President’s Column
Volume XVI, No. 3 • Summer 2004
Nature of Attachment
Deficits: Part 1
Ethics: Terminating
Therapy with Clients
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David Prescott, L.I.C.S.W.
Forum Editor
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Explore New Mexico!
President’s Column
Nature of Attachment
Deficits: Part 1
Ethics: Terminating
Therapy with Clients
The ATSA Forum
Turns 20
Committee Report:
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2004 issue:
September 1, 2004
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Submitted by
Michael Miner, Ph.D. Conference Chair
This fall, the ATSA family will convene for a new and unique
conference in Albuquerque, New Mexico. This conference will be
different in that it is the first annual conference of the post
Connie Isaac era and the conference will be held at the
Albuquerque Convention Center rather than a single conference
hotel. For the last 10 years, in addition to her other roles, Connie
has been the major force behind the annual conference. Her
organizational skills and leadership has made our annual
conferences the major events they are today. Luckily, we had the
opportunity to benefit from her skills and knowledge during the
formative stages of planning for this conference, and she
graciously agreed to return for a short time this spring to help us
when things were up in the air. In addition to Connie, Ingrid Ortiz
also came back this spring to help with the administrative and clerical tasks necessary to complete
the conference program. I thank you Connie and Ingrid and thank you to Kelly McGrath, who has been
the constant at the ATSA office throughout the process of planning this year's conference.
Something Old
Back, by popular demand, are the Sex Offender Assessment, Treatment and Supervision Training
Tracks. These balanced and comprehensive overviews are designed for those new to sex offender
work and were well received at last year's annual conference. Again, Jim Worling will present the
adolescent track, and Bob McGrath and Georgia Cummings will co-present the adult track. These 12
hour programs will be meet all day on Wednesday and on Thursday and Friday afternoons.
Participants attending these sessions and the six plenary sessions are eligible to sign up for 18 hours
of CE credits.
Something New
This year's plenary sessions will include a Point/Counterpoint discussion by Adelle E. Forth, Ph.D. of
Carleton University and John Edens, Ph.D., of Southern Methodist University addressing the
Psychopathy Across the Life Span: Controversies and Applications. This discussion by these two
eminent researchers, with time for audience participation, will be enlightening and challenging.
I am very excited about this year's conference. The setting in Albuquerque, with its unique climate,
New Mexican cuisine, and the beauty of the desert and mountains, will provide the perfect backdrop
for an excellent mix of enlightening professional sessions and social activities. The breakout session
schedule of symposia, papers and workshops provides participants with a selection of topics that
address the important clinical, supervision, policy and research issues for adult, adolescent, and
special populations. In addition to the educational stimulation, this year, as a special treat, the
Conference Committee brings you the spectacular ATSA band, which will perform at the opening
reception. Listen and, per chance, dance to the music of this group of prominent ATSA members.
As with everything in ATSA, the upcoming conference reflects the work of an astonishing group of
volunteers. I want to offer my thanks to the Conference Committee, who provided aid, insight, and
time to developing a program that I believe you will find intellectually stimulating and professionally
useful, whether your interests are in applicable skills, useful knowledge, or scientific rigor. Please join
me in thanking Ray Knight, Lloyd Sinclair, Robin McGinnis, Moss Aubrey, Carol Ball, Lucy Berliner,
David Burton, Richard Laws, Jean Proulx, Connie Koch, David Thornton, and Kevin Nunes, this year's Conference Committee. Also,
joining these individuals in reviewing abstracts for the conference were Lawrence Ellerby, Robin Goldman, Art Gordon, Carmen
Gress, Jim Haaven, Karl Hanson, Stephen Hucker, Stephen Huot, Keith Kaufman, Janice Marques, William Murphy, Jacque Page,
Robert Parham, David Prescott, Marnie Rice, Steve Sawyer, and Carl Viesti. Thank you all for your important contributions to this
year's program.
I am looking forward to seeing all of you in Albuquerque.
Michael Miner, Ph.D.
Conference Chair
Come Learn and Explore New Mexico!
On behalf of the Executive Board and Conference Planning Committee, I want to personally invite you to
come to ATSA's 23th Annual Conference, DIRECTING DECISIONS: Assessment for Disposition,
Treatment and Outcome in Albuquerque, New Mexico October 27th - 30th. Five of us have just
returned from a weekend planning trip in Albuquerque. We toured the Convention Center and hotels
and sampled the delightful cuisine as we prepare for your arrival for four wonderful days of learning,
networking and fun. The Program Committee has planned a great curriculum that will be coming your
way in a printed brochure to be mailed to you in July. What can't be fully shared in the brochure is the
incredible diversity both in landscape and cultures that exists in New Mexico. The deep roots of the
Hispanic New Mexico can be seen throughout the city along side the Pueblo Indian traditions.
Albuquerque is an old historic area yet, young changing city. Remember Route 66? It runs right through
the main street of the downtown area. It is just walking distance from any of the conference hotels.
Route 66 is dotted with restaurants, museums, shops and nightlife for your enjoyment. Old Town
Albuquerque in just a short taxi ride from the any of the hotels. Old Town is steeped in history and for
more modern interests - great restaurants and shopping that will give you the flavor of the cultures. We
will have excursions available on the weekend to take you up the mountains to Santa Fe, just an hour's
drive from Albuquerque. Santa Fe is known for its art and history, and eateries. Or Taos! Did you know
that New Mexico has some of the oldest wineries in the United States? The wine vineyards were planted
by the old Spanish Monks who needed celebration wine for the masses. Winery maps and tours are
available for a wonderful post-conference Saturday afternoon. Or you can plan your own side trip to
southern New Mexico and tour Carlsbad Caverns - an incredible place that I remember seeing as a young
child while vacationing with my family - but keep your head low because the bats can snoop down at
you in the caves!
Any way you plan it - before the conference begins or afterward - don't miss New Mexico, the "Land of Enchantment". We will offer
you an educational opportunity to hear of the newest research in the field, discover different treatment techniques, and to
exchange ideas with old or new friends that we see only at the annual ATSA conference. I hope to see all of you in Albuquerque in
October.
Robin McGinnis
Executive Board - Midwestern Representative
Dear ATSA colleagues,
To say that the three months since my last Presidential column have been eventful is clearly an
understatement. When we went to press in March, the Search Committee was flying to Portland to
interview our top four candidates for Executive Director. The interviews went well and the committee
agreed on our top candidate--Kathleen Eymann, J.D. She was recommended to the Executive Board, who
in turn voted unanimously to offer her the Executive Director position. Katy accepted the position and
began training with Connie on March 23rd.
Katy had previously been employed as a public defender, legal affairs administrator, private attorney,
executive director, state and federal government lobbyist, campaign manager, and private business
owner. She was a seasoned veteran with extensive executive director experience, and substantial skills
in management, finances, grant acquisition, lobbying, and convention planning. Unfortunately, Katy's
tenure with ATSA was short. It was evident within a short period of time that despite Katy's skills and
background ATSA and Katy were not a good match, and she decided to end the relationship.
This left us without an Executive Director. The Search Committee moved into high gear to replace Katy. Fortunately, in the final
pool of applicants whom the committee had interviewed in March, there had been a second candidate about whom the committee
was equally excited, John Gruber. After Katy's resignation, the Search Committee immediately contacted John to determine
whether he was still available for the position. Luckily, he was. The Search Committee presented his credentials and their review of
his competence to the Executive Board. The Board voted to offer John the position. On May 10th the committee finished
negotiations with John on his contract. John started as new Executive Director on Tuesday, May 11, and he attended his first
Executive Board meeting on May 15th and 16th in Portland.
John brings substantial managerial, financial, and organizational skills to the position. John has a Masters in clinical psychology and
substantial experience in rehabilitation training and alcohol treatment. He has founded and successfully developed and managed his
own company. We are very pleased to have him as our new Executive Director. It is clear from his performance during the last three
weeks that ATSA and he are a good match.
In the interim between Katy's departure and John's beginning, Connie Isaac returned to keep the office going and to make sure that
all the important functions of the Executive Director continued unabated. She also kindly agreed to spend considerable time training
John in all of the details of running the ATSA office, interfacing with the Executive Board, and keeping the planning for the
conference on track. We are deeply indebted to Connie for her help and devotion to ATSA.
Despite the disruption of the ATSA office, progress has continued on a number of fronts, and I will comment on a few of the more
salient areas. The planning for the conference in Albuquerque is on schedule. The theme for this year's conference, "Directing
Decisions: Assessment for Disposition, Treatment, and Outcome" taps core tasks that face us all, whether we are attempting to set
up a prevention program, adjudicating juvenile or adult sexual offenders, determining the kind and the course of interventions for
offenders, victims, or their families, or making dispositional decisions about release, community management or notification, lifetime parole, or civil commitment. Consequently, the program of the conference encompasses a diversity of topics that will meet the
educative needs and the broad range of the interests of our membership. Plenary talks cover a range of topics from the effects of
pornography, to assessing the consequences of community the notification, to assessing psychopathy in juveniles. We have an
exciting program, and we hope that as many of you as possible will join us in Albuquerque.
During the last few months several initiates that have been undertaken by the Board have continued to move toward imminent
completion including the revision of the standards and guidelines for adults, the task force on treatment, the information packages
on treatment and on medical intentions, and a number of public policy fact sheets. New initiatives include creating an ad hoc
committee, co-chaired by Migdalia Baerga and Maia Christopher, to recommend to the Board a process for adopting future
changes/revisions of the standards and guidelines, finalizing the composition of the prevention and adolescent task forces, creating
a mentoring program, and the developing affiliation agreements with several international sister organizations.
I am pleased to announce that the Executive Board has decided to fill a position authorized in our by-laws that we have not
previously used, Secretary. The Board voted unanimously to appoint Robin McGinnis to fill this position. Robin was a member of the
Search Committee and made critical contributions in guiding us through our recent transition difficulties. The Executive Committee,
which was a subcomponent of the Search Committee, wanted to continue to make use of Robin's considerable executive skills and
wise counsel, and therefore recommended her appointment at our recent Board meeting in Portland.
Even though the search process and the transition to a new director have incurred unexpected expenses that have put some
economic strain on our budget, ATSA remains in excellent financial condition. Our commitment to streamlining costs, to keeping
dues as low as possible, and to maintaining a realistic budget has again kept ATSA on solid financial footing. Despite the recent
transitional problems that we have encountered, ATSA is healthy and moving in positive directions to meet future challenges.
Raymond Knight, Ph.D.
President
By Phil Rich, Ed.D., L.I.C.S.W.
Editor's note: This is the first part of a two-part series. Dr. Rich is the Clinical Director of Stetson School, a residential
treatment center for sexually abusive youth in Barre, Massachusetts.
Attachment Theory and its Link to the Development of Sexually Abusive Behavior
There's been a tremendous amount written on the subject of attachments in both human beings and in primates and other animals,
and there's a wealth of literature on the subject, most of which is drawn from the field of attachment theory. Because the
"attachment" construct is most closely related to attachment theory, it's important to understand the evolution of ideas about
human attachment into a distinct theory of attachment, as well as understanding how attachment is represented and discussed in
the contiguous fields of developmental and social psychology, and even neuropsychology. Of course, in particular, we have great
interest in understanding if the ideas of attachment theory are relevant to understanding the onset of sexually abusive behavior,
and if so how deficits in attachment are connected.
In the literature of both adult and juvenile sexual offending a great deal has been discussed in terms of attachment, and the
disturbed sexual behaviors and sexual offending that may perhaps result from failure to attach, or from "disturbed" attachment.
Increasingly, and for quite some time, the field appears to have increasingly taken the position that attachment disorders are
primary in developing an understanding of sexually disturbed behavior in children, adolescents, and adults. However, what's not
clear is whether juvenile sexual offenders and sexually reactive children are any different in their disturbed attachments than other
troubled children, or if they are any different in their patterns and qualities of attachment than the general (non-clinical)
population. Further, exactly what we mean by "attachment," as we discuss the behaviors of juvenile and adult sexual offenders, is
poorly defined and does not match the definitions provided throughout the extensive literature and operationalization of
attachment theory.
Indeed, although sexual offender specific literature has increasingly described "attachment disorder" as part of the etiology of sexual
offending, these ideas have largely been described only in passing. Little work has actually been conducted with respect to
operationalizing the terms and ideas, and little has been attempted in the way of well designed and/or consistent research studies
that examine correlations between attachment and sexually abusive behavior. Most of the written material descriptions are either
anecdotal, based on observational current experiences of children and adolescents, or explorations of their past. The few studies
implemented thus far, mostly through the work of Marshall and his colleagues and, more recently, Smallbone and his colleagues,
fails to clearly define the terms and does not show any significant or consistent correlation between disturbed attachment and the
later development of sexually abusive behavior. Both groups offer interesting theoretical explanations that suggest (or assert) links,
and the research of both have shown some partial support for the ideas they are pursuing, but as Smallbone and Dadds (2000, p. 13)
have written, "it would be premature to conclude that prevention and treatment of sexual aggression should adopt attachment
concepts and respond to their implications; there is insufficient evidence to support such a broad conclusion (based upon the
present study)."
Attachment Theory: What is Attachment?
"Attachment Theory," developed by John Bowlby (1969), is a very specific model that essentially defines attachment as a biological,
and not a psychological, process. It was Bowlby's interest in ethology, or animal science, that took him along this path and through
which he created a theory that coupled human behavior and the psychology behind human behavior with a model of animal science.
Attachment behaviors are embedded within an attachment behavioral system, and this is one of several systems that operate within
the infant and throughout life. In particular, attachment behaviors operate in a mutual and inverse relationship with behaviors in
the organized exploratory system of the child in which when one behavioral system is activated the other is, in effect, switched off.
Also of special note, in the child the attachment system operates in synchrony with what is, more or less, the adult equivalent found
in the behaviors that constitute a caregiver behavioral system. That is, attachment behaviors are found in the child and not the
adult.
In this regard, the attachment bond does not reflect the dyadic relationship between two people (the child and caregiver), but
exists within the individual and represents the bonded relationship, and, more to the point, the dependency, that one individual
(the child) has upon another individual (the mother) who is perceived as the caregiver. A child can thus be attached to a person who
is not in turn attached back. The "attachment bond" is a specific type of a larger class of bonds referred to as affectional or
affiliative bonds, many of which may form during an individual's life, but which are not attachments in the language or intent of
attachment theory (which underscores the biological underpinnings of attachment). Attachment bonds are thus not symmetrical and
not simply interchangeable (from one individual to another, although the child can form more than attachment relationship), but
derived from the attachment bond comes the development of the "internal working model," or the development of an internalized
representation of the world that includes self and others.
Over time, attachment behavior eventually reflects both the partnership between the attachment figures (marrying attachment
behaviors with caregiving behaviors, ideally in an attuned and synchronous relationship) and the increasing capacity of the child to
build and act upon attachment strategies, triggering and meeting goals for exploration based primarily upon an internalized
experience of safety and security (or lack thereof). In this regard, the attachment relationship ideally becomes the "secure base"
from which the child will explore and emotionally grow, and eventually move into the larger world outside of the attachment
relationship. From the balance between the linked, inverse activation and deactivation of the attachment system and the
exploratory system is derived the secure base that contributes to and is the embodiment of the secure internal working model, or
the child's internalized representation of the world. The attachment bond, then, is a special relationship, not to be confused with
affectional bonds, which are part of the larger sociable, or affiliative, behavioral system.
Attachment is neither the result of a psychological drive nor a by-product resulting from the satiation of other needs, such as food
or shelter. In itself, it is a primary physical drive in which security and safety are actively sought. Hence, if attachment needs are
not met then exploration behaviors will not ensue, except under unusual circumstances. In fact, it is the absence of attachment
behaviors, coupled with other behaviors in an otherwise well-adjusted infant, that suggest secure attachment, rather than a display
of attachment behaviors. Just the opposite, if attachment behaviors are exhibited, at that moment at least, the child is feeling
insecure, uncertain, and or fearful and in need of physical or psychological protection.
However, attachment theory is concerned with more than attachment per se, and in effect presumes that the ultimate psychology
of individuals derives from three related systems that interact with one another during early childhood. The attachment,
exploration, and fear systems together serve to modulate and regulate the child's behavior, out of which develops the internally
developed and neurologically "hard wired" internal working model through which the child, and eventually the adolescent and the
adult, finds representations of self and others, serving as the template for all experiences of the world, its interactions, and its
relationships.
The Biology of Attachment
The aspect that most defines and makes attachment theory unique is its biological underpinning. That is, from an biological point of
view, the primary function of attachment behavior is to maintain proximity to a primary caregiver (presumably the mother), in order
to receive protection from possible predators, and to thus survive. When secure, that is free of fear, attachment behavior is
terminated.
Despite its growth from the field and practice of psychoanalysis, and a close relative (really evolving out of) object relations theory,
in this regard attachment theory is not a theory of psychology at all. In this model, attachment is a biological imperative upon which
the later development of human cognition and psychology is built. Attachment theory postulates that humans are no different in the
need for safety and survival (or attachment), exploration, and eventually reproduction, than any other animal, all of which also
have similar behavioral systems in place to ensure their survival and growth. The difference is that human beings have
consciousness, and it is from this level of self awareness, that our ideas about human cognitive development and psychology
emerge. As the infant develops, and thus develops consciousness, internal representations of the external world are formed and
imprinted into the developing central nervous system which, in turn, in a neurobiological model, influences and acts back to further
influence an experienced sense of security and the developing neurobiology of the central nervous system.
Probably the most important and most significant aspect of attachment theory is that, in terms of psychology, secure attachment
results in the development of a secure and confident personality from which, absent of neurobiological difficulties, the many fruits
include the ability to feel confident, tolerate and suffer emotional difficulties, be perceived by others as confident and sure, pursue
and achieve goals, and become self-efficacious. Attachment theory really is a biopsychosocial theory in that it really embraces these
three aspects of human development (biological, psychological, and social) in understanding the functional psychology of individuals
as they move through a world inhabited, driven, and defined by relationships, from the earliest pre-cognitive development of the
new born to the socially flooded life of the adolescent and adult.
Operationalizing Attachment Theory
Bowlby's great partner was Mary Ainsworth (Ainsworth, Blehar, Everett, & Wall, 1978) who operationalized his ideas and allowed
them to be tested in a laboratory setting. She created and developed the "strange situation" as the model by which 12-month-old
children could be observed under rigid and controlled conditions, and from this derived a model of attachment style, or a set of
three defined categories into which the attachment behavior of young children could be classified (more recently expanded to four
categories by Main and Solomon, 1986).
By one year of age, then, attachment patterns have been formed, and are generally believed to largely serve as a template for the
ongoing experience of and demonstration of security throughout life. By age 3 or 4, and the development of cognitive perspectivetaking, the manner or strategy in which a child interacts with his or her caregivers becomes organized and involves goal-corrected
partnership. The nature of this partnership as secure or insecure defines how the child interacts and what strategies the child
employs to get needs met, including the on-going need for security (which, in turn, evokes attachment behaviors or reduces the
need for attachment behaviors and instead allows the enactment of exploratory behavior).
Attachment and the Internalization of the External World
Virtually every model that recognizes an internal, cognitive world (non-behaviorist models) recognizes the inevitable reality of and
conjectures one version or another of a mental map, or internalized representations about the world, self representations, cognitive
schemas, or mental models. These models propose that the internal world is developed through interactions with the external
world, and that the external world is absorbed and re-created in a neural form within the brain. In the biologically based
attachment model, this is no different than the mental map of the bumble bee that allows the bee to consistently find its way
between its hive and a flower garden, and further to communicate this map to other bumble bees who then absorb this map of the
external world into their own internal maps. The difference may be in the complexity and depth of the internal representations of
the world built by human beings, that increases in complexity and depth over time and upon which human cognition and psychology
is built, recognized and allowed by the human capacity for self awareness and consciousness.
This interaction between the external physical world and the internal mental world reflects an interactive neurobiology that is
tuned and responsive to the external physical world, and in turn acts upon that external world through the physical activities of the
individual. Beyond this, the neurobiology of the individual is attuned to the neurobiology of other individuals in that external world;
beyond dyadic relationships, it is attuned to the neurobiology of other family members, the community, and society as a whole,
thus, in effect, producing social beings. In this respect, neurobiology as a process that is both experience expectant and experience
dependent is shaped by others and acts back upon others, tied to a larger social reality.
Attachment and Attunement in Relationships
Easily applied to dyadic caregiver and even family interactions, an attachment theory approach can be applied to a larger
interacting system. Here we're no longer talking about a specific neurobiology, as each individual has a separate brain. But the
implication is that two brains can be tuned to one another.
Two or more brains can be tuned to one another as in synchrony, and it precisely this model of attunement and connected brains (or
minds) that is central to the essential ideas of attachment theory, in which minute, fleeting, and almost imperceptible signals serve
as "hidden regulators" to trigger and influence a synchronous relationship between mother and child, affecting both parties. The
same external event - the fleeting look, the gesture, the spoken word, the interaction - is a potentiator, and accordingly creates an
event in the brain. In a neurobiological model, this event is a synaptic firing, forming the basis for "hard wired" neural circuits that
embed into the brain events and interactions that occur repeatedly.
In a secure attachment relationship, brains are tuned into the thing same things and create a similar reality for both parties,
creating a shared experience, leading to an experience of linked reality between the brains, even in the infant. Here perhaps, in
this conceptualization of finely attuned relationships, even in the pre-cognitive infant, lie the roots of empathy.
The trouble is that most of what we know about attachment comes from studies of infants and pre-school children, and somewhat
about romantic relationships in adults and in adult conceptualizations regarding their own parents, but little is known or understood
about attachment in adolescents.
The Development of Internal Working Model, Representations, and Schemata: Self and Other
The development of metacognition is a process also referred to as mentalization. It is closely linked to the ability of individuals to
reflect upon, understand, and make sense of their own mental experiences and thus find a means for looking into the mind of
others. In this conceptualization, the ability to mentalize has everything to do with the ability to be self reflective, and thus develop
the capacity to develop reflective functioning. In turn, the ability to be self reflective influences the ability to reflect upon and
understand the mind of others, resulting, in part, in a "theory of mind." In such a theory, the capacity to recognize, reflect upon,
and understand the mind of the other is key in developing a sense of self, for in the pre-cognitive infant it is in the mind of the
other (the mother) than the roots of self awareness and selfhood are found. In this regard, awareness of "other" establishes the
capacity for and possibly the origins of awareness of "self."
Through the formation of a resilient internal working model, the experience of being with, understanding, and interacting with
others is formed and stored, and serves as a mental representation upon which ideas about other and self are based. In attachment
theory and similar object relations theories, the internal working model contains not only mentalized representations of self and
others, and is the basis for personality, self image, and behavior, but is the filter through which different forms of memories are
recalled into a working model of the world, and which in turn serves as the building block for varying levels and systems of
schemata.
The internal working model is the basis for the grand schemata by which individuals understand themselves and others, as well as
relationships between themselves and others. Whether cognizant of their internal working model or not, all individuals, according to
attachment theory (and object relations theory in general) have an internal working model, and in higher forms of self awareness
(and occasionally through therapy) individuals become aware of and have access to these internal maps. The internal working model
begins in the pre-cognitive infant, but is not static. It is a dynamic (hence, psychodynamic) phenomenon that grows and develops,
and accumulates and evolves, throughout the life of the individual. The "working" in the internal working model, suggests constant
growth and change over time in internalized representations.
The Attachment Relationship and the Internal Working Model
The response of the attachment figure (the caregiver) to the child is more than the mere provision of reassurance, but is the
primary means by which the internal working model and hence sense of other (object) and self develop, and is hard wired into the
central nervous system. This involves the process of biofeedback and incorporation, and provides the platform upon which all else
develops, or can develop. In some ways, it is the basis for the assimilation and accommodation process central to Piaget's ideas and
observations about cognitive development and growth. In attachment theory, in pre-cognitive and even pre-emotional stages of
development, through the process of being experienced, understood, and accurately responded to by the caregiver (and other
caregivers) we learn to recognize, understand, and regulate our own internal states. This capacity for self regulation represents an
important foundation upon which an understanding of both self and others is further developed, and thus continues to contribute to
the development of selfhood.
Through the robust internalization of security, incorporated into the internal working model, we see the development of resilience,
as well as self modulation. Many writers have described the ability of the secure individual to experience discomfort and failure to
get needs or desires met, but nevertheless remain able to deal with the difficulties of life and its demands, and the demands and
requirements of relationships within it. The establishment of the secure internal working model also allows the development of
mentalization, or theory of mind, and thus the capacity to experience and understand the mind of another, and join with that mind,
in a rudimentary and perhaps basic form of empathy. Through this secure union of minds comes both social development and the
acquisition of social norms, and hopefully pro-social and moral values. Attachment, then, provides the basis for all emotional and
cognitive experiences of self and others. In its neurobiological counterpart, attachment is thus hard wired into the brain, affecting
the growth and trajectory of the brain.
Attachment and Neurobiology
As described, in attachment theory, the internal working model is a biological entity, hard wired into the brain. It is not merely a
psychological phenomenon, but is in principle no different than the bumble bee's internalized representation of the path to the
flower bed or the duck's migratory pattern. The internal working model is embedded into the central nervous system, and perhaps
the right orbitofrontal cortex, and is a neurobiological structure out of which human cognition and psychology emerges.
Why is it important to know about neurobiology and attachment? Because experience affects the neurobiology of individuals, and
their neurobiology then affects their experiences. The connection between memory, encoded in the brain in neurobiological packets
containing prior experiences, and emotion is critical here as memories are intertwined with emotion. Emotions don't simply "shade"
memory, but are embedded within memory and even define the experience of that memory and perhaps even what, and how, we
remember, including the nuances of the memory. Not everything is captured in memory, or at least declarative memory (memory
accessible to consciousness), and we know, for instance, that eye witnesses are poor historians, or expressors of factual detailed
memory. Emotion doesn't just shade memory, it defines it and is built into memory, and is thus intimately connected to and part of
memory. Memory, as a form of recalled thought, is intertwined with emotion.
As we increasingly understand how the human mind develops and functions, we recognize that every aspect of internal experience
and external behavior has a neurobiological counterpart, or precursor. In this regard, everything is physical at the neural level. In a
model of neurobiologically driven personality, those experiences, responses, and processes that are frequently experienced are
hard-wired into the brain/central nervous system, and find expression in mood, attitudes, ideas, interactions, and behavior.
Functional Attachment as the Basis for Healthy Adaptation
Severe disruptions to childhood attachment have been implicated in serious adolescent and adult psychopathology, including
personality disorders, substance abuse, and aggression, and, of course, sexually abusive behavior. As described by the National
Research Council Institute of Medicine (2000) normal experience supports normal brain development, and abnormal experience can
cause abnormal neural and behavioral development. Brain plasticity, in this regard, "is a double-edged sword that leads to both
adaptation and vulnerability" (p. 194).
Levy (2000) has written that beyond the basic function of secure attachment, attachment and its reciprocal relationship to
exploration and ultimately self regulation contributes to other developmental functions that children must accomplish:
1.
2.
3.
4.
Learning basic trust and reciprocity, serving as a template for future emotional relationships.
Exploring the environment with a feeling of safety and security, leading to healthy cognitive and social development.
Developing the ability to self-regulate, resulting in effective management of impulses and emotions.
Creating a foundation for the formation of identity, including a sense of competency, self-worth, and balance between
dependence and autonomy.
5. Establishing a pro-social and moral framework, involving empathy, compassion, and conscience.
6. Generating a core belief system, which comprises cognitive appraisals of self, caregivers, others, and life in general.
7. Developing a defense against stress and trauma, incorporating resourcefulness and resilience.
Levy writes that children who begin their lives with secure attachment fare better in all aspects of their later capacity to function
well, a finding much reported in the literature of attachment theory. Similarly, Siegel (1999) writes that emotional regulation is "at
the core of the self" (p. 274), and asserts that the development of self regulatory skills emerges from early caregiver-child
attachment experiences.
The Classification of Attachment
It becomes clear that it's not clear exactly what we mean by attachment style, and various terms have been used to describe the
quality or content of the experience of attachment in individuals: attachment style, attachment strategy, attachment
representations, attachment patterns, or attachment type and prototype (Ross, 2004).
Although we can describe attachment, as in attachment theory, it's not necessarily clear how to definitively operationalize the
ideas, measure the content of the attachment experience, and classify the behaviors. In Ainsworth's case, she initially merely
established a procedure and then classified toddlers into groups based on behavioral commonalities expressed in that particular
setting and under those particular conditions, and did not even give names to the groups, choosing instead to simply group similar
behaviors without providing descriptive labels for each group, or assigning positive or negative value to any particular group. It was
only later that the attachment groups A, B, and C led to the attachment classification labels commonly used today, in one form or
another, in which attachment behavior was considered to be either secure (group B) or insecure (groups A and C).
Typically, these attachment patterns (or are they styles or strategies?) are considered to represent secure attachment, insecure
avoidant attachment, or insecure anxious/ambivalent attachment. Main and Solomon (1986) reclassified a number of the children in
earlier studies and devised a fourth category of attachment behaviors that they named disorganized-disoriented.
Despite the idea that these group labels are considered descriptive, the very terms used (secure or insecure) imply that a positive or
negative value is attached to one group or another. However, in attachment theory each of the organized groups is considered as an
adaptive version of attachment, neither positive or negative.
Recognizing Attachment Strategies
Regardless of descriptive labels or variants on those labels, the three primary patterns/groups of demonstrated attachment
behaviors are considered to have organized strategic value. They are designed by the experience of the child to ensure that the
child has an attachment figure (remember that attachment bonds are not necessarily symmetrical) through an organized pattern of
attachment behaviors. Remember also, that attachment is considered a biological tool for evolutionary survival, and not a
psychological construct. Therefore, virtually every child seeks attachment to someone, even if the attachment figure is insensitive
and not attuned to the needs of the child, unavailable, neglectful, rejecting, malicious, or abusive. Out of this latter category
comes the concept of "traumatic attachment." Although the concept of traumatic attachment is not particularly well defined, it
implies that attachment is inevitable in almost every case, even under adverse conditions. The term suggests that attachment
develops even within and against a backdrop of trauma, in which attachment is intimately shaped by developmentally traumatic
events which are imprinted into the attachment experience, and therefore the central nervous system.
Crittenden (2001, 2002; Crittenden & Claussen, 2000) has asserted that the avoidant attachment pattern is most closely related to a
cognitive style of attachment behavior, in which affect and emotion are not to be trusted and the child instead learns to use
planned cognitive strategies to maintain proximity (and, hence, safety). Conversely, she associates affective behaviors with the
anxious-ambivalent pattern of attachment, in which the child does not use, or necessarily trust, cognitive strategies but instead
experiences and engages in displays of affective behavior designed to maintain proximity and the attention of the attachment
figure. For Crittenden, the securely attached child is able to balance these two attachment strategies (cognitive and affective) in an
integrative, flexible, and effective whole. On the neurobiological level, Siegel (1999, 2001) describes avoidant attachment as a left
brain strategy, reflecting therefore the cognitive and language based processes of that hemisphere, and other writers, including
Siegel, suggest that right-brain processing is heavily involved in the processing of emotionally (and particularly negative emotionally)
charged experiences. In the neurological counterpart of a secure attachment strategy, emotional right brain and logico-language left
brain processes are integrated into a cohesive, balanced whole brain experience.
Classification: Categorical or Dimensional
Crittenden (2002; Crittenden & Claussen, 2000), along with others, notes that it not necessarily appropriate or accurate to describe
attachment falling into distinct and discrete categories, but instead asserts that attachment behaviors are dimensional, with shades
and blends of attachment behaviors rather than discrete extremes. Fraley and Waller (1998) also favor a dimensional approach to
classifying the nature attachment styles, describing attachment "types" (or distinct categories) as inadequate to "capture the natural
structure of attachment security" (p. 108). Nevertheless, the most popular and common models of attachment classification are
categorical, rather than dimensional. For instance, although conceptualizing attachment along two dimensions (essentially anxiety
and avoidance), Bartholomew (Bartholomew & Horowitz, 1991; Bartholomew & Shaver, 1998) nevertheless describes adult
attachment falling into one of four "prototypes," very much supporting the categorical classification of attachment.
Using the Adult Attachment Interview (AAI), four corresponding patterns of adult attachment experiences have been devised, which
reflect the experience of adults in their relationships with their own parents. These four categories in adults, often used or from
which variants are drawn, are secure/autonomous, dismissing (matching the insecure avoidant category in children), preoccupied
(insecure anxious), and unresolved/disorganized (disorganized). In her two-dimensional/four-category scheme, Bartholomew
(Bartholomew & Horowitz, 1991; Bartholomew & Shaver, 1998) describes these as categories as secure, dismissing, preoccupied, and
fearful prototypes.
One way or the other, in classifying attachment behaviors into these particular classifications, it is important to note that the three
primary (organized) types are not only not considered pathological, but are considered to be adaptive, although, again, the secure
type is most associated with healthy and successful adaptation.
Organization of Attachment Strategies and the Development of Pathology
However, defined, some variant of Ainsworth/Bowlby's original conceptualizations remain at the center of virtually every
attachment scheme. Although the single secure attachment classification and the two insecure attachment categories defined by
Ainsworth are organized strategies for maintaining attachment and proximity to an attachment figure (hence the concept that the
labels represent attachment "strategies" rather than attachment "styles" or "patterns"), the fourth category of disorganized
attachment more recently defined by Main and Solomon represents a pattern of attachment behaviors that are not organized, or do
not appear to be, and appear disoriented, erratic, and irrational. It is this classification that is most likely to be associated with the
development of later psychopathology.
That is, although the secure form of attachment is for the most part considered to yield the most effectively functioning children,
adolescents, and adults as they progress through the life span, and insecure forms are considered to place the child (and later
adolescent and adult) at risk for difficulties, strained relationships, and behavioral problems none of these attachment categories
are considered to be pathological, or even necessarily related to the development of later pathology. Although, among clinical
populations there is a far greater incidence of insecure attachments (as opposed to secure), most individuals with insecure
attachment styles do not develop psychopathology. In fact, the general population is mostly comprised of individuals who fall into
the secure classification category: about 67% of the general population is considered to experience some variant of secure
attachment.
Attachment, Adaptation, and Pathology
Crittenden (2002; Crittenden & Claussen, 2000) argues that all forms of organized attachment are adaptations, and presumably it is
the adoption of an attachment pattern that doesn't match the environment that makes it unhealthy, rather than the pattern itself.
She objects to the concepts of secure and insecure as they imply "healthy" and "pathological." Similarly, Teicher (2000, 2002)
described neurobiological changes (under-development of left brain regions and neural biases to right hemispheric brain processes)
resulting, in part, from the experience of early trauma on the developing brain. However, revising his earlier thinking Teicher
describes these morphological developments as adaptations, rather than the result of maladaptation or under-development.
Although Teicher (2000) starting with the hypothesis that early stress is a toxic agent that damages normative brain development
and leads to psychiatric difficulties, he instead concluded that the brain is designed to respond to and be shaped by experience
(Teicher, 2002). In response to ongoing maltreatment, trauma, or other adverse environmental conditions, the shift to right
hemisphere dominated brain processing and its rapid, self protective responses, is an appropriate adaptation to an adverse
environment, rather than evidence of malfunction/damage. In response to the behavior and attunement of the caregiving
environment, Teicher writes that "stress sculpts the brain to exhibit various antisocial, though adaptive, behaviors" (p. 75).
In fact, as noted, there is little evidence to support the idea that any of the organized attachment classifications are related to
psychopathology, but a strong belief nonetheless, as well as research evidence, that troubled children, adolescents, and adults are
more likely to emerge from the population of insecurely attached children than those who are securely attached. It is from the
disorganized group that the development of later pathology is most likely to be linked. However, evidence of all sorts suggests that
the emotional/psychological and neurobiological sequelae of insecure attachment, and particularly when attached to neglect,
abuse, or other forms of overt maltreatment, contribute to psychological and neurobiological vulnerabilities. If we consider
attachment "disorders" to be disturbances in internal working models, we're describing the quality and internalization of the
attached relationship as the starting point and on-going shaper of the development of mind (and selfhood). When insecurely
developed, the internal working model subsequently leads to disturbances in emotional regulation, thinking and cognitive processes,
behaviors, and social relationships.
Measuring Attachment
It is difficult to measure attachment, and obviously requires a clear model of what attachment means and what attachment
behaviors look like in the real world and under defined conditions. For the most part, attachment studies have been directed
towards very young children, up to and including pre-school, and these involve observations and interpretations of observed
behaviors. Next to young children, attachment patterns have most been studied in adults, both with respect to their memories and
descriptions of their relationships with their own parents, and in romantic adult relationships. Although there are some paper-andpencil tests available, for the most part in the attachment theory world, the Adult Attachment Interview (AAI) is the preferred form
of attachment study in adults. The AAI attempts to measure coherence in the capacity of adult subjects to narratively describe their
formative and early relationship with their parents. Siegel (1999) writes that through providing a narrative/autobiographical
description of the childhood experience, the AAI measures the current level of coherent thought in the subject, and that this
measure of coherence is de facto the product of a well integrated mind, which in itself both reflects and is a product of a balanced
and secure childhood attachment experience (that gives rise to the secure attachment designation in the adult as well). For Siegel,
coherence is evidence of the individual's capacity for integrative bi-lateral brain functioning, using and blending left and right brain
processes, a reflection of the early attachment experience in which the attuned caregiver develops and enhances in the child the
capacity for such integration and self regulation.
Nevertheless, administering the AAI is a costly and time consuming process, and, as with studies of young children, requires
observation and later interpretation following a code book that classifies, defines, and recognizes set previously determined
behaviors. Even so, although the AAI is sometimes used with adolescents, it is designed specifically for adults and not adolescents,
and for this reason, as well as its impracticality, is rarely used in studies of adolescent attachment. Even more to the point, for the
very same reasons, the AAI, which is probably the strongest and certainly the most well researched and standardized tool for the
assessment of attachment in adults, is rarely used in attachment studies with juvenile or adult sexual offenders, or for that matter
juvenile or adult non-sexual offenders.
Even if the AAI is used, it is not measuring attachment behaviors, but simply the recollections through the spoken narratives of
adults about their own parents, through a semi-structured interview process, and thus is attempting to access the internal working
model. This creates major difficulties in assessing "attachment" in adults, and even more so juveniles. In fact, it is not entirely clear
how to assess attachment in either adults and especially juveniles, and more so when one considers that the nature of attachment
as a physical survival mechanism in children is no longer a necessity for adults, and usually not for adolescents either. In fact, it is
not clear what attachment means in adults and adolescents. And, as we shall see in Part II of this article, the measurement of
attachment in both juvenile and adult sexual offenders is even more troubling.
The Internal Working Model is the Thing: Attachment, and Social Connectedness
It seems that we are more interested in the psychological and relational aspects of attachment than in its reflection of our
biologically-derived animal behavior. Nevertheless, as we can see, concepts and descriptions of attachment are quite ethereal and
difficult to define, as is our capacity to develop a complete understanding of attachment as a psychological construct.
Despite several different classification schemas, the measurement of attachment is generally similar regardless of the specific
schemata, essentially breaking into categories of organized and disorganized attachment (although subgroups within categories are
recognized). The trouble is that these few categories, even in a dimensional model, do not seem rich enough to capture the
meaning, nuances, and experiences of attachment in people. As we look harder at these categories, we see also that the description
of attachment categories describes both the behaviors of the individual within an attached relationship and the relationship itself
(between caregiver and child), rather than describing a structure that exists as a psychological entity outside of that relationship, or
existing within either of the two individuals. For instance, although only briefly described, although attachment relationships are
limited in number children may nevertheless form multiple attachment relationships. Thus, the same child may have different
attachment relationships with different caregivers. Is the child, then, securely attached if this is the case with one parent, or
insecurely attached if this is the case with the other parent?
In fact, it is the internal working model that serves as this feature that resides within the individual, birthed by the attachment
relationship but taking on a life of its own outside of the relationship as it continues to develop, setting the neurobiologically hard
wired and psychological base for all future experiences of relationships. Whereas attachment classifications represent the nature of
the attachment relationship between the child and caregiver (or adult and other), it is the character of the internal working model
that we should be classifying. This presumably will reflect attachment experiences and patterns that underlie and are consistent
across all relationships, according to attachment theory most of which are not attachment relationships. As defined by attachment
theory, most of these relationships are affiliative rather than attachment relationships. Further, it is not all clear, despite the focus
of attachment therapy on adult romantic relationships, that adults experience "attachment" relationships with other adults, and this
is even less true for older children and adolescents.
The term "attachment" is thus too limited for our purposes, and as we describe the attachment experience embedded into the
internal working model, it seems we are really describing "social connectedness" as a psychological construct that can be held to
exist within the individual, and not within the relationship. In fact, as we examine the few studies of juvenile and adult sexual
offenders, and the measures used in those studies, we do appear to be looking more at social experiences and connection than
"attachment" as conceived of in attachment theory.
In part II of this article, we will turn our attention to the diagnoses of attachment difficulties, and the proposed relationship
between attachment difficulties and the development of sexually abusive behavior.
Citations & References
Ainsworth, M. D. S., Blehar, M. C., Everett; W., & Wall, S. (1978). Patterns of Attachment: A psychological study of the strange
situation. Hillsdale: NJ. Lawrence Erlbaum Associates.
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of
Personality and Social Psychology, 61 (2), 226-244.
Bartholomew, K., & Shaver, P. R. (1998). Methods of assessing adult attachment: Do they converge? In J. A. Simpson, & W. S. Rholes
(Eds.), Attachment Theory and Close Relationships (pp. 25-45). New York: Guilford.
Bowlby, J. (1969/1982). Attachment and Loss, Vol. 1: Attachment (2nd ed.). New York: Basic Books. Commission on Children at
Risk. (2003). Hardwired to connect. New York: Institute for American Values.
Crittenden, P. M. (2000). A dynamic-maturational approach to continuity and change in patterns of attachment. In P. M. Crittenden
& A. H. Claussen (Eds.), The organization of attachment relationships: Maturation, culture, and context(pp. 343-383). Cambridge,
England: Cambridge University Press.
Crittenden, P. M. (2001). Transformations in attachment relationships in adolescence: Adaptation versus need for psychotherapy
(Transformaciones en las relaciones de apego en la adolescencia: Adaptacióón frente a necesidad de psicoterapia). Revista de
Psicoterapia, 12, 33-62.
Crittenden, P. M. & Claussen, A. H. (Eds.). (2000). The organization of attachment relationships: Maturation, culture, and context.
Cambridge, England: Cambridge University Press.
Fraley, R. C., & Waller, N. G. (1998). Adult attachment patterns: A test of the typological model. In J. A. Simpson, & W. S. Rholes
(Eds.), Attachment Theory and Close Relationships (pp. 77-114). New York: Guilford.
Levy, T. M. (2000). Handbook of Attachment Interventions. San Diego: CA: Academic Press.
Main, M., & Solomon, J. (1986). Discovery of a New, Insecure-disorganized/disoriented attachment pattern. In T. B. Brazelton & M.
W. Yogman (Eds.), Affective development in infancy (pp. 95-124). Norwood, NJ: Ablex Publishing.
National Research Council and Institute of Medicine (2000). From neurons to neighborhoods: The science of early childhood
development. Committee on Integrating the Science of Early Childhood Development. J. P. Shonkoff & D. A. Phillips (Eds.). Board on
Children, Youth and Families, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy
Press.
Ross, T. (2004). Attachment representation, attachment style, or attachment pattern? Usage of terminology in attachment theory.
In F. Pfafflin, & G. Adshead (Eds.), A matter of security: The application of attachment theory to forensic psychiatry and
psychotherapy (pp. 57-84). London: Jessica Kingsley. Publishers, 2004
Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York: Guilford.
Siegel, D. J. (2001). Toward an interpersonal neurobiology of the developing mind: Attachment relationships, "mindsight," and
neural integration. Infant Mental Health, 22, 67-94.
Smallbone, S., & Dadds, M. (2000). Attachment and coercive sexual behavior. Sexual Abuse: A Journal of Research and Treatment,
12, 3-15.
Teicher, M. H. (2000, Fall). Wounds that won't heal: The neurobiology of child abuse. Cerebrum, 2 (4), 50-67.
Teicher, M. H. (2002, March). Scars that won't heal: The neurobiology of child abuse. Scientific American, 68-75.
By Sandy Jung, M.A.
Student Member, ATSA Ethics Committee
Nothing lasts forever. It is certainly to be hoped that this is true of therapy. As a therapist and the client begin to believe the client
is able to handle his or her problems independently, discussions of termination should be initiated. However, at times, a transition
in the professional career necessitates that the therapists move on to different opportunities, often leaving behind a caseload of
clients who are in the midst of their process of therapy.
The Ethics Committee has addressed many issues this past year, and one case highlighted the importance of an adequate
termination process for clients. This article focuses on these issues as outlined in the ATSA Professional Code of Ethics:
7. CLIENT RELATIONSHIPS
(g) Members shall not withdraw services from a Client in a precipitous manner. When considering termination of services, each
member shall give careful consideration to all factors involved in the situation and take care to minimize possible adverse
effects on the Client.
(h) If a member anticipates the termination or disruption of services to a Client, he or she shall notify the Client promptly and,
when possible, provide for transfer or referral to another service provider.
Typical Terminations
Just as the initial session sets the tone for the therapeutic relationship, the ending phase enables clients to maximize the benefits
from the relationship and decide how they can continue the change process on their own. As well, the therapeutic relationship helps
clients to generalize the skills they've acquired in therapy to other settings in their lives, and to create new and meaningful support
systems. From your first contact with clients, it is important to convey the idea that your intention is to assist them to function
effectively without you. It is not helpful to clients if their therapy continues indefinitely or if counselors facilitate dependence.
Basically, termination assists clients in consolidating their learning and determining how they can proceed once they cease attending
treatment. The tasks of termination include reviewing the counseling experience, summarizing gains; identifying goals and progress;
discussing future work and establishing contracts; and suggesting referrals, if appropriate.
Some guidelines:
• Remind clients of the approaching end of the sessions with you.
• Plan out the final few sessions (e.g., instead of meeting weekly, your client might come in every three weeks), allowing more
opportunity to practice and to prepare for termination.
• Review course of treatment; what lessons did clients learn, how did they learn them, and what do they intend to do with
what they have learned? What did they find most helpful in the sessions? It is well for clients to take the lead in addressing
these questions.
• Allow clients to talk about their feelings of separation; just as clients may have had fears about seeking help, they may have
fears about terminating the counseling relationship.
• Remember that if you are an effective counselor you'll eventually put yourself out of business-at least with your current
clients; your task is to get them moving on their own, not to keep them coming to you for advice. Give clients the tools to
become their own counselors.
• Realize that a counseling experience is not aimed at curing all of the client's problems. Counseling is an ongoing and
evolutionary process rather than an absolute point of arriving at an ultimate cure.
• Let your clients know of your availability at a future time; encourage clients to return at a later time should they feel a need
for further learning.
• Discussing available programs and making referrals are especially timely toward the end of your work with clients.
Termination is typically seen as a gradual process in which meetings are reduced, for example from once a week to once per every
three weeks and then to once every two months, and so on. Regardless of the reasons for termination, it is important that it be
discussed in detail and the client's feelings and attitudes thoroughly aired and processed with the therapist and the group.
Termination should provide a healthy experience that is, for some clients who have experienced losses in their lives, a new and
corrective experience.
Abrupt Terminations
Clients sometimes terminate suddenly and, in some cases, before the therapist feels it is appropriate. In sex offender treatment,
this may occur when the client's criminal sentence expires before he has mastered the goals of treatment. Or, in some cases, clients
drop out of therapy because they have relapsed or been re-arrested.
In some instances, the termination is forced because the therapist must leave the clinic. This can precipitate numerous client
reactions. Clearly there are times when clinicians' own personal or professional needs conflict with the needs of clients and the
therapist makes a professional change. Abrupt termination, however, can be potentially compromising to the clients' progress,
particularly when clients have experienced abuse, neglect, and abandonment in their families of origin. It is important to find the
time to discuss the client's feelings about the ending of the relationship and to facilitate new alliances with other helpers.
Related References:
Leigh, A. (1998). Referral and termination issues for counsellors. Thousand Oaks, CA: Sage Publications.
Murdin, L. (2000). How much is enough?: Endings in psychotherapy and counselling. New York, NY: Routledge.
Pearson, Q. M. (1998). Terminating before counseling has ended: Counseling implications and strategies for counselor relocation.
Journal of Mental Health Counseling, 20(1), 55-63.
With the summer of 2004 upon us, I've had some opportunity to reflect on this newsletter and its
contributors. The "ABTSA Professional Forum" began in 1984 and was edited by Steven Mussack on what
has been described as a "limping dot matrix printer". Subsequent editors have included Gary Horton, Theo
Seghorn, and Mike Miner. Somewhere along the line, the word "professional" was dropped, and I have
often quipped that this enabled people like me to edit it.
In recent years, Connie Isaac and I worked to increase The Forum's publication schedule to four times a
year, and it is now available to the membership in web-based form, with a printing option. This means
members can now find back issues as needed. Less obvious, however, is our emphasis on putting as much
information into each issue despite our space limitations. In total, we've been able to produce more
newsletter for less money.
The Forum reflects a fascinating membership. The best and the least known have all participated.
However, contributing to it can be difficult. Many of us have formulae that we follow for writing reports
and articles, and Forum contributions rarely fall within these parameters. This can make even small articles and book reviews seem
complicated. Unfortunately, I've seen many good ideas fail to come to fruition for exactly this reason.
Although distributing information that can reduce the harm of sexual abuse is the most gratifying element of editing The Forum,
interacting with contributors is the most fun. I have spent a great deal of time looking at areas where authors have difficulty, and
thought I would put together some suggestions and guidelines, in the hope that it inspires new ideas. The Forum is the membership's
newsletter, and it is my intention to keep it as accessible as possible. First some basics:
• Articles can be up to 2400 words, or about 4 pages, single-spaced, at a ten-point type. However, any word count up to this is
acceptable.
• I have received a couple of excellent articles without any prior notice. However, I suggest you contact me first.
• Book reviews can range from 400-600 words, or in the area of on to one and a third pages, single-spaced.
What sets The Forum apart from Sexual Abuse: A Journal of Research and Treatment is that it provides more flexibility for looking
at direct approaches to specific problems (e.g. Michael O'Connell's recent article on speaking with neighbors about community
notification) or the development of new approaches based on diverse aspects of our work (e.g. Carl Schwartz and Steven Brown's
article on promoting normative sexual development in residential treatment). The Forum is also a venue for describing recent
progress on various topics in the field (e.g. Dennis Doren on risk assessment, Fran Henry on adopting a public health perspective
towards sexual abuse). In fact, articles that have not been accepted in The Forum have typically resembled articles that belong in
ATSA's Journal.
A common problem for contributors is getting started. I've found that the majority of technical problems are in the first two
paragraphs. This is complicated by the fact that submitting anything can make anyone feel remarkably vulnerable. In order to best
"take the plunge", I recommend going back to the basics. Create an outline first, and then rely on that structure as a kind of
"invisible co-author" while you get things started. You can always return to improve the wording later. To best put together a
structure, you may want to consider these points:
The diversity of the ATSA audience needn't be a problem. Although it is easy to be apprehensive about the level of expertise and
cultural differences within the largest organization of its kind, this can be an opportunity to return to the fundamental elements of
an issue and define the problem that your article addresses. Material that is introductory to the novice is also a refresher to more
experienced members, and even the most seasoned among us can benefit from seeing how others approach a topic.
With that in mind, start with an introduction that includes a problem statement and ideas for its solution (e.g. "providing housing to
indigent sex offenders may serve the community better than having their whereabouts remain unknown"). A review of the recent
literature can also provide a context for your approach (see Carich and Metzger's article on the unconscious in this issue). It can be
useful to review ATSA's three-year plan for ideas on tailoring your article or review.
Additionally, useful questions for contributors to ask themselves might include:
• With what issues do ATSA members struggle?
• How does a particular approach help provide solutions and results?
• What direct skills can be offered to members through an article?
• Is there an aspect of an issue and article that can help members become more committed to their work, inquisitive, or
reinvigorated?
• What are the implications for future research and practice?
Showing your article or review to a colleague can be very useful, and is often overlooked. You can certainly feel free to contact me
with a rough draft. Although I can never guarantee that an article will be accepted, I will certainly respond to all ideas and
questions.
I have found book reviews to be unnecessarily problematic. If you have read a recent book and have responses to it, please feel free
to contact me. Likewise, if you have a particular area of interest, let me know so that when a review copy comes along I can send it
to you. Likewise, if you are an author, you may wish to have your publisher send a review copy to ATSA. I am always looking for
balanced reviews that inform our work. Reviews containing an overview, comparison to similar works, and a description of its
stronger and weaker points are particularly helpful.
As in other areas of human existence, genuine contribution is hard work. However, I've found that by writing for The Forum, authors
have an opportunity to sharpen their own thoughts and approaches towards a topic, and that by reviewing books; they challenge
themselves to understand the topic at an even deeper level.
As The Forum turns twenty, I invite any and all to contact me about contributing. Although it is my great honor to edit the
newsletter, it belongs to all of us. I can be reached at [email protected], or at (608) 847-4438, extension 2146, Monday
through Friday, 8 am to 4 pm Central Time.
Respectfully,
David S. Prescott, L.I.C.S.W.
ATSA Forum Editor
Submitted by Peggy Heil, L.I.C.S.W., Chair
The Organization and Development Committee members include all of the Executive Board regional
coordinators: Lawrence Ellerby, Ph.D, the Canadian Provincial Coordinator covering Canada; David S.
Prescott, L.I.C.S.W., Eastern Regional Coordinator covering Maine, New Hampshire, Vermont,
Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, New Jersey, Delaware, and Maryland;
Robin McGinnis, M.S.W., Midwestern Regional Coordinator covering Ohio, Michigan, Indiana, Illinois,
Wisconsin, Minnesota, Iowa, Missouri, Nebraska, Kansas; Robert A. Mosher, M.A., LPC, the Pacific Regional
Coordinator covering Washington, Oregon, California, Hawaii, and Alaska; Grace L. Davis, LMSW-ACP the
Southwestern Regional Coordinator covering Arizona, New Mexico, Oklahoma, Texas; S. Levenson, Ph.D.,
L.C.S.W., the Southern Regional Coordinator covering Arkansas, Louisiana, Mississippi, Alabama,
Tennessee, Kentucky, West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida; and Peggy
Heil, L.C.S.W., Mountain Regional Coordinator covering South Dakota, North Dakota, Montana, Wyoming,
Colorado, Utah, Nevada, Idaho.
Each coordinator is elected by the members in their region to represent local needs on the Executive Board. Some regions have
active list-servs which help coordinators understand the concerns of members in their region. In regions that do not have active listservs, coordinators obtain information on regional needs from state chapter presidents. Members can also directly contact their
regional coordinator. Contact information for each coordinator is posted on the ATSA website.
In addition to providing regional representation on the ATSA Executive Board, coordinators also provide a liaison function with state
chapter presidents. This includes obtaining feedback on membership applicants and reporting state chapter activities in quarterly
regional reports. These reports are posted on the Members Only section of the website. Currently, there are 22 states with ATSA
chapters and four additional states forming chapters. Some of the activities that state chapters have been involved in include:
offering workshops and annual conferences, producing newsletters, monitoring and effectively impacting state legislation by offering
thoughtful position papers regarding proposed legislation, creating websites, maintaining a statewide directory of providers,
providing representation on state standards boards, and working on collaborative efforts with other state organizations. The New
York chapter even applied for and received a grant to plan and implement a five county demonstration project. The grant will fund
a regional center for sex offender management to enhance the investigation, prosecution, supervision and treatment of adult sex
offenders. All of these activities are in addition to membership meetings which afford members an opportunity to meet with
colleagues in their state. For those states without chapters, information on forming a state chapter can be found on the Members
Only section of the ATSA website: www.atsa.com.
Peggy Heil, L.I.C.S.W.
Chair
The following members were approved in March, 2004 and May, 2004.
Rebecca D. Abramson
Portsmouth, VA
Martin Cochran
Oklahoma City, OK
Geoff Hall
Courtland, AL
Selonda M. Moseley
Oklahoma City, OK
Theresa Albro
West Seneca, NY
James Coupe
Norristown, PA
Jordan Hanley
Vancouver, British Columbia
Christopher J. Murphy
Virginia Beach, VA
Judith W. Alper
Longwood, FL
Robert Crawford
Marlton, NJ
Teion L. Wells Harrison
Marianna, FL
Robin Murphy
Monroe, WA
Chad E. Anderson
Kansas City, KS
Michelle Cutler
Chicago, IL
Teri A. Herrmann
Belmont, NC
David L. Neidel
Nevada, MO
James D. Anderson
Steilacoom, WA
William D. Darsey
Hinesville, GA
Sarah J. Higley
Phoenix, AZ
Bruce Nystrom
Wichita, KS
Gregory J. Arabie
Covington, LA
David P. DeFrancesco
San Diego, CA
Sue A. Hoffman
Coal Township, PA
Caroline Anne Page
Brockville, Ontario
Richard E. Berry
Brampton, Ontario
Sonia Delavante
Honolulu, HI
Alana R. Hollings
Portsmouth, VA
Donald R. Pake
Chicago, IL
David A. Biegen
Glendale, AZ
Melanie Doggett
Mountain Home, ID
Dana L. Johnston
Virginia Beach, VA
Matthew P. Pereira
Santa Rosa, CA
Jo-Ann Bird
Gainesville, FL
Zita M. Duffy
Columbus, OH
Cheryl L. Kaiser-Ulrey
Tampa, FL
Susan E. Persons
Saint Paul, MN
Stephanie L. Bishop-Collum
Rockmart, GA
Michelle Dykes
Carrollton, GA
Katherine Katzen-Perez
Jacksonville, NC
David L. Pogge
Katonah, NY
Tommy D. Black
Hinesville, GA
Maria M. Evile
Portsmouth, VA
Matthew W. King
Orono, ME
Christine D. Pratt
Billings, MT
Chris J. Carr
Fort Myers, FL
Gina Lonea Fiferman
Rapid City, SD
Patricia Koenen
Honolulu, HI
Michelle Prinzo
Toronto, Ontario
Joi Chester
Atlanta, GA
Paula Garay
Mountain Home, ID
Patrick B. McGinnis
Plantation, FL
Bascom Ratliff
Overland Park, KS
Candice A. Cleveland
Corning, NY
Darrell Grizzle
Marietta, GA
Rhonda Meacham
Forest Park, IL
Carol Hajdasz
Middleton, WI
Donald D. Montoya
Las Vegas, NM