presented at the 28th annual conference of the Association for the Treatment of Sexual Abusers, Dallas, TX.

Hanson, R. K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent sexual offenders: A meta-analysis of recidivism studies. Journal of Consulting and Clinical Psychology, 73(6), 1154.

Henshaw, M., Ogloff, J. R., & Clough, J. A. (2017). Looking beyond the screen: a critical review of the literature on the online child pornography offender. Sexual Abuse, 1079063215603690.

Krueger, R. B., Kaplan, M. S., & First, M. B. (2009). Sexual and other axis I diagnoses of 60 males arrested for crimes against children involving the Internet. CNS spectrums,14(11), 623-631.

Seto, M. C. (2013). Internet sex offenders. American Psychological Association.

Seto, M. C., Karl Hanson, R., & Babchishin, K. M. (2011). Contact sexual offending by men with online sexual offenses. Sexual Abuse, 23(1), 124-145.

Suler, J. (2004). The online disinhibition effect. Cyberpsychology & Behavior,7(3), 321-326.

Taylor, M., & Quayle, E. (2003). Child pornography: An internet crime. Psychology Press.

Looking After Ourselves and Each Other

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

A long time ago, most of us who work in sexual violence prevention made a few critical decisions. We were bright-eyed, bushy-tailed teenagers who had no idea what we wanted to do when we “grew up.” In high school we talked with our friends and family about the sorts of things we’d like to study in college or university. I initially thought I would go to medical school and become a surgeon, but shaky hands put the boots to that idea. That’s how I found psychology. I suspect many of you also had academic dilemmas with which to contend, but you ultimately found yourself in the humanities or studying something that would eventually lead to work in social services.

Interestingly, I didn’t pick sexual violence prevention as a career; it sort of chose me. After my third year of full-time study in psychology at the University of Toronto, I needed a break and went looking for a job. I managed to secure a position at the university’s psychiatric teaching hospital, working for a Czech psychiatrist named Kurt Freund who, it turned out, was the pioneer of the phallometric test (or penile plethysmograph as it’s known more broadly in the USA). Working for Dr. Freund was the single greatest influence on my future and after having had the opportunity to conduct research, study human sexuality, and to rub shoulders with other great practitioners in Canada, my career path was set. I’ve never looked back and I can honestly say that I’ve never had a boring day at work. However, that’s not to say that I haven’t also had some very upsetting days at work.

We work in a field that brings us in contact with people who have been harmed in a particularly intimate way, as well as with the people who have harmed them. We’re in the public safety business. We work with victims of sexual offenses to help them survive their experiences, knowing that some of them – particularly young persons – may find themselves engaging in abusive behaviors in the future. These abusive behaviors are not necessarily always sexual in nature, nor are they always directed at others; they may be more inwardly destructive. In our work with offenders, we try to help them become desisters, instead of persisters.

So, why do we do this work? Because we want to make a difference. We care about our families, friends, and communities and through our interventions we strive to achieve the ATSA goal of making society safer. But, this potentially comes at a cost to each and every one of us. We know that the work we do can be hugely exhilarating when we see the successes of our clients, but we shouldn’t kid ourselves that there aren’t darker experiences of which we need to be mindful.

There is no denying that working with persons with sexual behavior problems and antisocial orientations is challenging (see Edmunds, 1997; Ellerby, 1998; Ennis & Horne, 2003). Some of our clients are really good at “pushing our buttons.” How do we offset our natural tendencies to be empathic and helpful with our natural tendencies to be angry and upset at what our clients have done (or continue to do)? Because we know the consequences of such strong emotional responses in clinical environments. We also know that it is unconscionable to do nothing. So, we work to reduce the number of potential victims, knowing that poorly managed clients have the capacity – already demonstrated – to do tremendous harm. We work to ensure that clients receive appropriate treatment and care according to evidence-based practices, like the Risk-Need-Responsivity framework with which we’re all so familiar. We work to ensure that our clients are able to approximate a quality of life as close as possible to that of others without sexual behavior problems – that’s the essence of the Good Lives Model.

One of my absolutely most favorite concepts I learned in school is that of the “balanced, self-determined lifestyle.” I try to include this phrase in almost everything I write (as I just did here) and I try to follow it myself and to instill it in others around me. I co-opted this concept from the YWCA’s Life Skills Coach Training program in Canada, as they did from Saskatchewan NewStart. NewStart was a basic job readiness training program for Aboriginal Canadians in the mid-60s. Search it out on Google, if you like; it bears a striking resemblance to many aspects of the GLM, but some 30 years earlier. At its heart, a balanced, self-determined lifestyle means making time for all the important elements of life – self, others, community, job, leisure. And, it also encourages people to think about the range of opportunities they have in life and to make good choices while learning from mistakes. Clearly, our clients have not always done both of these things, and that is perhaps why they land themselves in trouble.

Job stress is the result of a complex interaction between the individual and the challenges of the job. Burnout involves physical, mental and emotional exhaustion that is attributable to work-related stress (Leiter & Maslach, 2009; Mayo Clinic, 2012). It is a uniquely human phenomenon that if a person holds the capacity for empathy, he or she will experience distress when hearing about terrible things that have happened to others. Have any of you ever experienced anything like that – during an assessment, when reading police reports or victim impact statements, or during a group or individual treatment session?

Even though we weren’t there when our clients committed their offenses, we are privy to intimate details of what happened. This can lead to what is known as vicarious trauma (www.headington-institute.org; Pearlman & McKay, 2008). Because we are caring people and because we express empathy and feel compassion, we often experience characteristics of victimization just by hearing about what happened to others. This emotional contagion can sometimes lead to compassion fatigue – a key component in burnout. Ultimately, this is the cost of caring, but there are things we can do about it.

The first thing we need to acknowledge is that we are members of a select group of persons who are at higher risk for vicarious trauma and compassion fatigue. These workers include, but are not restricted to:

The effects of vicarious trauma and compassion fatigue can be particularly pertinent to people who interview and counsel trauma victims, those who work with victims and their families and, notably for us, people who work with clients who have abused others.

It’s important to recognize that not everyone will be affected by troubling information or traumatic stress in the same way. Some of us are really resilient and it doesn’t seem to matter much what we see or hear – we get past it. Others, however, may find certain situations or scenarios much more difficult to manage. The research on self-care and burnout tells us that there are individual factors to consider, as well as situational and environmental factors at play. This shouldn’t surprise us, as this is pretty much the case with virtually everything in social services – it’s a mix of internal and external variables.

A good bit of how we respond to traumatic stress has to do with our personal history; that is, our personal experiences of trauma, loss, and victimization and how we’ve managed to cope (or not) with situations throughout our lives. Our personality style (and ego defenses) will influence our coping style and the mechanisms we use to deal with difficult situations – either at work or in other environments (e.g., have you ever found yourself bringing work crap home with you?).

Another important consideration is current life context. What’s happening for you outside of the work environment? Is your teenage daughter or son having difficulties, are you having problems in important relationships, has someone in your family or friend circle just experienced a situation of abuse? All of these private life situations can affect our ability to cope with difficult situations at work.

Here are some individual risk factors to consider (see Pearlman & Caringi, 2009; Pearlman & McKay, 2008):

What can we do to protect ourselves? I won’t get too far into that right now, but some obvious recommendations are to take opportunities to increase our training base and to take the time to debrief situations we experience at work with our colleagues and trusted confidantes. And, keep in mind that we may need to practice what we preach: If you have problems you can’t manage, maybe think about seeking professional help.

As much as there are factors we bring to the table in terms of our own personal makeup and experience bases, there are factors over which we have a lot less control. In the beginning part of this article, I suggested that we all made a choice to work in the field of sexual violence prevention. I guess that means that we probably can’t, at this point, change the nature of the work we do. Nor are we able to change the nature of our clientele; at least, not without leaving the field.

At many of the workshops I do, I often ask participants whether or not they work for an agency that has too much money or too many staff. I’m never surprised by their answers. I also typically ask them whether or not they feel like they have enough time in a day to do all the things expected of them – either by superiors or their own work ethic. Workload is a big factor. The more we do in a compacted work week, the less time we have to step back and inoculate ourselves from the cumulative exposure to trauma material. This can affect our relationships with co-workers, which can sometimes lead to the “cubicle-effect” in which people keep their heads down, working away in isolation and ultimately losing important social and cultural contexts and opportunities present in the work environment.

Here are some workplace risk factors to consider (see Pearlman & Caringi, 2009; Pearlman & McKay, 2008):

Over the years, I’m moved away from direct service provision and more into administration and consultation. As a worker, I knew all too well that there were expectations on me and that there were minimum production quotas (e.g., three psychotherapy clients a day, two groups a week, two assessments, etc.). I, too, worked in relative isolation with little opportunity to debrief my work experiences with others. As an administrator, I became keenly aware of the need for “real” supervision – not the annual performance appraisal, but REAL supervision. Frankly, the last performance appraisal I got was emailed to me by a supervisor who cared very little for my experience of my job.

As a word, “supervision” connotes a certain cringe-worthy experience. None of us like being informed of our faults, nor do we like being told what to do. As such, it’s something of an unfortunate choice of word and many of us may have experienced supervision as a chore. However, when I say supervision here, I mean something wonderful – the opportunity to sit down with someone who cares about you and the work you do enough to listen like David Prescott, consider the information provided like Karl Hanson, and give advice like Robin McGinnis. Supervision is the opportunity to share what you’re proud of, as well as what causes you to quietly freak out. Regularly sharing your work experiences with concerned peers or supervisors – either individually or as a group – can have profound effects on quality of life, both professionally and personally. And, we don’t do it often enough. Period.

Maintaining a balanced, self-determined lifestyle is central to effective self-care. How well are you taking care of yourself? Of course, self-care needs to be practiced in the workplace as much as in your personal life. We’ve seen the effects of the holistic revolution in our treatment approaches with clients. Why shouldn’t we also apply these ideas to aspects of our lives? The more balanced we are across the full range of personal care, the more we are able to cope with the stresses and demands that we will face in our admittedly very challenging professional experiences.

People are at less risk for burnout if they feel they have some degree of control or influence over their work situation, believe that they are important enough to be treated fairly, and value the work they do and are committed to it. We need to create opportunities for renewal, but this is a shared responsibility. We need to get out of our cubicles and talk to one another! We need to recognize that when someone is cooped-up in their cubicle that that’s a cause for concern and requires a check-in.

These are the sorts of questions we owe to ourselves and others to ask. It’s often been said that there is safety in numbers, and there is a lot of truth to this when we think about how we can lessen the negative effects of trauma we may experience as sexual violence preventers.

If you’ve been reading between the lines in this article, you may have noticed that a lot of the concepts we apply to our clients who have sexually offended may also hold some worth for us. Many of you will know that I have spent a lot of time in my career working in a framework known as Circles of Support & Accountability. One key idea behind CoSA is that “nobody does this alone” – meaning that reintegration to the community after incarceration should not be a solitary endeavor. I would extend the CoSA idea to other domains, including high-risk professionals as noted above – that means us. We need a strong, interactive, and reciprocal social support network to keep us on the right track, too. So, look out for yourselves and your colleagues as you continue to make society safer.

Edmunds, S.B. (1997). Impact: Working with sexual abusers. Brandon, VT: Safer Society Press.

Ennis, L. & Horne, S. (2003). Predicting psychological distress in sex offender therapists. Sexual Abuse, 15, 149-157.

Leiter M.P. & Maslach C. (2009). Banishing burnout: Six strategies for improving your relationship with work. San Francisco, CA: Jossey-Bass.

Pearlman, L.A. & Caringi, J. (2009). Living and working self-reflectively to address vicarious trauma. In C.A. Courtois & J.D. Ford (eds), Treating complex traumatic stress disorders: An evidence-based guide, New York: The Guilford Press.

[1] Laurie Anne Pearlman is a powerhouse in the burnout and vicarious trauma research and practice world. This online resource – and the others that go with it – is particularly helpful. Visit http://www.headington-institute.org.

Utilizing Recreation Therapy as Part of the Treatment Model

Christin Santiago-Calling, CTRS
Director of Recreation Therapy, The Whitney Academy

When we look at the effects of trauma, neglect and abuse on adolescents, we see lasting and pervasive effects. One of the largest impacts tends to be in socialization, and the ability to form positive and reciprocal relationships. Often, they struggle to build trust, have low self-esteem, question their competence and see the world as a dangerous place; all of which impede ones’ ability to build relationships. Many prefer social isolation as a coping mechanism, though what they often desire most is social integration.

Although I will go into more specifics later, the overarching theme in the literature is that these negative experiences impact on the brain and greatly impede the ability of the traumatized individual to control their arousal and behavior, which also greatly impacts their ability to form relationships (Cohen, Perel, DeBellis, Friedman, & Putnam, 2002).

As clinicians, we are taught language-based methods to assist clients in dealing with the effects of trauma, and ways to cope with stressors in an attempt to lead safer and more productive lives. While these methods may work for some individuals, research is finding that adolescents especially, are responding more positively to body-based interventions, and interventions utilizing Recreation Therapy (RT) techniques (Arai, Mock, & Gallant, 2012)

Recreation Therapy is a systematic process, which utilizes activity-based interventions with the aim of improving the psychological and physical health of the client. RT interventions are goal-oriented, strengths-based and are whole-person centered, focusing on improving the physical, emotional and psychological well-being of the client. Interventions range from sports, games, dance, music, drama, arts and work with animals. The main purpose of the activity is a clinical goal, rather than pure enjoyment, which is what distinguishes RT interventions from simple leisure activities.

RT interventions may address many of the same clinical goals as traditional trauma talk therapy, such as shame, guilt, emotional regulation, problem solving, impulse control, self-worth, risk taking behaviors, executive functioning, effective communication, stress reactions, competence and sensory integration. An important difference being that RT interventions are on the surface “just for fun”. This allows the client to participate fully without feeling “assessed”, giving the clinician greater insight into the client.

We know that traumatized and neglected children suffer from deficits in brain development. Studies have shown reduced volume in the hippocampus, corpus callosum and cerebellum, as well as a smaller prefrontal cortex, an overactive amygdala and abnormal levels of cortisol in the brain (Perry, 2009)

These impairments lead to decreased learning abilities, decreased ability to self-regulate and soothe, reduced hemispheric integration, reduced motor coordination, reduced executive functioning, reduced emotional and behavioral control, an overreaction to stimuli and an abnormal reaction to stress (Perry, 2009)

Individuals who have been traumatized may lack impulse control, and are often easily flooded, vigilant and guarded, dysregulated behaviorally and emotionally, and struggle with language-based instruction. They tend to endorse low self-esteem and self-worth, hopeless and powerless, and may exist in “survival mode” whereby they attempt to manage what they perceive to be a very dangerous and threatening world (see van der Kolk, 2003).

Though these brain deficits occur, given the brain’s plasticity, changes may occur with intervention. Although there is no evidence to date, this writer’s hypothesis is that RT interventions may work (in)directly to repair and restore brain connections to overcome the effects of trauma.

Because RT interventions are multi-sensory and body-based, they can be used effectively to overcome deficits in brain development as a tool to manage responses to the effects of trauma. RT interventions can be designed to address the following objectives: hemispheric integration, sensory integration, executive functioning, emotional and behavioral regulation, motor coordination and situational responses to perceived stressors. This article will look at four RT activities, which have been developed by the author, to illustrate the specifics of how such interventions may impact and augment recovery from trauma.

A favorite activity of adolescent clients is “Gotcha”. The setup of “Gotcha” is as follows: the group stands in a circle. The facilitator prompts the group to place their right thumb (thumbs down) into the open left palm of the person standing next to them, just touching the palm. When the facilitator calls the “magic number”, 3, all must pull their thumb away while grabbing the thumb that is touching their own palm. The result is the ultimate in multi-tasking, pulling your thumb while remembering to grab the other thumb.

“Gotcha” addresses multiple areas of deficit. The most predominate is hemispheric integration. Since the left and right hands of the clients are tasked with doing different things, the activity increases connections between the left and right hemispheres. Any activity that crosses the midline of the body, works to enhance hemispheric integration, and therefore increases the volume of the corpus callosum. Beyond this, executive functioning is developed, through the ability to focus on the “magic number” and reacting appropriately to it. Sensory integration, specific to touch, is also an important part of this activity. The activity calls for the clients to touch each other in safe, but unfamiliar ways, therefore allowing the clinician to assess comfort with touch and safety with touch within their clients. Furthermore, this activity allows the client to address motor control, as well as controlling arousal.

The setup of “Up Chuck” is as follows: the group stands in a circle. The facilitator empties a large bag of soft throwable toys (stuffed animals, soft rag balls, stress balls, etc.) onto the floor and instructs each member of the group to grab at least two items. One person begins in the middle of the circle. The facilitator instructs the group that on the “toss” command, the entire group should toss their items into the air with the intent that the person in the center of the circle can catch the items. The person in the center is asked how many items they think they will catch, and then asked if they are ready. Once ready, the facilitator says, “one, two, three, toss”, and then the group tosses their items toward the person in the center. After a few rounds of one person, add more people to the center to catch items.

Within “Up Chuck” many brain areas are being activated. The most salient function is the sensory aspect to this game. Many of our clients have never had the sensation of having safe and soft items fall all over them, similar to the feeling of jumping into a ball pit. Many clients who participate in this activity report feeling safe and secure as the soft toys rain down upon them. Beyond the sensory aspect of this game, the client has the opportunity to experiment with various strategies to increase their success, allowing for creativity, choice and safe failure. “Up Chuck” also provides the client with the chance to increase motor control and how they use their bodies in space, both of which can be areas of deficit with relation to trauma and brain development. This is often a new sensory experience for them, and assessing how they react to it is a valuable tool for the clinician. Also, this activity addresses making realistic or unrealistic goals and problem solving strategies to meet those goals; and seeing what happens when we do not meet our goals is valuable to the assessor as well. Watching the strategies of others that have gone before, and evaluating their effectiveness is an executive function that many of our clients lack, but one that is highly beneficial. Lastly, this activity allows those doing the throwing to have a helper role to those in the middle. As a clinician, that is valuable information, and it provides clinical direction and a framework for further discussions in both individual and group work.

In “Human Pyramid Challenge”, the group leaders instruct the group that they are tasked with making as many human pyramids as possible within a given time frame (30 seconds). Give no time for questions or strategies, and simply say, “ready, go” and watch your watch. With each human pyramid, the facilitator should offer brief praise (yes!, nice!) and keep a count of each pyramid. Once they realize that any triangle they make with their bodies count, the creativity ensues. After the first 30 seconds, challenge them to beat their time and run the activity again.

In “Human Pyramid Challenge”, validation, problem solving, creativity and hemispheric integration are the main drivers of this activity. Since the activity prompt is vague, it allows for the clients to create their own version of what is meant by a “Human Pyramid”. And once the first is attempted and accepted by the facilitator, it allows for more creativity and greater risk taking within the bounds of what constitutes a human pyramid. Many of our clients externalize their treatment success onto their clinicians, and look to us for the answers. When presented with an ambiguous task, it often causes frustration and anxiety initially. Again, this is an excellent way to assess how clients handle those feelings, and what they do to cope with, and overcome them. By validating their efforts, they feel increased competence and confidence, which builds self-worth. There is a measurable difference in the demeanor before and after completing this activity (Barry & Meisiek, 2010).

In “Have you Ever?” each person in the group stands in a circle and is given something to stand on (poly spots, pieces of paper, etc.). The facilitator does not have anything to stand on. The facilitator tells the group that the game is similar to “Musical Chairs” in that each person has a spot, except for one person. The person in the middle asks a question to the group, “Have you ever…” and fills in the blank with something that they have done. The answer to their own question must be yes, which will allow them to move. A “yes” answer to the question allows you to leave your spot and find a new spot, a “no” answer allows you to stay on your current spot. If a group member chooses not to answer the question, they can just stay on their current spot. For example: the person in the center of the circle asks the group, “Have you ever eaten pizza?”, for those that have eaten pizza, they move from their spot and find a new spot, those that have not eaten pizza stay put. The person that has no spot, is the new person in the middle and asks a new question. After a few rounds, challenge the group to ask clinically driven questions.

“Have you Ever” offers an activity with the potential for the most overt clinical application for the client. Initially, the questions posed are often superficial in nature, allowing for a sense of belonging and normalcy. Once those feelings are established, moving on to more clinically driven questions is highly beneficial. Allowing clients to ask the questions is a powerful way to derive what they are thinking and feeling based on their own comfort. They have the choices of what to ask, and more importantly, what to answer, in a non-judgmental and non-confrontational manner. Since answering the questions involves moving rather than speaking, clients often feel freer to answer questions they might otherwise avoid. When questions are hard to come by or there seems to be something being held back, the facilitator can find a spot to ask the question of the group, which tends to open up a new direction of questions. Clients typically really enjoy this activity, and will often request to play it again and again.

Two adaptations to this activity: take away one or more spots to have multiple people in the center, and an “all answer”.

By taking away one or more spots, it forces more than one person in the middle, and they must find a question that they all can answer “yes” to. The adaptation builds commonalities, and group development. Beyond that, it gets them talking to each other about issues in a manner that is safe and non-threatening.

An “all answer” can be used when a question is too sensitive for the group members to answer in the activity. Rather than move from their spots, the person in the center calls for an “all answer”. When this is called, all group members turn and face out the circle and put both hands behind the back, facing the person in the center of the circle. If they choose to answer “yes” to the question, they open one hand and keep one hand closed in a fist. If they choose to answer “no” to a question, they keep both hands closed in fists. This allows a safe way to answer more sensitive questions.

Whitney Academy is a 50-bed residential treatment center for adolescent boys aged 10-22. There is a self-contained school and four residences in the local community. Clients at Whitney Academy are all dually diagnosed, have histories of trauma/abuse/neglect and have a sexualized behavior problem.

At Whitney Academy, RT is seen as one of the most important interventions in the program. The RT program is used throughout the Academy, across all disciplines. During the school day, RT interventions are used in the classrooms, as well as form the basis of the Physical Education program. Medically, RT interventions are often used to assist with behavior regulation, weight management, sensory issues, and treatment of various diagnoses (for example: ADHD, depression, anxiety, ASD). In the residences, RT interventions are used as part of the daily schedule and routine. RT groups are held daily, with community trips and life skill focused programming occurring on weekends. Also within the RT program, traditional sports are offered as part of Special Olympics of Massachusetts, where RT principles guide the athletic team development, and are coached by RT clinicians. Within the clinical department, RT interventions are used as part of the clinical treatment model, and RT staff often co-lead group therapy sessions. RT plays an integral role in meeting the clinical, residential and academic needs of the clients at Whitney Academy.

Planning is the single most important factor in using RT interventions. Plan for every possible outcome, and have backup plans for your backup plans. Even if most of the plans do not get used, having them will increase the confidence of the facilitator, which will translate to the group. The more confident you, the facilitator feel, the more safe the group will feel. Understand the limits to what you can do with time, setting, and equipment, and plan activities that can be done within those limits. Having a plan will help to avoid the biggest threat to successful RT interventions: helicopter facilitation.

When facilitators do not feel confident in their abilities, or when they do not trust their group, they tend to overcompensate and become helicopter facilitators, who attempt to fix every problem, and create every solution. Effective facilitation allows for the group members to dictate the direction and find their own solutions to problems. As clinicians, we tend to want to be leaders, in RT interventions, we have to facilitate the learning, rather then teach it. Allowing clients the freedom to make choices, to take on leadership roles and problem solve on their own allows for increased feelings of competence, which leads to increased confidence and self-esteem. Their learning is internalized to their own abilities and skills, rather than externalized to our instructions. Things will go wrong, but that is often where the learning occurs. Allowing clients to fail in a safe environment, will foster a sense of trust and allow for more risk taking within their clinical work. Connections that are made will be their connections, and therefore have greater meaning to the client. Giving them the sense that you trust that they will be safe and that they can handle these activities will be met with the clients being safe and rising to the expectation.

This writer proposes that effective use of RT interventions will lead to more effective trauma work for both the client and the clinician. Goals will be achieved faster, and the work will be deeper and more meaningful. Adding one activity per group will lead to better buy in from the clients, and more enjoyment from all involved. Clients will look forward to the interventions, and will develop in ways not seen in traditional clinical work; and, it is fun, and isn’t having fun while doing our professional and clinical work a wonderful thing?

Arai, S. A., Mock, S. E., & Gallant, K. A. (2011). Childhood traumas, mental health and physical health in adulthood: testing physically active leisure as a buffer. Leisure/Loisir 35(4), 407-422.

Butler, S., & Rohnke, K. (1995). Quicksilver: Adventure Games, Initiative Problems, Trust Activities and a Guide to Effective Leadership. Sage Publications.

Cohen, J., Perel, J., DeBellis, M., Friedman, M., & Putnam, F. (2002). Treating traumatized children: Clinical implications of the psychobiology of posttraumatic stress disorder. Trauma, Violence & Abuse, 3(2), 91-108. doi:10.1177/15248380020032001

Kraus, R., & Shank, J. (2010). Therapeutic Recreation Service: Principles and Practices. Wm. C. Brown Publishers.

Perry, B. (November 4, 2009). Understanding the Effects of Maltreatment on Brain Development. Child Welfare Information Gateway.

Rohnke, K. (1984). Silver Bullets: A Guide to Initiative Problems, Adventure Games and Trust Activities. Kendall/Hunt Publishing.

van der Kolk, B. A. (2003). The neurobiology of childhood trauma and abuse. Child and adolescent psychiatric clinics of North America, 12(2), 293-317.

Christin Santiago-Calling is a board certified Recreation Therapist, and is the Director of Recreation Therapy for the Whitney Academy. She has worked at Whitney Academy for 11 years, 8 of which have been in the role as Director. As the Director of Recreation Therapy, she has taken the department from a once per week group, into the full department that now exists. The RT department offers seven traditional sports, daily RT groups, weekly community integration trips, weekly life skill groups, daily PE, co-leading group therapy and social skills groups, and various weekly club offerings.

Beyond her work at Whitney Academy, Christin is also on the Board of Directors for the National Adolescent Perpetration Network. Christin has also presented her work at conferences throughout the US, Canada, Sweden and England. She has done consulting work to bring RT services to other organizations, as well as utilizing RT interventions within various clinical and recreational models.

Understanding and Preventing Adolescent Pedophilia TEDMED Talk

Please watch Dr. Elizabeth Letourneau deliver a powerful message about youth who commit sexual abuse in the TEDMED talk (link below). Many of you working in this area already know Elizabeth to be a passionate and dedicated pioneer in the prevention of child sexual abuse, and in this video you see her educate, narrate, and advocate in a way that can make all of us proud to do this work. Elizabeth provides clear explanations of basic research on youth who have sexually offended. She delivers compelling arguments against problematic policy, while providing a new way of understanding child sexual abuse through a public health lens. Finally, she shares her own learning and subsequent work with non-offending youth to make the case for prevention, not punishment, as our response to this issue.

Step One of Cultural Competency Addressing Privilege & Power

Note to readers: This article by Cordelia builds upon and adds to the blog post by Kieran McCartan and David Prescott, “Race, culture, community & abuse”.

A related event, "Dismantling Racism: The Relevance to Prevention," will be held at this year's ATSA Conference on Thursday, October 26, 2017 from 5:30 to 6:30 pm at the Sheraton Kansas City Hotel at Crown Center, in Kansas City, Missouri. If you are in the area, we welcome you to attend the event and join the conversation.

Child sexual abuse, sexual violence and pornography are not easy topics to talk about, but in my experience raising questions related to power, privilege and race are even tougher. Just like trying to talk about “sex offenders”, invitations to talk about such difficult topics often results in defensive, protective, ambivalent, or even angry responses. Most organizations who work with victims and survivors are raising these difficult questions. In fact, most of my thinking related to power, privilege and what’s all involved in cultural competency, I have learned from and with those who work with survivors/victims, and with those who work on social justice as part of prevention.

However, I wonder how the sensitive but pervasive issues related to our own sense of power, race, class, and disabilities translate into the work of treating and researching those who sexually offend. As a member of the ATSA Prevention Committee, I am hoping our entire organization will grapple with how this all fits within the priorities and engage in these discussions. I am writing this blog as an invitation to further conversations and perhaps more attention to this in your practice, your research and in discussions at our conferences.

We know that sexual abuse thrives in secrecy and shame. For years, our organization and our practices might have reflected the isolation of the very issue we have been working on. More recently, we have begun to also understand the need for increasing cultural competency. However, if we expand our vision even further, we will see that there are tensions between the focus on cultural competency versus racial justice. At the core of that difference is our need to not only learn more about the individuals we work with but to begin to address our individual and collective privileges as professionals that do this work. We have made a commitment to healing and to minimize the harm that has been done. But what if we are also, unintentionally increasing the harm?

Therapists and advocates appreciate the importance of dealing with the whole person, their family and community of support to address the presenting problem or issue. Those who do prevention work know the importance of expanding that view even further to also address the environment and social norms that create families, communities, organizations and societies where harm is likely to develop and continue.

The issues we work with are complex enough that the tendency is to say we cannot afford to further muddy the waters by addressing race, power and privilege. Or we may say that there are more pressing issues in the work we do in terms of community safety.

I’ve been at this work for over 40 years and in the time I have left, I hope to engage in meaningful conversations with colleagues and organizations that I care deeply about in ways that address the intersections of these issues. I believe the first step toward cultural competency and a social justice framework is to more fully and intentionally face my white privilege and the norms of institutional and systemic white supremacy. It is not comfortable to talk about or easy work to do but it is essential. One example of the work in this area that’s underway is the 2018 theme of the MASOC/MATSA’s conference which is cultural competency.

Since first writing this blog in May, and then holding off on submitting it until closer to the ATSA conference, there has been so much happening in this country and around the world that raises the urgency of engaging in these discussions and taking appropriate action. With such challenging issues, it can be helpful to consider actions we can actually take. We can:

I am writing with great humility about my own limitations related to all of this. I know likely I have I stepped in it in one way or another. Still, I believe the risk is worth it to get more meaningful conversations on this topic going and to revisit ATSA’s role. I believe it is an opportune time for ATSA to do even more with these conversations and related actions. The ATSA Prevention Committee is hosting a panel related to how these issues fit with prevention. It will be on Thursday, October, 26, from 5-6. We hope you can attend, read some of the writings below and/or find other ways to engage further in this work.

Say the Wrong Thing: Stories and Strategies for Racial Justice and Authentic Community, by Dr. Amanda Kemp, Lisa Graustein, June 16, 2016,

“White Privilege: Unpacking the Invisible Backpack,” by Peggy McIntosh, http://code.ucsd.edu/pcosman/Backpack.pdf;

Assessment of Deviant Preferences Using Novel Behavioral Assessment Procedures

Recently, I was fortunate to be awarded a Predoctoral Research Grant from ATSA to fund an exciting new project, “Assessment of deviant preferences using novel behavioral assessment procedures.” Broadly, my research interests include the assessment and treatment of illegal sexual behavior (ISB) and severe problem behavior among adolescents adjudicated for ISB, traumatic stress, delay and probability discounting, legal decision-making strategies, and behavior analysis. This new project will encompass many of these research areas, as I hope to evaluate the utility of several novel behavioral assessment procedures to assess inappropriate preferences for deviant visual stimuli among adjudicated youth.

Although many contextual developmental factors, such as social skills deficits, lack of supervision, and impulsivity contribute to the development or maintenance of ISB among juveniles (e.g., Chaffin, 2008), inappropriate sexual interests may also be a contributing factor for some adolescent offenders. Given that juveniles who engage in illegal sexual behavior are more likely to offend against children than adults (Finkelhor, Ormrod, & Chaffin, 2009), it may be necessary that clinicians evaluate these individuals’ preferences for inappropriate sexual partners in addition to assessing all other critical contextual factors that are related to adolescent offending. Thus, identifying procedures to assess preferences for inappropriate sexual partners is a crucial step towards adequate treatment and assessment of recidivism risk for these youth. Unfortunately, there are relatively few reliable and valid objective procedures available to assess sexual preference for juveniles relative to adult offenders. For example, phallometric assessment, which is considered a very good measure of deviant sexual arousal (e.g., Letourneau, 2002), is largely viewed as inappropriate for juvenile populations because of the lack of evidence of its reliability and validity with adolescents (e.g., Kaemingk, Koselka, Becker, & Kaplan, 1995) and because of the obvious ethical concerns associated with using this procedures with juveniles (Worling, 2006). In contrast to phallometric assessments, viewing time (VT) procedures have emerged as a less-intrusive alternative to assess preferences for deviant sexual stimuli. Though both VT and penile plethysmograph may accurately identify deviant preferences in adult offenders (Letourneau, 2002), the use of VT-based procedures is largely unsupported with adolescents (Smith & Fisher, 1999). Accordingly, few options remain for assessment of deviant sexual interests in adolescents apart from self-report measures, which have numerous drawbacks (e.g., Gannon, Keown, & Polaschek, 2007; Rea, Dixon, & Zettle, 2014).

Fortunately, translational behavioral research may hold the key to improving assessment procedures concerning juvenile offenders and deviant sexual stimuli. Specifically, research involving conjugate schedules of reinforcement suggests that objective, behavioral measures of deviant sexual arousal may be attainable for adolescents. Conjugate schedules of reinforcement have garnered increased attention recently for their roles in a wide variety of complex behavior (e.g., MacAleese, Ghezzi, & Rapp, 2015; Rapp, 2008). In conjugate schedules, the schedule of reinforcement is continuous, and the rate or intensity of the reinforcer is proportional to one or more dimensions of the target response (e.g., Rapp, 2008). Pressing the accelerator on a car is one example of conjugate reinforcement, as there is a proportional relation between the magnitude of the target response (i.e., applying strong pressure to accelerator) and the reinforcing event (i.e., rapidly accelerating). The more force that one applies to the accelerator, the faster the vehicle accelerates. This is in contrast to discrete schedules, under which there is no proportional relationship between responses and reinforcers (e.g., regardless of how much force is applied to the accelerator, the vehicle always accelerates at the same rate).

In contrast to assessment procedures that use discrete schedules of reinforcement, conjugate schedules provide a dynamic mechanism for understanding response-reinforcer relationships (see Rapp, 2008 for an overview). Recently, MacAleese et al. (2015) demonstrated that changes in clarity of a preferred visual stimulus can effectively be used in a conjugate-reinforcement experimental preparation. Importantly, this unique procedure allows clinicians and researchers to systematically assess whether stimuli that participants report are highly-preferred are actually appetitive. Conversely, this procedure may allow clinicians to test whether stimuli (e.g., pictures of young children vs. peer-aged individuals) that are reported to be non-preferred or punishing are actually non-preferred/punishing. That is, clinicians may be able to measure the degree to which deviant and/or non-deviant visual stimuli (e.g., pictures of age-appropriate peers, pictures of young children, pictures of non-evocative stimuli) are appetitive without many of the drawbacks, such as obvious demand characteristics, associated with other procedures used to evaluate preferences for appropriate/inappropriate stimuli with juveniles (i.e., self-report measures, VT procedures). There are numerous advantages to using this or similar conjugate-reinforcement procedures to assess for deviant preferences with juvenile offenders. First, these computer-based procedures generate numerous dependent variables, such as the number of responses, the duration of the responses, and the time in the sessions when the responses end, all of which may be modeled as behavioral indices of preference. Furthermore, other apparatus may be used in these conjugate preparations such as force transducers, which can generate the aforementioned dependent variables in addition to the maximal peak force in grams of each response. This is stark contrast to data produced from VT procedures, which only include the duration that each stimulus is viewed and is a relatively insensitive, passive measure of preference (e.g., Letourneau, 2002). Additionally, these type of conjugate schedule procedures lack many of the demand characteristics associated with VT procedures (Smith & Fisher, 1999), potentially making these procedures more discrete and less prone to impression management (Gannon et al., 2007).

Overall, in the current project I will assess the utility and application of several conjugate-reinforcement based assessment procedure for measuring deviant preferences with juveniles adjudicated for illegal sexual behavior in a secure residential facility. Using a computer-based force-transducer procedure with audiovisual stimuli, the study aims to establish the convergent validity and reliability of these procedures using available data regarding participants’ offense characteristics and a variety of established risk assessment tools and protocols. The current study will be unique in several aspects. For example, there is a paucity of research on the development of behaviorally based assessment procedures for deviant sexual preferences, and the current study will utilize a heterogeneous population of juvenile delinquents, including those receiving mandatory inpatient treatment for ISB. Thus, the current study has the potential to develop novel assessment procedures that hold important applied and translational implications for researchers and clinicians interested in the assessment of risk for re-offending. If you would like more information about this project, please send me an e-mail at jmf0031@auburn.edu. I would also like to recognize and thank my project advisors, Drs. John Rapp and Barry Burkhart. This project would not be possible without the generous financial support offered by ATSA through the Predoctoral Research Grant.

Chaffin, M. (2008). Our minds are made up—Don't confuse us with the facts: Commentary on policies concerning children with sexual behavior problems and juvenile sex offenders. Child Maltreatment, 13, 110-121.

Finkelhor, D., Ormrod, R., & Chaffin, M. (2009). Juveniles who commit sex offenses against minors. Juvenile Justice Bulletin. Washington, DC: US Government Printing Office.

Gannon, T. A., Keown, K., & Polaschek, D. L. (2007). Increasing honest responding on cognitive distortions in child molesters: The bogus pipeline revisited. Sexual Abuse: A Journal of Research and Treatment, 19, 5-22.

Kaemingk, K. L., Koselka, M., Becker, J. V., & Kaplan, M. S. (1995). Age and adolescent sexual offender arousal. Sexual Abuse: A Journal of Research and Treatment, 7, 249-257.

Letourneau, E. J. (2002). A comparison of objective measures of sexual arousal and interest: Visual reaction time and penile plethysmography. Sexual Abuse: A Journal of Research and Treatment, 14, 203-219.

MacAleese, K. R., Ghezzi, P. M., & Rapp, J. T. (2015). Revisiting conjugate schedules. Journal of the Experimental Analysis of Behavior, 104, 63-73.

Rapp, J. T. (2008). Conjugate reinforcement: A brief review and suggestions for applications to the assessment of automatically reinforced behavior. Behavioral Interventions, 23, 113-136.

Rea, J. A., Dixon, M. R., & Zettle, R. D. (2014). Assessing the Generalization of relapse-prevention behaviors of sexual offenders diagnosed with an intellectual disability. Behavior Modification, 38, 25-44.

Smith, G., & Fischer, L. (1999). Assessment of juvenile sexual offenders: Reliability and validity of the Abel Assessment for Interest in Paraphilias. Sexual Abuse: A Journal of Research and Treatment, 11, 207-216.

Worling, J. R. (2006). Assessing sexual arousal with adolescent males who have offended sexually: Self-report and unobtrusively measured viewing time. Sexual Abuse: A Journal of Research and Treatment, 18, 383-400.

A Student’s Guide to the ATSA 2017 Conference

Andrew E. Brankley
Ryerson University, Toronto, Canada
ATSA Student Representative on the Board of Directors

FO·MO /ˈfōmō/
Origin – English “fear of missing out”
Noun informal
Anxiety that an exciting or interesting event may currently be happening elsewhere.
“My FOMO is bad because I don’t know what to do at the ATSA 2017 Conference!”

The opportunities at ATSA Conferences can seem overwhelming—especially for students. From the start you are handed a thick package of information about concurrent sessions, plenaries, receptions, and other events where you can learn, share your interests, and meet colleagues and leaders in the field. With so many options you feel burdened with the tyranny of choice - Where do you go?

The purpose of this guide is to direct students’ attention towards events that are either specially designed for students or are cornerstone events that should not be missed at any ATSA conference (See Table 1 for an outline).

Think of conferences like major theme parks that deliver knowledge and collegiality instead of screams and disappointing/overpriced food. There are a few common practices that can help you get the most out of your day:

Before the conference begins check out the only free preconference workshop that is designed especially for students eager to get the most out of ATSA and their training experiences. The focus of this workshop is developing professional skills critical to a successful career. The three areas of professional growth are (1) constructing a professional identity, (2) networking and self–promotion, and (3) improving self–care. Presenters will use a combination of lecture, demonstration, group activity, discussion, and detailed resource material to actively engage and inform audience members. the goal of this workshop is to provide a comfortable environment for students and early career professionals to learn, share ideas, and network.

The Student Clinical Case and Data Blitz caps off the first conference day, just before going to the poster session. The Blitz features 14 presentations examining important issues related to the prevention, assessment, management, and treatment of individuals who engage in nonconsensual sexual behaviours. Even if you are not presenting, you should come and hear these rapid 5-minute presentations from upcoming researchers and professionals. This year promises to be the best yet as we received more submissions than ever before

Just after the Blitz on Thursday, and again on Friday, is the Poster Session. Do not let the name fool you—student content dominates the poster session. The content is so good we have a tradition of awarding prizes for the top student posters for each day. Posters will be evaluated on their visual presentation and quality of research. So come by and check out the stellar posters while taking advantage of the hors d'oeuvres and cash bar.

Your first conference day is still not finished as we invite you to The NextGen Student Reception. The reception is a “backstage pass” designed to connect ATSA student members with leaders in our field. You enter a comfortable, social environment where students can network and engage established researchers in the field of sexual abuse in lively conversation to discuss issues and ask questions. This is especially important for students planning on graduate school. We invite the ATSA Lifetime Achievement Award winner to give a few words of wisdom and, new this year, will be networking games with prizes for the winners.

The ATSA conference has several not-to-be missed events that are great opportunities for students to mix with ATSA membership. The morning network events are hidden gems as you have the opportunity to meet people interested in meeting you. I also cannot say enough good things about the annual Speakers Event. Picture private Cirque Du Soleil-style performances, Mexican food and dancing, and go kart racing. These events are so popular that back channel competitions are held to secure the few leftover tickets, or so I am told.

The Annual ATSA conference is the highlight of my professional and social calendar. I praise it so highly because I have been to many other conferences and I have yet to see such a genuine combination of quality learning and professional socializing. Whether you are presenting or listening, ATSA is a supportive nurturing environment. Don’t miss out!

Authors Note: I would like to thank the members of the student committee for their help and input in writing this piece: Carisa Collins, Carissa Toop, Danielle Loney, Darragh McCashin, Ian McPhail, Jacinta Cording, Kelcey Puszkiewicz, Laura Kuhle, Sacha Maimone, Mina Ratkalkar

RNR Principles in Practice In the Management and Treatment of Sexual Abusers

Who knew that three simple principles could be so difficult to understand and implement? They exist at the center of roughly four decades of research and practice around the world. In brief, the risk principle holds that the most intensive interventions should be reserved for those who pose the highest risk for re-offense. The need principle holds that interventions should target those treatment needs associated through research with re-offense risk. The responsivity principle holds that interventions should be provided in accordance with the individual characteristics of each treatment participant.

As Jung quickly points out in the first pages, it can be easy to look backwards at the principles and the research that supports them, and conclude that they are inherently obvious while wondering why anyone would have ever thought differently. She then lays out an excellent case for why this sort of retrospective bias would be wrong. Starting with the tragically misguided conclusions of Martinson (1974), Jung walks the reader through the origins of what is now known simply as “RNR”.

Why is this important? From an empirical perspective, it is vital, since Hanson, Bourgon, Helmus, & Hodgins (2009) found that these principles apply as much to people who have sexually abused as to any other person who comes into contact with the criminal justice system. It is equally vital from a practical standpoint when one considers how difficult these principles can actually be to understand and implement. Consider the furor in the wake of Hanson and Bussiere’s (1998) meta-analysis finding that denying one’s offense is not a risk factor on its own. Much debate ensued (e.g., Lund, 2000), with many coming to conclude that denial should likely be considered a responsivity factor. Indeed, Jill Levenson and the author conducted three consumer satisfaction studies in which the belief of treatment participants was clear: being accountable for one’s actions was the most important part of treatment (Levenson & Prescott, 2009; Levenson, Prescott, & D’Amora, 2010; Levenson, Prescott, & Jumper, 2014). Similarly, consider the plight of self-esteem in treatment. Scant research shows it to be a risk factor, and yet it can be vital to meaningful engagement in treatment.

Jung’s is among the first books to take on the RNR principles and their place in treatment specifically with people who sexually abuse (Looman and Abracen’s 2016 book also addressed RNR, although theirs was focused exclusively on treating those who pose the highest risk). Compared to other writings in this area, it is presented with refreshing clarity and elegance. This is particularly welcome, as many readers have – frankly – criticized the original books by Don Andrews and Jim Bonta as being difficult to read. It has often seemed that while most professionals want to have read authoritative works about RNR, few actually want to go through the process of reading them. With this effort, Sandy Jung has made these principles significantly accessible. When reflecting on their earlier efforts, it is equally clear that Safer Society has “upped their game” in terms of production values.

The chapters each come with examples, bullet points of important concepts, and summaries of key points. Readers should not be fooled by the simple language: Jung has distilled this material only after years of study and work with these principles. After an abridged history of RNR, Jung discusses what the principles are and are not. She next reviews why they are important to consider, how they contribute to overall program efficiency, how programs can maintain adherence to them, and why a book on them is necessary in the first place.

Jung next takes each principle in its turn, from risk assessment to distinguishing between general and specific responsivity and key factors to consider in all three principles. These chapters will be helpful to novices and more seasoned readers alike. A chapter of case illustrations follows, followed by an exploration of implementation challenges; as pristine as the principles can appear in print, they still require fallible humans to put into practice. To this end, Jung’s efforts reflect very considerable experience.

The production, clarity, and importance of the topic make this a welcome and necessary addition to our field’s knowledge and practice. While Sandy has publicly commented on the amount of work involved in producing a volume of this sort, the field owes her a debt of gratitude. Here’s hoping that we hear from her again soon.

Hanson, R.K., & Bussiere, M.T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348-362.

Hanson, R.K., Bourgon, G. Helmus, L., & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 36, 865-891.

Levenson, J.S., & Prescott, D.S. (2009). Treatment experiences of civilly committed sex offenders: A consumer satisfaction survey. Sexual Abuse: A Journal of Research and Treatment, 21, 6-20.

Levenson, J.S., Prescott, D.S., & D’Amora, D.A. (2010). Sex offender treatment: Consumer satisfaction and engagement in therapy. International Journal of Offender Therapy and Comparative Criminology, 54, 307-326.

Levenson, J.S., Prescott, D.S., & Jumper, S. (2014). A consumer satisfaction survey of civilly committed sex offenders in Illinois. International Journal of Offender Therapy and Comparative Criminology, 58, 474-495.

2017 ATSA Conference Events

ATSA Gives Back
Tuesday, October 24, 11:30 am - 3:30 pm
During ATSA’s first corporate social responsibility event, a new half-day pre-conference activity, you will have the opportunity to give back to our host community by helping a local non–profit. The 2017 recipient is Sunflower House, an organization that assists children who have been physically and sexually abused. We will be providing a range of services from helping clean and organize the interior to doing some exterior landscaping, to stuffing envelopes, to organizing bags and toys for the children. There’s a project for everyone’s interest. enjoy a day of exercise and camaraderie as you help make life better for children. there is limited space available, so sign–up today with on your online registration! for more information contact Ann Snyder, ATSA Public Affairs Coordinator: ann@atsa.com

Public Engagement Event
Tuesday, October 24, 6:30 pm - 8:00 pm
This event brings together community members, professionals, practitioners, academics, and researchers to have a frank and informative discussion about preventing sexual harm. this discussion will be led by experts in the field around residency restrictions, sex trafficking, youth registration and campus sexual assault. Everyone is welcome!

Morning Networking Event
7:45 am – 8:15 am | Wednesday, Thursday, Friday
Back by popular demand! Start your morning off with a brief networking experience sure to put a smile on your face. Some of the most memorable and valuable opportunities at a conference come from the people you meet, so join us for a 30 minute networking event to broaden your professional circle. Experience a new approach to networking, meet some new colleagues, and possibly win one of our wonderful door prizes! Great for those new to the ATSA conference as well as long–time members. Registration not required.

Dismantling Racism: The Relevance to Prevention
Thursday, October 26, 5:30 pm - 6:30 pm
Talking about sexual abuse and violence may seem easy compared to talking about race, power and privilege. Yet facing this discomfort is necessary to understand how the biases we all have can get in the way of positive use of the privileges and power we have along with our ability to build authentic relationships. Join us for this unique and thought– provoking discussion.

Preventing Harmful Sexual Behaviors in Youth: An Infographic from the ATSA Prevention Committee

Every child and adolescent who engages in harmful sexual behaviors does not have the same motivations, risks, strengths and skills. They face different risks, they have different histories, and therefore their need for support systems will be different. A “one size fits all” intervention will not work for every child and teen. Our support and education must be individualized for each child.

Welcome Incoming Board Members

To nominate yourself or a colleague for the ATSA Board, submit your nominations beginning in March, 2018.

2017 ATSA Awards

In recognition of researchers and clinicians who have made significant contributions to our mission and to the prevention of sexual violence through research, treatment, and management, the ATSA Board of Directors is pleased to announce this year’s award recipients.

Lifetime Significant Achievement Awards

ATSA is proud to present Grant Harris, Ph.D. and Marnie Rice, Ph.D. with posthumous Lifetime Significant Achievement Awards.

Grant Harris (1950–2014) and Marnie Rice (1948–2015) were pioneers in the development and evaluation of sex offender treatment programs, appraising the risk of sexual and violent re-offending, the assessment of sexual preferences, and developing theories to explain sexual offending. In terms of the criteria for the award, they made important contributions to the state of knowledge of sexual abuse, the reduction or prevention of sexual abuse, and the development of programs to assist abusers.

Gail Burns–Smith Award

Patty Wetterling is a nationally recognized educator on the issues of child abduction and sexual exploitation of children. Patty and her husband Jerry, co–founded the Jacob Wetterling Resource Center (JWRC) to educate communities about child safety issues in order to prevent child exploitation and abductions. Patty co–founded and is past Director of Team H.O.P.E. a national support group for families of missing children. She is also a founding member and past president of the Board of Directors of the Association of Missing and Exploited Children’s Organizations (AMECO). She has also co–authored a book, “When Your Child is Missing: A Family Survival Guide,” along with four other families. For nearly 27 years Patty has been a visible spokesperson effective public policy and importance of keeping hope alive.

Distinguished Contribution Award

Detective Bob Shilling is known internationally for his expertise in tracking down individuals who have sexually abused children. He has written or co–authored numerous laws to help protect children and has become one of the world’s most sought– after experts in catching individuals who sexually offend against children. For the majority of his 32–year career, he has served in the Seattle Police Department's Sexual Assault and Child Abuse Unit. During that time, he was invited by Interpol to serve a special three– year assignment beginning in 2012 to lead their Crimes Against Children Group, the first time in Interpol history that a municipal–level police detective and an American has filled this highly distinguished position. In that role, he coordinated efforts for the agency’s 190 member countries and implemented best practices globally. He continues to work with the Seattle Police Department and consult with Interpol. “My passport is very full," the 61–year– old grandfather of three says of his travels to France, Germany, Switzerland, the U.K., Italy, Sri Lanka, Thailand, and the island of Mallorca, all on Interpol business.

2017 Student Awards Recipients

Graduate Research Award
Lesleigh Pullman, Ph.D. Candidate
Differences between Biological and Sociolegal Incest Offenders: A Meta-Analysis

Pre-Doctoral Research Grant
Maddison Schiafo, M.A.
Personality, Decision-Making, and Sexually Coercive Behaviors among College Students

Pre-Doctoral Research Grant
Natalie Germann, Ph.D. Student
Sexual Violence Prevention: The Development an Integrative Psychometric Tool to Evaluate Outcomes of Sexual Violence Primary Prevention Programmes in High-School Populations

Pre-Doctoral Research Grant
Nicole Graham, M.S.
Examining the Use of Hebephilia and Paraphilia Non-Consent in Sexually Violent Predator (SVP) Evaluations

ATSA Professional Code of Ethics 2017 Revisions and Additions

The arduous task of revising and updating the ATSA Code of Ethics (COE) has been completed. The rigorous review and input by all committee members has helped shape this updated version. The COE are currently at the printer, likely by the time you receive this article you will have access to the updated version.

Ethics by definition are moral principles that govern a person’s or group’s behavior. Our hope is that each of you will make it your personal and professional responsibility to review our 2017 COE. While implicit and at times explicit within the revised document you will find encouragement to seek peer or professional consultation, it’s always a helpful reminder that we alone do not possess all of the answers to any question or dilemma we may face in our professional lives. Thankfully we have many caring and brilliant colleagues who are more than willing to talk through any ethical questions you may have. The committee also encourages you to reach out before your situation becomes a “sticky wicket”.

Of course as anyone who has spent time writing professional guidelines, standards or codes of ethics can tell you, expect to spend time discussing the occasions of when to use shall-will, should-would, and may-can. So, yes we did spend some time having robust discussions on the proper word usage but you may not notice them throughout the updated document. The ATSA Ethics Committee hopes that each Member will find this updated version of our COE to be a helpful resource and provide some direction when faced with potential ethical questions.

Our COE is divided into two sections: Section A) Ethical Principles and Section B) Rules and Procedures. Of note our COE is meant to complement ATSA Practice Guidelines for Male Adults.

In Definitions you will notice that the definition of client has been enhanced to identify that a client is not just a person, but rather with the increasing trend of courts and agencies paying for treatment and assessments it is important to remember that we have a professional responsibility to referring agents as well.

The additional points for this section of the COE will be noted as k) ATSA may consider deviations from the ATSA Adult Practice Guidelines and ATSA Adolescent Practice Guidelines an ethics violation except to the extent that a guideline conflicts with applicable laws or professional regulations that pertain to a Member’s practice. Also of note is the addition of l) It is unethical for ATSA Members to conduct evaluations with the primary purpose of determining guilt or innocence.

We updated the professional conduct section to include sexual orientation as a part of sexual harassment and so it is not gender specific.

(e) Members shall not engage in sexual harassment. Sexual harassment is unlawful discrimination within a professional relationship on the basis of gender and/or sexual orientation and includes any unwelcome verbal or physical sexually oriented conduct that is sufficiently severe or pervasive to have the purpose or effect of unreasonably interfering with a professional relationship or creating a hostile, intimidating, or offensive professional environment.

The standard for determining whether harassment based on an individual’s gender and/or sexual orientation is sufficiently severe or pervasive to create a hostile, intimidating, or offensive professional environment is whether a reasonable person in the circumstances of the complaining individual would so perceive it.

Bartering for services may result in a dual relationship and therefore may leave a Member open to an ethical complaint. Members should conform to their specific professional discipline’s codes of ethics for further guidance (e.g., the Canadian Psychological Association or American Psychological Association). For further discussion of dual relationships, see Section 8, Dual Relationships.

An addition to this section of the COE is: Members shall address the following financial matters with clients: i. The Member shall describe the fees for services to the client either before or at the time of the initial appointment. ii. The Member shall settle payment arrangements for fees at the beginning of an assessment or a therapeutic relationship. iii. If there is a change in fees, or if a service is to be provided for which the fees have not been discussed, the Member shall inform the client of the change in fees before providing the service. In the case of an emergency, the Member shall inform the client of any fees as soon as is practical after rendering the service. iv. If the client is a minor or lacks the capacity for consent, the Member shall inform the parent or legal guardian of all fees in the manner outlined above. This has been removed from the client relationships section.

Promoting professional obligations you will notice the following inclusions under Client Relationships. (j) If Members anticipate the termination or disruption of services to a client, they shall notify the client promptly and, when possible, provide for transfer or referral to a different practitioner.

(k) Members who serve a client of a colleague during a temporary absence or emergency shall serve that client with the same consideration they afford to their own clients.

(l) Members recognize that their primary professional obligation is to the client to whom they are providing services, regardless of who is paying for those services. Additionally, Members recognize that third-party relationships have the potential to create conflicts of interest and that the primary professional obligation remains to the client.

(m) When performing consulting services, the client may be an agency or organization. In this case, Members shall behave in accordance with the ATSA Code of Ethics and take steps to protect the organization and the individuals within.

The former section of Multiple Relationships is now titled Dual Relationships and has the following section has been added to help navigate social media, electronic communications, texting, and phone usage. Members shall clarify with clients what are considered appropriate means of communication to avoid dual relationships and to protect client confidentiality, which may include interacting via social media, electronic communication, and/or phone.

An important addition to this COE is Record Keeping. We encourage you to familiarize yourself with your professional obligation regarding good records, keeping them confidential, treatment planning and document storing, accessing, transferring and disposing of records.

It is not uncommon that many of our clients have been in treatment with another treatment provider. The committee felt it was imperative to clarify the importance of making reasonable attempts to contact any current or previous practionners.

Note the addition in this section: Members shall be aware that incarcerated individuals, probationers and patients in secure forensic settings are vulnerable populations and that, therefore, additional human subject protections may apply.

Perhaps the most noticeable change in this section is that the ATSA ethics committee will no longer rely on a Special Advocate and the committee can commence an investigation by its own motion. Of course it goes without saying that if a complaint does come to the committee, then committee members will recuse themselves if they have a conflict of interest with any party that is involved in the complaint.

Procedurally, we encourage Members to address their concerns at the lowest level when possible. The ATSA Ethics Committee also encourages you to seek consultation from any of its members or a colleague.

New ATSA Members

The following ATSA members were approved for Membership from June to September 2017.

ATSA Forum

Editor's Note

President's Message

Why is Juvenile Polygraph Not Recommended by ATSA?

Responding to Problematic Technology Use:
Creating a Therapeutic Toolbox

Looking After Ourselves and Each Other

Utilizing Recreation Therapy as Part of the Treatment Model

Understanding and Preventing Adolescent Pedophilia TEDMED Talk

Step One of Cultural Competency Addressing Privilege & Power

Assessment of Deviant Preferences Using Novel Behavioral Assessment Procedures

A Student’s Guide to the ATSA 2017 Conference

RNR Principles in Practice In the Management and Treatment of Sexual Abusers

2017 ATSA Conference Events

Preventing Harmful Sexual Behaviors in Youth: An Infographic from the ATSA Prevention Committee

Welcome Incoming Board Members

2017 ATSA Awards

Lifetime Significant Achievement Awards

Gail Burns–Smith Award

Distinguished Contribution Award

2017 Student Awards Recipients

ATSA Professional Code of Ethics 2017 Revisions and Additions

New ATSA Members

ATSA Forum

Editor's Note

President's Message

Why is Juvenile Polygraph Not Recommended by ATSA?

Responding to Problematic Technology Use: Creating a Therapeutic Toolbox

Looking After Ourselves and Each Other

Utilizing Recreation Therapy as Part of the Treatment Model

Understanding and Preventing Adolescent Pedophilia TEDMED Talk

Step One of Cultural Competency Addressing Privilege & Power

Assessment of Deviant Preferences Using Novel Behavioral Assessment Procedures

A Student’s Guide to the ATSA 2017 Conference

RNR Principles in Practice In the Management and Treatment of Sexual Abusers

2017 ATSA Conference Events

Preventing Harmful Sexual Behaviors in Youth: An Infographic from the ATSA Prevention Committee

Welcome Incoming Board Members

2017 ATSA Awards

Lifetime Significant Achievement Awards

Gail Burns–Smith Award

Distinguished Contribution Award

2017 Student Awards Recipients

ATSA Professional Code of Ethics 2017 Revisions and Additions

New ATSA Members

Responding to Problematic Technology Use:
Creating a Therapeutic Toolbox