38
Journal of Psychotherapy
and Counselling Psychology
Reflections
Reflections Research Centre
Volume 1
Number 2
September 2016
ISSN 2054-457X
Editor
Editorial Board
Dr Maria Luca
School of Psychotherapy & Psychology,
Regent’s University London, Inner Circle, Regent’s Park,
London NW1 4NS, UK
Dr Marie Adams, Metanoia Institute, London, UK
Dr Meg-John Barker, Open University, London, UK Dr Michael Berry, McGill University, Montreal, QC Canada
Dr James Davies, University of Roehampton, UK
Dr Lisa Doodson, Regent’s University London, UK
Dr Stelios Gkouskos, University of Surrey, UK
Dr Ralph Goldstein, British Psychological Society’s Register
of Psychologists specialising in Psychotherapy
[with senior status], UK
Professor Brett Kahr, Regent’s University London, UK
Dr Elaine Kasket, Regent’s University London, UK
Professor Desa Markovic, Regent’s University London, UK
Professor Martin Milton, Regent’s University London, UK
Dr Lyndsey Moon, University of Roehampton, UK
Christina Richards, Nottinghamshire Healthcare Foundation
NHS Trust, UK
Dr Paul Smith-Pickard, Counselling and Psychotherapy
Private Practice, Dorset, UK
Dr Michael Worrell, Royal Holloway, University of London, UK
[email protected]
Managing Editor
Professor Helen Cowie
Emeritus Professor, Faculty of Health and Medical Sciences,
Duke of Kent Building, University of Surrey, Stag Hill,
Guildford GU2 7TE, Surrey, UK
[email protected]
Editorial Assistant
Shirley Paul
School of Psychotherapy & Psychology,
Regent’s University London, Inner Circle, Regent’s Park,
London NW1 4NS, UK
[email protected]
International Editorial Advisory Board
Dr Geoff Denham, La Trobe University, Melbourne, Australia
Dr Andrew Geeves, Macquarie University, Sydney, Australia
Dr Theodoros Giovazolias, University of Crete, Greece
Dr Dennis Greenwood, University of Brighton, UK
Dr Martin Lečbych, Palacký University, Olomouc, Czech Republic
Professor John Nuttall, Regent’s University London, UK
Andrea Sabbadini, British Psychoanalytical Society, London, UK
Professor Carla Willig, City University, London, UK
Aims and Scope
The Journal of Psychotherapy and Counselling
Psychology Reflections (JPCPR) is an international
peer-reviewed journal, underpinned by the
aspiration for a non-doctrinaire, pluralistic attitude to
psychotherapy and counselling psychology. It aims
to provide a forum for open debate and encourages
submissions from different traditions, epistemological
positions and theoretical modalities enabling the
development of a more open, reflective thinking to
philosophy, theory and practice of psychotherapy and
counselling psychology. JPCPR encourages critical,
broad and experimental interpositions in discussions
on psychotherapy and counselling psychology. It
tends to transcend the methodological and metatheoretical divisions. We welcome submissions
using both quantitative and qualitative methods,
including ethnographic, autobiographical, and
single patient or organisational case studies.
1
Journal of Psychotherapy
and Counselling Psychology Reflections
Volume 1 • Number 2 • September 2016
CONTENTS
Guest Editorial................................................................................................................................................ 2
Supporting Survivors: A Strategic Model to Address Rape Culture in Universities
Shaheen Shariff and Alyssa Wiseman..................................................................................................... 5
Adolescent Girls’ Declining Mental Health: Where is the Feminist Perspective?
Rosalyn H. Shute........................................................................................................................................... 13
The Poetry of Self-Harm, Suicide and Oppression: Theoretical and Clinical
Explorations of Self-Harm and Suicide
Terence Nice.................................................................................................................................................. 21
Therapy with Victims who have gone on to Offend
Andrew Smith................................................................................................................................................ 25
Book Reviews................................................................................................................................................ 31
Announcements.......................................................................................................................................... 33
2
GUEST EDITORIAL
I was recently invited to write a review on a new
outstanding book called ‘Karl Abraham – Life
and Work, a Biography’, just published by Karnac.
Apart from being ‘treated to a real “master class”
in history, theory, and technique’ (Kahr, 2016,
p.xvii) of the earliest period of psychoanalysis, the
book illuminates Abraham’s views on the issue of
ambivalence in early childhood; views that set the
course for the advance of object relations theory.
The author catches it, ‘In fact Abraham spent all
his psychoanalytic working life expanding and
refining his theory on depression’ (Bentinck van
Schoonheten, 2016, p.153). These theories were
not entirely reconciled with Freud’s concept of
the death instinct, and it was for Melanie Klein,
an analysand of Abraham’s, to elaborate how
the vicissitudes in object relations harnessed
the aggression inherently supplied by the death
instinct. So, it is quite a synchronous occasion
that I should also have been invited to write
this editorial on sexual oppression, a term that
encapsulates the coniunctio of the life and death
instincts as manifest in a range of individual
and social contexts. And this edition considers
sexual oppression from the perspective of both
the psychology of the individual and of the
psycho-social context in which it takes place.
One such highly publicised social context is
highlighted in the first paper, ‘Supporting Survivors:
A Strategic Model to Address Rape Culture in
Universities’. Shariff and Wiseman describe, with
some disturbing evidence, the ‘rape culture’ that
seems to pervade university campuses, at least in
North America. Although the authors acknowledge
that sexist attitudes probably develop prior to
university age they argue that this should only
strengthen the resolve of universities to dismantle
the social discourses that maintain such views.
They point out the devastating effects on student
performance and psychological well-being of
victims and perpetrators and yet the paucity of
concerted policies from university authorities and
allied social institutions to deal with the problem.
Such policies seem more like defences against
reputational damage than effective means of
addressing the issue. They might be considered
classic responses to the depressive position of
having to acknowledge the institutional shame
which, sadly, is all too often left with the victim. The
authors propose a strategic model to counter this
oppressive culture. Grounded in case material, it
responds to, and draws together the many cultural,
educational and administrative factors involved.
The theme of social context and its impact is
demonstrated further in Rosalyn Shute’s paper,
‘Adolescent Girls’ Declining Mental Health – Where
is the Feminist Perspective?’. This paints a broad
picture of societal denigration of women and argues
for a return of a feministic perspective to counter
and understand the overall declining psychological
health of adolescent girls. Shute suggests that the
so-called post-feminist era, whilst encouraging
girls to believe they can be anything they want,
has brought pressure for sexual emboldenment
rather than empowerment, which is merely a
response to the overarching patriarchal forces
in society. Indeed, it seems this pressure to be
expressly feminine, along with post-feminist career
and role aspirations, frustrated by pervasive sexist
and misogynistic values, are causing a serious
deterioration in adolescent girls’ mental health.
The author argues that clinical psychology has
neglected gender role socialisation issues, in both
its research and clinical practices, in deference
to the prevailing positivistic inheritance of a
patriarchal society. Shute argues that it is time
for a new feminist thrust in both psychological
theories and therapies that will promote wellbeing across the range of gender identities.
The individual effect of the death instinct is more
overtly discussed in Terence Nice’s paper ‘The
Poetry of Self-Harm, Suicide and Oppression:
Theoretical and Clinical Explorations of Self-Harm
and Suicide’ in which he explores the use of poetry
as a therapeutic communications medium in
understanding self-harm and suicidal behaviours.
He discusses the correlation between self-harm and
suicide and demonstrates how the words of poetry
have the potential to illuminate both the life and
death instincts (or good and bad objects relations)
in this client group. Nice argues that, ‘poetry can
offer us a specific type of knowledge regarding selfharm and suicide’ and presents a ‘clinical’ analysis
of a poem from a self-harm support website.
3
Relating this to a case vignette he discusses the
resonance between poetry and the often poetic
language used by such clients. He argues that
such a poetic understanding of client-therapist
communications can provide a Bionian containing
function in which ‘nameless dread’ can be
articulated and thought about. He draws attention to
the real dread that whole communities experience
from the use of sexual violence during war and
the perpetuating effect this has on successive
generations. He concludes by asserting that poetry
has ‘an epistemological value, which invites us
into the interior world of the other’ fostering a
mutative and healing therapeutic relationship.
The individual and social factors driving sexual
oppression are brought together in the last article,
‘Therapy with Victims of Abuse who have gone
on to Offend’. Andrew Smith’s paper highlights
how and why victims of sexual abuse might go on
to experience more abuse or become offenders
themselves. He makes it clear that research does
not support the argument that being an early
victim leads to later offending behaviour, but points
out that ‘each individual’s experience of sexual
abuse is different, and many victims of sexual
abuse can go on to lead happy, constructive lives’.
While acknowledging Freud’s concept of the
repetition compulsion, he highlights a number of
contemporary theories and aggravating factors.
He argues that a key factor is that early victims
often find it difficult to mix with pro-social groups
at later significant developmental stages resulting
in either retreat or overt pro-social boundary
challenges. From his research, and case vignettes,
Smith offers therapists some suggestions on how
they might understand, treat and deal with their
own ambivalent feelings with client offenders
who were once victims themselves, but find
it difficult to recognise their own offence. He
highlights the difficulty for therapists of balancing
therapeutic attention between the ‘victim’ and the
‘offender’ and the need for therapists to know
their own biases and bring these to supervision.
There are two book reviews that evoke a sobering
mix of existential concerns. The first is a review
of ‘Tea with Winnicott’ by Brett Kahr. The review
and the book are written by long-standing and
esteemed associates of the School, certainly people
we would never like to let go. And, arguably, both
books are about the difficulty of letting go. ‘Tea
with Winnicott’ is a virtual resurrection of Winnicott,
whilst ‘Forced Endings in Psychotherapy and
Psychoanalysis: Attachment and Loss in Retirement’
by Annie Power (co-incidentally the reviewer
of ‘Tea with Winnicott’) is about the process
and difficulty of retirement for a therapist. The
reviewers have taken their task seriously, offering
intelligent and informed guidance to our readers.
Finally, the editors and School would like to
invite readers, students, alumni and professional
members to transform themselves into writers
for the journal. There can be real rewards,
professionally and personally, for getting your ideas
into print. Equally, contributions such as a review
of a book, a conference or professional event
would contribute to the professional and learning
experience we wish this journal to become.
Professor John Nuttall
Assistant Dean and Head of School
Regent’s School of Psychotherapy & Psychology
References
Kahr, B. (2016). Series Editor Foreword. Van Schoonheten, A. (2016).
Karl Abraham: Life and Work, a Biography. London, Karnac.
Van Schoonheten, A. B. (2016). Karl Abraham: Life and Work, a
Biography. Karnac Books.
5
SUPPORTING SURVIVORS: A STRATEGIC MODEL TO
ADDRESS RAPE CULTURE IN UNIVERSITIES
Shaheen Shariff and Alyssa Wiseman
Abstract
Recent highly publicised incidents of sexual assault on university campuses have
propelled ‘rape culture’ to the forefront of public policy agendas. This is a controversial
term: its use here refers to insidious and/or overtly violent and offensive, misogynist
and sexist forms of expression or actions that have significant psychological and
physical impacts. Studies have revealed the devastating psychological and emotional
trauma experienced by survivors following incidents of sexual violence. With ‘rape
culture’ prevalent on university campuses, it is essential to examine current reactionary
responses by postsecondary institutions to sexual assault, which might create barriers
for student survivors. As institutions of higher learning, universities have responsibility,
not only to dismantle rape culture within their on-campus and online communities,
but also to mobilise social responsibility and digital citizenship within society in the
long-term. To help universities fulfil this mandate, we propose a Strategic Model that
implicates partnerships with multidisciplinary public sector organisations and private
businesses, including those with a focus on arts and popular culture, news and
social media, as well as community advocacy, towards sustainable responses. These
responses include the creation of safe dialogic spaces on-campus, student-informed
university policies and curriculum modules to critically and mindfully unearth rape
culture. Importantly, the Strategic Model aims to reduce sexist attitudes and reduce the
psychological fear, emotional harm and post-traumatic impact experienced by survivors.
Keywords: Rape culture, sexual violence, universities, survivor support, psychological
trauma, multidisciplinary
Introduction
On January 18, 2015, Brock Turner, a student at Stanford
University, sexually assaulted a young woman while she
was unconscious, after both had been drinking at a party.
Turner suggested that the entire encounter was consensual
and that he was himself too intoxicated to recognise her
incapacity (Sanchez, 2016; see Bever, 2016). In March 2016,
Turner was convicted of three felony charges: (1) assault with
intent to commit rape of an intoxicated person, (2) sexual
penetration of an intoxicated person with a foreign object
and (3) sexual penetration of an unconscious person (Stack,
2016). At the sentencing hearing, Judge Aaron Persky
took into account a probation officer’s recommendation
for leniency given Turner’s lack of prior convictions and
apparent remorse. The sexual assault survivor read out
a powerful victim impact statement, which addressed
every inconsistency in Turner’s defence, and effectively
highlighted the permanent psychological impact of the
incident, as well as the painful and humiliating physical
experience she had endured. She implored the judge to
punish Turner in accordance with the seriousness of his
crimes (see Bever, 2016). Her statement, which has since
been published online, spoke not only to her physical
trauma, but also to her psychological and emotional scars
following the assault. She testified:
I tried to push it out of my mind, but it was so heavy I
didn’t talk, I didn’t eat, I didn’t sleep, I didn’t interact with
anyone. After work, I would drive to a secluded place
to scream. I didn’t talk, I didn’t eat, I didn’t sleep, I didn’t
interact with anyone, and I became isolated from the
ones I loved most. For over a week after the incident, I
didn’t get any calls or updates about that night or what
happened to me. The only symbol that proved that it
hadn’t just been a bad dream, was the sweatshirt from
the hospital in my drawer. (as cited in Bever, 2016)
Contact:Dr Shaheen Shariff, Associate Professor, McGill University, Canada
Alyssa Wiseman, Define the Line Research Centre, McGill University, Canada
[email protected]
[email protected]
6
Judge Persky’s decision to sentence Turner to only six
months in county jail and three years’ probation sparked
such outrage both on-and-offline that more than one million
individuals signed an online petition to recall Persky from his
judicial post (McLaughlin, 2016). Since then, Persky has been
removed from another sexual assault case at the request
of the Santa Clara District Attorney’s Office due to a “lack
[of] confidence that [he could] fairly participate” and preside
over the hearing (Revesz, 2016).
Inequity that favours defendants in sexual assault cases is,
unfortunately quite common, and one could even argue, a
normalised response within the criminal justice system. For
example, a YWCA info-graphic illustrates that out of every
1,000 sexual assaults occurring in Canada each year, only
12 offenders are charged, and only three are convicted
(Patel, 2014). Furthermore, a 2015 survey by the Association
of American Universities found that 23% of female college
undergraduate students had experienced some form of
sexual assault or misconduct under force, threats of force or
incapacitation. The frequency of such incidents, however, is
persistently downplayed by campus sexual assault reporting
rates. One study found that on average only 12% of student
survivors report the assault to law enforcement or public
authorities (Kilpatrick, Resnick, Ruggiero, Conoscenti &
McCauley, 2007). For many, the university campus has
become an increasingly unsafe space.
Thus, while the defendant and Judge Persky have each come
under fire for their statements and actions, it is troubling that
Stanford University has not responded publicly or commented
through the media. Its sexual assault policies and response
in the Turner case have been subject to little media or public
scrutiny. Given the statistics concerning sexual assault on
college campuses, it is essential to examine current reactionary
responses by postsecondary institutions to sexual assault, which
in turn might create barriers for student survivors.
The context of sexual violence
It is our position that universities as central educational
institutions of higher learning need to reclaim responsibility,
not only to unearth and dismantle rape culture within their
on-campus and online communities, but also to ensure that
social responsibility and digital citizenship are mobilised
in greater society in the long-term. This is feasible through
the creation of partnerships with multidisciplinary public
sector organisations and private businesses, including those
with a focus on arts and popular culture, news and social
media, as well as community advocacy, towards sustainable
responses. Later, we provide a framework that would help
universities, protect and engage students in safe and
educational dialogues that would result in student-sector
informed university policies and curriculum modules that
would critically and mindfully unearth rape culture on campus
and in broader society. Our model is expected to reduce
sexist perspectives and attitudes and in doing so reduce the
psychological fear, emotional harm and post-traumatic impact
experienced by survivors.
Defining rape culture
The definition of “rape culture” is increasingly debated.
Despite widespread acknowledgment by academics, news
media and the general public, its use has nevertheless
been criticised for framing acts of sexualised violence as
unequivocally heterosexual in nature, excluding sexual
violence among same sex or trans individuals (Malinen,
2013), as well as its tendency to focus on the physical act of
rape. Some scholars also argue that the term is hyperbolic
and as such, serves to demean “true” acts of sexual
aggression and demonise men (Hutchinson, 2014). Others
suggest that defining the term limits the parameters and
ignores the nuances and complexities of sexual violence in
all its overt and covert forms (Johnson, 2015).
Debating the value of the term itself, however, is not
within the scope of this article. In using the term, we have
chosen to adopt feminist perspectives (Williams, 2007;
Kelly, 2013) as these scholars successfully illustrate ways
in which sexual violence in many of its forms can lead to
devastating and long-lasting psychological impacts. Their
definition is realistic and contextualises the environments
in which rape culture thrives. They point to the ways
in which sexist societal attitudes and language tacitly
condone, minimise and/or normalise sexual violence,
mostly against women, but also against other genders,
through institutions, communities and individuals. Rooted
in discrimination, these forms of rape culture reside
and proliferate along a continuum of sexual violence,
which include sexist or sexualised jokes, harassment,
nonconsensual distribution of intimate images and rape. It is
this “language of rape” that is tacitly condoned, reinforced
and normalised through popular culture and everyday social
conversations (Benedict, 1993, p. 103).
A by-product of rape culture is “slut-shaming.” Research
confirms that many women are reluctant to report sexual
violence for fear that police would not take them seriously.
They worry about being victim-blamed (Visser & McCaffrey,
2013) by defence attorneys, peers and the public. As such,
slut-shaming becomes a tool or policing apparatus that
perpetuates rape culture. According to Poole (2013), peers,
adults, media and courts all give attention to how much
make-up a girl uses, the type of clothing she wears, how
late she stays out, and how she acts towards males (p.
242). Poole explains that slut-shaming is a way to control
a female’s sexual agency and to regulate the extent to
which females (and some males) are allowed to express
their sexual agency before enduring societal scorn. Policing
female sexuality creates a double standard between males
and females, and ultimately marks female sexuality as
deviant. Disturbingly, women slut-shame each other (Bailey,
2013; 2015). They regulate themselves in accordance with
long-standing patriarchal norms that persist and have
strengthened to govern many societies (Shariff, 2005;
Attwood, 2007). The Internet provides a forum that can
amplify the shame felt by girls and women who fall victim
to this cruel behaviour. In the well-publicised Steubenville
rape case in the United States, high school athletes were
found guilty of the rape of an intoxicated 16 year-old girl at a
party. Shocking images of the rape surfaced online (WelshHuggins, 2013) but equally shocking, was the outpour of
public online comments posted to Tumblr (Binder, 2013)
such as: “Shouldn’t they charge the lil’ slut for underage
drinking?” or, “I honestly feel sorry for those boys in that
Steubenville trial, the whore was asking for it” (n.p.). These
unsympathetic attitudes and comments by the general
population evidence rape culture as pervasive beyond postsecondary communities.
While vernacular debates about how or whether to define
rape culture are paramount to the development of informed
and sustainable institutional and public policy, they can
also detract from much needed focus on the reality of the
situation. Legal definitions of consent and intent in cases
involving sexual violence are often interpreted and applied
within a sphere of what is “reasonable” to conclude. Notions
of reasonableness, however, differ from one judge to the
next and allow for a level of subjectivity, including sexual
and racial discrimination that can yield unacceptable results.
Too often have judges taken into account the survivor’s
Journal of Psychotherapy and Counselling Psychology Reflections
level of alcohol consumption or attire in their determinations
of “consent” (Harris & Crawford, 2015). This is true despite
women’s advocacy efforts to draw attention to the fact that
only explicit and continued consent amounts to consent.
Hence, an unwillingness to define rape culture and put pen to
paper in this regard maintains the status quo of passivity and
discretion in on- and off-campus institutions and communities
(Heldman & Brown, 2014).
Rape culture in universities
Highly publicised incidents of sexual assault on university
campuses have propelled rape culture to the forefront
of public policy agendas. In 2014, CBC’s The National
aired a special news report examining rape culture in
postsecondary institutions across North America, noting
that it is extensive, embedded, insidious and systemic
(Ormiston, 2014). Its pervasiveness has been corroborated
by the chilling statistics of recent surveys and studies. As
previously mentioned, a 2015 survey by the Association
of American Universities found that 23% of female college
undergraduate students had experienced some form of
sexual assault or misconduct under force, threats of force or
incapacitation. This supports an earlier study’s assessment
that 15% to 25% of North American university-aged women
will experience some form of sexual assault during their
postsecondary academic career (Lichty, Campbell &
Schuiteman, 2008). Despite heightened public awareness of
rape culture in universities, based on the consistency of this
data over the years, it appears that little progress has been
made by way of mitigation or deterrence.
In Canada, for example, three critical events dominated
recent news headlines: (1) Three male students at the
University of Ottawa published “jokes” online about raping
their female student union president (Ormiston, 2014); (2)
Male and female students endorsed non-consensual sex
through chants at St. Mary’s University during freshmen
orientation (CBC News, 2013a; CBC News, 2013b); (3) A
group of male dentistry students at Dalhousie University
joked about sexually assaulting female classmates after
drugging them with chloroform in a Facebook group
(Backhouse, McRae & Iyer, 2015). Meanwhile, in the United
States, one may recall the case of Emma Sulkowicz who
carried her mattress around campus in protest of Columbia
University’s inaction in expelling her alleged rapist (Gambino,
2015). In May 2015, she carried her mattress across the
stage as she accepted her diploma. No disciplinary action
was taken against her alleged attacker; although an
internal investigation was carried out (Gambino, 2015).
This is one of many high profile cases in the United States,
including the most recent case at Stanford University.
Psychological impact on survivors
Although these cases are memorable for their notoriety,
each carries with it the weight of psychological and
emotional trauma. For example, Zinzow et al. (2012) found
that survivors who were forcibly raped while under the
influence of drugs or alcohol were approximately five times
more likely to suffer from lifetime major depressive episodes
than non-victims. Sexual assault survivors are also more
likely to attempt suicide or engage in suicidal ideation.
One particular study found that high school students who
were raped were more likely to report suicidal ideation in
the preceding 12 months than non-victims (Basile et al.,
2006). Similar findings have been reported in the context
of sexual assault amongst postsecondary students. It has
been shown that victims of sexual assault suffer from high
rates of posttraumatic stress disorder, depression and
substance abuse, which can be detrimental to academic
performance (Kilpatrick, Resnick, Ruggiero, Conoscenti &
7
McCauley, 2007) and a risk factor for university drop out
(Eisenberg, Golberstein & Hunt, 2009). Thus, while rape
culture represents a deep-rooted systemic issue, the stakes
of inaction are as high at the individual-level as they are at
the community-level.
Upon graduation, many students take up leadership
positions and develop professional practices that require
them to embody and model respectful, ethical and
inclusive behaviour as the best educated members of
society. Universities are best positioned to effect deep and
sustainable educational change because their graduates
are looked upon as role models. If graduates are to
take leadership positions as society’s next generation
of “influencers,” whether in government, media and
entertainment, medicine, law, engineering, academia or
communications, it is essential to tackle and destroy rape
culture at the heart of society’s postsecondary education
systems and their influencing sectors.
While there is evidence that sexist attitudes among
students may develop prior to university (Shariff, 2015),
such data should only serve to strengthen universities’
resolve to dismantle the social constructs that allow such
ideas to proliferate. For many students, university marks
their first time away from home, as well as their first test
in independence. Problematically, universities, unlike
primary and secondary schools, are not considered “in loco
parentis” (in the place of a parent), as university students
are not minors. Thus, as it stands, universities do not have
the same duty of care towards their students (Stamatakos,
1990). Nonetheless, this should not completely absolve them
from ensuring and maintaining learning environments that
are not “deliberately dangerous” (Davis v. Monroe County
Board of Education, 1999) so as to foster the physical
and psychological safety, security, health and well-being
of their students. Canadian courts and tribunals require
public institutions to ensure that learning and working
environments are “not poisoned” (Ross v. New Brunswick
School District No. 15, 1996; Jubran v. North Vancouver
School District, No. 44, 2002). Accordingly, we are faced
with competing objectives—on the one hand, students
must be independent and responsible for their own actions
and expressions without university supervision while on
the other hand, universities are obliged to ensure a safe
learning environment for their students. For these reasons,
the extent to which universities ought to intervene can
be unclear. We have always maintained (Shariff, 2005;
2009; 2015), however, that institutional responses that are
implemented in reaction to incidents are often superficial
and put in place to safeguard the institution’s reputation
rather than to tackle the problem effectively.
Reactive university responses
University administrators have responded with minimal
action in some cases and at the other end of the spectrum,
suspension or expulsion of alleged perpetrators with
questionable due process. As noted in CBC The National’s
special news report examining rape culture, despite its
endemic nature on university campuses in North America,
few clear or effective policies and procedures exist to
address it (Ormiston, 2014). This is best evidenced by the
variety of reactions adopted by university officials and
administrators in response to incidents of sexual assault
on campus. In the case of Dalhousie University’s Faculty of
Dentistry, the university’s decision to use restorative justice
(Leung, 2014; Clark, 2014) resulted in controversy and public
protests, where many in the university community felt that
justice was not served, calling for expulsion. The university
Volume 1, Number 2, September 2016
8
ultimately allowed the students to complete their degrees in
a physical location separate from the female students they
discussed online (Auld, 2015). Meanwhile, at the University
of Ottawa, the administration decided to suspend the
hockey program rather than the team members themselves
following an internal review into allegations of a gang sexual
assault by some of the team’s players (Bell, 2014).
Following three high profile Canadian cases, University of
Ottawa (Andrew et al., 2015), St. Mary’s University (MacKay,
2013) and Dalhousie University (Backhouse, McRae & Iyer,
2015) established respective task forces to study, explore
and analyse on-campus rape culture with the aim of making
policy and procedure recommendations with a mind to
prevention and survivor support. It is noteworthy that each
report uncovered a range of characteristics engendering
rape culture; namely, a lack of administrative transparency,
inadequate policies to address the issue, unfair procedures
and safe spaces for reporting, as well as the exclusion of
ethics training specific to professional programs such as
dentistry, medicine, engineering or management. They
also reported poor communication and indecision between
faculty and university administrators on how to respond
to incidents of sexual violence, highlighting a general
reluctance by administrators to act upon and follow up
reports effectively.
Importantly, these reports illuminate and inform our
model that aims to help universities ensure safe, informed
and supportive learning environments. Thus, our
recommendations provide a strategic model for long-term
development of sustainable university policies and responses
towards unearthing, dismantling and reducing rape culture
on university campuses, as well as in the online and public
environments that serve to sustain and reinforce its existence.
Report of the Task Force on Respect and Equality:
Ending Sexual Violence at the University of Ottawa
(Andrew et al., 2015)
The University of Ottawa Task Force Report highlighted
serious feelings of distrust for the administration.
Specifically, there was a general consensus that the
administration preferred to act alone in handling incidents
of sexual violence on campus, refusing or failing to accept
the input of various stakeholder groups on campus. As such,
policies and procedures were developed unilaterally rather
than collaboratively.
Furthermore, the report revealed a need for increased
survivor support and outreach on campus. Specifically,
stakeholders asserted that the University needed to
properly acknowledge the physical, psychological and
emotional trauma lived by sexual assault survivors. To do so,
stakeholders proposed the implementation of a confidential
reporting process, as well as the staffing of “trained
counsellors with a robust understanding of the effects of
sexual violence on campus” (p. 18). Students also felt that
the University was lacking a safe space where students,
faculty and staff could speak out about, and against issues
of sexual violence and rape culture.
Another notable finding of the report was that universities
consistently fail to use and work with the readily available
resources just beyond their institution’s walls. Grassroots
community organisations with a focus on survivor
advocacy have a wealth of expertise in combatting rape
culture. Universities would thus do well to create advisory
committees that include community organisations to
help implement informed and sustainable policies and
procedures.
Finally, the report emphasised the importance of “naming
the problem” (p. 24). To properly address rape culture on
university campuses, the administration must be transparent
in its discussions and reporting on sexual violence, as well
as its existing and working policies and procedures. A lack of
transparency only serves to fuel any existing distrust for the
institution.
Promoting a Culture of Safety, Respect and Consent at
Saint Mary’s and Beyond: Report from the President’s
Council (MacKay, 2013)
The St. Mary’s University Task Force Report recognised the
need for a broad cultural change on campus. To underscore
this cultural change, the report identified six C’s that
ought to be kept in mind and built upon: (1) commitment,
(2) consent, (3) critical thinking, (4) communication, (5)
collaboration and (6) caring. These six elements form the
basis for MacKay’s recommendations.
Task Force Chair, Professor MacKay, suggested: (1)
developing a university-wide Code of Conduct, (2) revising
the university’s sexual assault policy, (3) increasing
understanding consent, (4) collaborating with student
associations, other postsecondary institutions in the
province and the provincial government, and finally, (5)
encouraging and creating the infrastructure for teaching and
research excellence in areas related to sexualised violence
(MacKay, 2013). These recommendations emphasise the
importance of well-established norms and policy in affecting
cultural change.
St. Mary’s University Task Force is the only task force of the
three that included students as members. Given the other
Task Forces’ emphasis on open communication between
administration, faculty, staff and students, and the need
for collaboration with student unions and associations, it
is significant to see St. Mary’s “walk their talk” by including
student members on the Task Force from the outset. Despite
the broad wording of the recommendations, the initial
inclusion of student voices in the creation and adaptation of
university policies is laudable and promising for their future
implementation.
Report of the Task Force on Misogyny, Sexism and
Homophobia in Dalhousie University Faculty of Dentistry
(Backhouse, McRae & Iyer, 2015)
The Dalhousie Task Force Report considered the Dentistry
incident as a product of complications in four intersecting
and overlapping ecosystems: (1) the Faculty of Dentistry; (2)
the wider Dalhousie University community; (3) social media;
and (4) society at large.
It found that the Faculty of Dentistry has no formal student
complaints process. As such, students were simply
encouraged to bring complaints to the Assistant Dean for
Academic Affairs or the Assistant Dean for Student Affairs,
who each had discretion to handle complaints as they saw fit.
It was also revealed that male students and faculty alike would
make crude and offensive comments to female students,
creating an unhealthy learning and working environment.
Meanwhile, at the university-wide level, the report found
that overall the institution was making some strides by way
of addressing rape culture on campus. For example, the
University published a pamphlet entitled “Sexual Assault:
Response Guidelines,” as well as video series exploring the
notion of consent. Nonetheless, students and faculty criticised
the administration for not being aware of the Dentistry
issue sooner, shining a spotlight on potential breakdowns in
communication between faculty and administration.
Journal of Psychotherapy and Counselling Psychology Reflections
The report emphasised not only the need to update social
media use and conduct policies but also implementation of
“participatory forms of learning about the legal and ethical
implications of [student and professional] online conduct”
(p. 42). Whether such programming would be mandatory or
optional, curricular or extra-curricular is yet to be determined.
Finally, the report recognised the symbiotic relationship between
universities and the wider community—they learn from each
other, both the good and the bad. As universities represent
centres for research and education, they find themselves in a
privileged position where they can effect real change.
The Task Force Reports are insightful, and one recommends
collaboration beyond university walls. In some ways however,
they adopt an oversimplified approach to a nuanced and
complex human issue. Universities cannot combat this
phenomenon alone. As cultural practices support conditions
leading to sexual violence, it is clear that we have a collective
responsibility to respond to its proliferation both on- and offcampus (May & Strikwerda, 1994).
At McGill University, we have brought together a
multidisciplinary network of academic researchers and
community collaborators. Our overarching goal is to unearth,
dismantle and prevent rape culture within universities, and
ultimately in society, through evidence-based research
that will inform sustainable curriculum and policy change.
We aim to shift the focus from commonly applied reactive
solutions to identify proactive ways to inform the current
policy vacuum, through preventative and legally defensible
policy responses. These will, in turn, support educational
practices that engage students in safe dialogues about this
complex social phenomenon. Our long-term research will
result in informed and equitable university policies, as well
as innovative, student-relevant curricula. We expect that our
strategic methodologies will have lasting impacts within and
beyond universities as collaborating sectors disseminate
research from the project into their respective fields and
students mobilise knowledge to create a cultural shift in how
rape culture is understood and addressed in society.
Unlike current efforts that occur in isolation, our approach
addresses rape culture by means of a systemic networked
solution between the fields of law, education, arts and popular
culture (“Arts”) and news and social media (“Media”).
Influence of arts, media and popular culture
University students are prolific consumers of social media,
online news and entertainment (Junco, Heiberger & Loken,
2011; Mihailidis, 2014; Rosengard, Tucker-McLaughlin &
Brown, 2014). As noted, high-profile Task Force Reports
(MacKay, 2013; Backhouse, McRae & Iyer, 2015) have
observed that while rape culture in broader society is
mirrored within universities, few studies have focused on
the influence of media and popular culture on university
communities. We address these oversights through the
implementation of working groups comprised of renowned
academic and community experts within the fields of: (a) Law
and policy; (b) Arts and popular culture; and (c) News and
social media. These three sectors are referred to collectively
herein as “Influencing Sectors.”
Strategic model objectives
It is necessary to engage three working groups (Project Teams
A-C), in three separate but integrated projects (Projects A-C),
to clarify complex policy, legal and educational questions
that contribute to the current confusion surrounding the
roots of rape culture towards increased prevention, empathy,
safe spaces, support for survivors, legal literacy, media
literacy and sustainable policy responses and programming
(see Diagram 1). We outline these questions below.
9
Project A - Role of Universities: Project Team A
(Universities) seeks six objectives:
• Systemic Barriers Sustaining Rape Culture: How might
universities tacitly condone and sustain rape culture
through policies, curriculum, and official responses
(“University Responses”) to sexual violence and how
can empirical research with students, faculty, staff and
administrators (“University Communities”) disclose
inadequacies in said responses?
• Intersections between Education and Human Rights Law:
(i) What legal frameworks govern, impact or intersect with
university administrative processes and provide human
rights remedies against discrimination and sexual violence
and (ii) To what extent are these reflected and applied in
University Responses?
• Legal Literacy among University Communities: To what
extent are universities aware of their legal responsibility
in providing effective University Responses and to
what extent do students understand the legal remedies
available to them following incidents of sexual violence?
• Case Law and Academic Literature: What case law, legalacademic literature and legal literacy programs might
provide University Communities with insight as they
grapple with balancing free expression, privacy, protection
and the regulation of sexual violence?
• Gaps in Social Awareness in Professional Ethics Programs:
Using the McGill Faculty of Dentistry as a pilot study,
our intention is to address concerns on student norms
identified by the Dalhousie Task Force Report (Backhouse,
McRae & Iyer, 2015) and drawing on research findings,
improve the Faculty’s policies and curriculum on social
awareness and ethics to address rape culture.
• Educational Potential of Universities: What role can
universities play through multidisciplinary programs to
engender a deeper understanding of rape culture, and
how can they create safe spaces for reporting and legally
defensible University Responses?
Project B - Role of Arts and Popular Culture: Project Team
B (Arts) seeks two objectives:
• Sustaining Influence: What is the nature and extent to
which this Influencing Sector fosters, tacitly condones,
and perpetuates rape culture through content, policy
and popular culture norms and how are these messages
interpreted within University Communities?
• Educational Role and Influence: How can Arts
organisations work with University Communities to
facilitate on-and-offline dialogic spaces, innovative
educational resources and critical literacies to address
rape culture in universities and greater society?
Project C - Role of News and Social Media: Project Team C
(Media) seeks two objectives:
• Sustaining Influence: What is the nature and extent to
which this Influencing Sector fosters, tacitly condones,
and perpetuates rape culture through content, policy and
communications norms, and how are these messages
interpreted within University Communities?
• Educational Role and Influence: How can Media
organisations work with University Communities to
facilitate on-and-offline dialogic spaces, innovative
educational resources and critical literacies to address
rape culture in universities and greater society?
Volume 1, Number 2, September 2016
10
Evidence-Based
lnformed Policy
lnformed Practice
Engage
Stakeholders
Project A: Responsive
University Subculture
Informed policies; codes
of conduct; safe spaces to
report; clear consequences;
informed curricula;
assessment and evaluation
Project B: Reflective
Arts and Cultural
Change
Safe spaces to create,
collaborate, and report;
engage students in creation
of arts and media-based
critical projects
Project C: Sensitive and
Professional Social and
News Media
Safe online spaces;
responsible reporting;
journalistic et hics; dialogic
print and online resources
and forums
PROACTIVE
+
IMPACT:
progress
towards
cultural
change
Addressing Rape Culture in Universities
REACTIVE
Current
Responses and
Tacit Condoning
Project A:Complacent
University Responses
Fewer policies; poor
follow-up; silencing; victimblaming; lack of informed
resources; lack of safe
spaces
Project B: Arts and Culture
that Proliferates Rape
Culture Violent
pornography; high threshold
for offensive speech and
music; female garners
shunned; misogynist
comedy
Project C: Media
Sensationalism and
Insensitivity
Limited critiques of
news media reports and
social media dialogues;
gaming and other forms of
media that perpetuate
rape culture
Diagram 1. Multidisciplinary Strategic Model for addressing rape culture in universities
Conclusion
The central role of universities is to effect transformational
change in society through intellectual debate, critical
and scholarly teaching, evidence-based research, and
publications concerning issues of public policy (METRAC,
2014; Shariff, 2015). Our Strategic Model aids and encourages
universities across Canada and abroad to address the policy
vacuum as follows:
1.Reclaim university research mandates for safer
learning environments: Although news media and
institutional surveys have been undertaken (Swain,
2015; Surman, 2014; Harvard Sexual Conduct Survey,
2015), few long-term academic research studies address
this phenomenon. Despite Canadian universities’
commitment to evidence-based scholarship, when it
comes to addressing sexual violence, the tendency of
administrators is to implement rather than preventative
policies (Backhouse, McRae & Iyer, 2015; MacKay, 2013).
A multidisciplinary Strategic Model that engages varied
Influencing Sectors is required to fill this gap, providing
opportunities for in-depth evaluation, reflection, research,
and mobilisation of study outcomes.
2.Reclaim university educational mandate for safer learning
environments: Through curricula as taught by sector
experts, the Strategic Model aims to develop capacity for
critically informed media, arts and legal literacy among
students and faculty, enabling opportunities to rethink
social norms and recognise the insidious nature of rape
culture in safe dialogic spaces. The unique strategy of
collaborating with key community experts and advocates
from Influencing Sectors to inform research, policy
and curricula serves to: (a) educate society at large, as
community advocacy groups learn from collaborative
research and engagement with students, disseminating
knowledge gained to their own sectors; and (b) educate
students who will graduate and go on to lead society
with informed insights on rape culture, thus reducing its
societal impact.
IMPACT:
Sustained
sexist
attitudes
–
3.Build student capacity through safe spaces: Our Strategic
Model empowers students to contribute to safer on-andoffline societies. Ideally, this would include the creation of
safe social media platforms and physical learning spaces
that include classrooms but extend to theatres, art galleries,
and conferences. In turn, these spaces will bring students
and the public together in critical but respectful discourse.
4.Connections that reduce the “silo effect”: Some might
argue our work is done, as several universities are already
implementing strategic plans to address sexual violence.
While admirable, these initiatives operate in isolation and
are thus, incomplete. Task Force Reports, for example,
may not always be grounded in empirical research, or
deeply consider how external sectors like media and the
arts specifically perpetuate rape culture within universities.
Our Strategic Model, which proposes long-term multisector research collaboration, critiques and builds on the
frameworks proposed by University Responses to uncover
the complexities of rape culture they fail to capture.
The systemic and deep-rooted nature of rape culture,
including its psychological and emotional impacts,
necessitates a collaborative approach between
multidisciplinary stakeholders. It requires postsecondary
institutions to come together with experts in psychology,
health care, and community advocacy, as well as sector
experts working in arts and media industries, to facilitate
sustainable impacts for universities, broader society and
importantly, survivors.
References
Andrew, C., Bernard, V., Gordon, K., Graydon, S., Green, K.,
Hrick, P., & Johnson, H. (2015). Report of the task force on
respect and equality: Ending sexual violence at the University
of Ottawa. Ottawa: ON.
Association of American Universities. (2015). AAU Campus
Survey on Sexual Assault and Sexual Misconduct. Retrieved
from http://www.aau.edu/Climate-Survey.aspx?id=16525
Attwood, F. (2007). Sluts and riot grrrls: Female identity and
sexual agency. Journal of Gender Studies, 16(3), 233-247.
Journal of Psychotherapy and Counselling Psychology Reflections
Auld, A. (2015, January 12). Dalhousie starts dentistry classes,
but students involved in Facebook scandal ordered to be
segregated. National Post. Retrieved from http://news.
nationalpost.com/news/canada/dalhousie-starts-dentistryclasses-but-students-involved-in-facebook-scandalordered-to-be-segregated
Backhouse, C., McRae, D., & Iyer, N. (2015). Report of the
task force on misogyny, sexism, homophobia in Dalhousie
University Faculty of Dentistry. Retrieved from http://www.dal.
ca/content/dam/dalhousie/pdf/cultureofrespect/DalhousieDen
tistryTaskForceReport-June2015.pdf
Bailey, J. (2013). ‘Sexualized online bullying’ through an equality
lens: Missed opportunity in AB v. Bragg?” McGill Law Journal,
59(3), 709-737.
Bailey, J. (2015). A Perfect Storm: How the Online Environment,
Social Norms and Law Constrain Girls’ Online Lives. In Jane
Bailey and Valerie Steeves (Eds.), eGirls, eCitizens: Putting
Technology Theory and Policy Into Dialogue with Girls’ and
Young Women’s Voices. Ottawa: Ottawa Press.
Basile, K. C., Black, M. C., Simon, T. R., Arias, I., Brener, N. D. &
Saltzman, L. E. (2006). The association between self-reported
lifetime history of forced sexual intercourse and recent healthrisk behaviors: findings from the 2003 National Risk Behavior
Survey. Journal of Adolescent Health, 39(5), 1-7 (available
online).
Bell, D. (2014, June 25). U of Ottawa suspends hockey team
after review into sex allegations. Ottawa Sun. Retrieved from
http://www.ottawasun.com/2014/06/25/u-of-o-suspends-itshockey-team-after-review-into-sex-allegations
Benedict, H. (1993). The language of rape. In E. Buchwald, P.
R. Fletcher, & M. Roth (Eds.), Transforming a rape culture.
Minneapolis, MN: Milkweed Editions.
Bever, L. (2016, June 6). ‘You took away my worth’: The full
statement a rape victim delivered to her attacker, the Stanford
swimmer. Washington Post. Retrieved from http://news.
nationalpost.com/news/world/stanford-swimmer-rape-victimstatement
Binder, M. (2013, March 19). If you thought these unbelievable
reactions to Steubenville would just peter out, I guess
you can say you were pretty, pretty wrong. [Web log
comment]. Retrieved from http://publicshaming.tumblr.com/
day/2013/03/19
Cantor, D., Fisher, B. Chibnall, S., Bruce, C., Townsend, R.,
Thomas, G., & Lee, H. (2015). Report on the AAU campus
climate survey on sexual assault and sexual misconduct
(Harvard University). Rockville, MD: Westat. Retrieved from
http://sexualassaulttaskforce.harvard.edu/files/taskforce/files/
final_report_harvard_9.21.15.pdf?m=1442784546 [Harvard
Sexual Conduct Survey]
CBC News. (2013a, September 7). UBC investigates frosh
students’ pro-rape chant: Chant condoned non-consensual
sex with underage girls. CBC News, British Columbia.
Retrieved from www.cbc.ca/news/canada/british-columbia/
ubc-investigates-frosh-students-pro-rape-chant-1.1699589
CBC News. (2013b, December 19). Saint Mary’s pro-rape chant
sparks 20 new recommendations. CBC News. Retrieved from
http://www.cbc.ca/news/canada/nova-scotia/saint-mary-s-prorape-chant-sparks-20-new-recommendations-1.2469851
Clark, B. (2014, December). Expel rape culture: Protesters
seek punishment for Dal dentistry students. The Vanguard.
Retrieved from http://www.thevanguard.ca/News/
Regional/2014-12-19/article-3983303/‘Expel-rapeculture%3A-Protesters-seek-punishment-for-Dal-dentistrystudents/1
Eisenberg, D., Golberstein, E. & Hunt, J. B. (2009). Mental Health
and Academic Success in College. B. E. Journal of Economic
Analysis & Policy, 9(1), 1-35.
11
Gambino, L. (2015, May 19). Columbia University student carries
rape protest mattress to graduation. The Guardian. Retrieved
from https://www.theguardian.com/us-news/2015/may/19/
columbia-university-emma-sulkowicz-mattress-graduation
Harris, K. & Crawford, A. (2015, November 9). Federal Court
judge under review for berating sex assault complainant.
CBC News. Retrieved from http://www.cbc.ca/news/politics/
canada-judge-judical-review-robin-camp-1.3311574
Heldman, C. & Brown, B. (2014, October 8). Why Colleges
Won’t (Really) Address Rape Culture. [Web log comment].
Ms. Blog Magazine. Retrieved from http://msmagazine.com/
blog/2014/10/08/why-colleges-wont-really-address-rapeculture/
Hutchinson, B. (2014, March 7). Is there an epidemic of ‘rape
culture’ at Canadian universities? National Post. Retrieved
from http://news.nationalpost.com/news/is-there-an-epidemicof-rape-culture-at-canadian-universities
Johnson, K. C. (2015, April 6). Fear of Facts: Rolling Stone’s
Negligence Is Just Part of a Larger Problem of Media Bias in
Sexual-Assault Cases. National Review. Retrieved from http://
www.nationalreview.com/articles/416538/fear-facts-rollingstones-negligence-just- part-larger-problem-media-biassexual
Junco, R., Heiberger, G. & Loken, E. (2011). The effect of Twitter
on college student engagement and grades. Journal of
Computer Assisted Learning, 27(2), 119– 132.
Kelly, L. (2013). Surviving sexual violence. New York: John Wiley
& Sons.
Kilpatrick, D. G., Resnick, H. S., Ruggiero, K. J., Conoscenti, L.
M. & McCauley, J. (2007). Drug-facilitated, Incapacitated, and
Forcible Rape: A National Study (NCJ 219181). Charleston:
Medical University of South Carolina, National Crime Victims
Research & Treatment Center.
Leung, M. (2014, December 18). Dalhousie ‘restorative justice’
response a ‘cop out’: student leader. CTV News. Retrieved
from http://www.ctvnews.ca/canada/dalhousie-restorativejustice-response-a-cop-out-student-leader-1.2153391
Lichty, L. F., Campbell, R. & Schuiteman, J. (2008). Developing
a university-wide institutional response to sexual assault and
relationship violence. Journal of Prevention & Intervention
Community, 36 (1-2), 5-22.
MacKay, A. W. (2013). Promoting a culture of safety, respect and
consent at Saint Mary’s University and beyond. Report from
the President’s Council. Halifax: NS.
Malinen, K. (2013). Woman-to-woman rape: A critique of Marcus’
‘Theory and Politics of Rape Prevention.’ Sexuality & Culture,
17(1), 360-376.
May, L. & Strikwerda, R. (1994). Men in groups: Collective
responsibility for rape. Hypatia, 9(2), 134-151.
McLaughlin, E. C. (2016, June 10). One million sign petition to
oust judge in Brock Turner case. Will it matter? CNN News.
Retrieved from http://www.cnn.com/2016/06/09/us/judgeaaron-persky-recall-petition-brock-turner-stanford-rape-trnd/
METRAC. (2014). Campus Safety Audit Services: Creating safer
campuses for everybody. Retrieved from http://www.metrac.org/
wpcontent/uploads/2014/11/campus.safety.audits.12nov141.pdf
Mihailidis, P. (2014). The civic-social media disconnect: exploring
perceptions of social media for engagement in the daily life
of college students. Information, Communication & Society,
17(9), 1059-1071.
Ormiston, S. (2014, September 29). University of Ottawa’s
hockey scandal raises questions about rape culture on
campuses. CBC News, The National. Retrieved from http://
www.cbc.ca/player/Shows/Shows/The%20National/About%20
the%20Show/Susan%20Ormiston/ID/2536086548/
Volume 1, Number 2, September 2016
12
Patel, A. (2014, October 30). 460,000 Sexual Assaults In
Canada Every Year: YWCA Canada. Huffington Post Canada.
Retrieved from http://www.huffingtonpost.ca/2014/10/30/
sexual-assault-canada_n_6074994.html?
Supreme Court of Canada Judgment. (1996). Ross vs. New
Brunswick School District No. 15. ([1996] 1 S.C.R. 825).
Retrieved from http://scc-csc.lexum.com/scc-csc/scc-csc/en/
item/1367/index.do
Poole, E. (2013). Hey Girls, Did You Know? Slut-Shaming on the
Internet Needs to Stop. USFL Review, 48, 221–221.
Supreme Court of Canada Judgment. (2002). Jubran v. North
Vancouver School District No. 44, B.C. H.R. T. No. 10 (Q.L.) 221.
Revesz, R. (2016, June 18). Stanford rape case judge could
be recalled—but not before November 2017. Independent.
Retrieved from http://www.independent.co.uk/news/world/
americas/stanford-rape-case-judge-could-be-recalled-but-notbefore-november-2017-a7089566.html
Surman, R. (2014, November 27). Ryerson University to review
sexual assault policies. The Ryersonian. Retrieved from http://
www.ryersonian.ca/ryerson-university-to-review-sexualassault-policies
Rosengard, D., Tucker-McLaughlin, M. & Brown, T. (2014).
Students and social news: How college students share news
through social media. Electronic News, 8(2), 120-137.
Sánchez, R. (2016, June 11). Stanford rape case: Inside the
court documents. CNN. Retrieved from http://www.cnn.
com/2016/06/10/us/stanford-rape-case-court-documents/
Shariff, S. (2005). Cyber-dilemmas in the new millennium:
School obligations to provide student safety in a virtual school
environment. McGill Journal of Education, 40(3), 457–477.
Shariff, S. (2009). Confronting cyberbullying: What schools
need to know to control misconduct and avoid legal
consequences. New York: Cambridge University Press.
Shariff, S. (2015). Sexting and cyberbullying: Defining the line on
digitally empowered kids. New York: Cambridge University
Press.
Stack, L. (2016, June 6). Light sentence for Brock Turner in
Stanford Rape Case Draws Outrage. New York Times.
Retrieved from http://www.nytimes.com/2016/06/07/us/
outrage-in-stanford-rape-case-over-dueling-statements-ofvictim-and-attackers-father.html?_r=0
Stamatakos, T. C. (1990). The Doctrine of In Loco Parentis, Tort
Liability and the Student-College Relationship. Indiana Law
Journal, 65(2), 471-491.
Swain, D. (2015, February 9). Sexual assault on campus. CBC
News, The National. Retrieved from http://www.cbc.ca/player/
News/TV%20Shows/The%20National/Canada/ID/2652946187
United States Supreme Court Judgment. Davis v. Monroe
County Board of Education. (1999). 526 US 629. Retrieved
from https://supreme.justia.com/cases/federal/us/526/629/
case.html
Visser, S. & McCaffrey, S. (2013, December 28). Campus rape
reports up, but prosecutions still rare. The Atlanta JournalConstitution. Retrieved from http://webmedia.newseum.org/
newseum-multimedia/tpt/2013-12-28/pdf/GA_AJC.pdf
Welsh-Huggins, A. (2013, March 17). Ohio football players guilty
in rape of 16-year-old girl, face year-plus in jail. National Post.
Retrieved from http://news.nationalpost.com/2013/03/17/ohiofootball-players-guilty-in-rape-of-16-year-old-girl-face-yearplus-in-jail/
Williams, J. E. (2007). Rape culture. In G. Ritzer (Ed.),
The Blackwell Encyclopedia of Sociology (vol. VIII, pp.
3783–3787). Malden: Blackwell Publishing.
Zinzow, H., Resnick, H., Amstadter, A., McCauley, M., Ruggiero,
K. & Kilpatrick, D. (2012). Prevalence and risk of psychiatric
disorders as a function of variant rape histories: Results from
a national survey of women. Social Psychiatry and Psychiatric
Epidemiology, 47(6), 893-902.
13
ADOLESCENT GIRLS’ DECLINING MENTAL HEALTH:
WHERE IS THE FEMINIST PERSPECTIVE?
Rosalyn H. Shute
Abstract
In adolescence, girls experience a concerning drop in their mental health and
wellbeing. I argue here that their tendency to ‘internalise’ in the face of adversity
and to ‘languish’ rather than ‘flourish’, is heavily influenced by their developmental
histories of gender role socialisation, compounded by the specific socialisation
pressures they face in adolescence, particularly concerning body image and
harassment from male and female peers. Although we are often said to live in
post-feminist times, there is ongoing evidence that girls and women in the West
as well as around the world continue to be disadvantaged by patriarchal social
systems. In the context of psychology’s positivist and individualist history, and
its current privileging of biological explanations, clinical psychology neglects
the role of patriarchy and gender socialisation in undermining adolescent
girls’ mental health and wellbeing. A resurgence of efforts to incorporate
feminism into clinical practice would be timely, given the current cultural push
in the West for acceptance of more diverse and fluid gender identities.
Keywords: Adolescence, clinical psychology, feminism, gender, girls, harassment,
patriarchy
Introduction
While early-onset mental health problems, such as autism
and conduct problems, are more common in boys, those with
an adolescent onset, such as anxiety and depression, are
more prevalent in girls (Zahn-Waxler, Shirtcliff, & Marceau,
2008). By 18 years, girls are twice as likely to experience
such internalising disorders, a robust finding across time and
cultures that carries over into adulthood (Belfer, 2008; Telzer
& Fuligni, 2013).
Taking a more positive view of mental health than the mere
absence of psychopathology, recent Australian research has
found that adolescent girls are more likely than boys, and
younger girls, to be ‘languishing’ rather than ‘flourishing’ (i.e.,
being productive, having positive relationships and coping
with change and adversity) (Skrzypiec, Askell-Williams,
Slee, & Rudzinsky, 2014). Similarly, recent research in the
United Kingdom has found girls in their early teens to have
lower life-satisfaction, self-esteem, emotional wellbeing and
resilience compared with younger girls; boys’ measures
decline a little or remain stable (Finch, Hargrave, Nichols,
& van Vliet 2014). The latest Europe-wide survey reports
similar findings (World Health Organization, 2016). As Finch
et al. (2014) commented, the data show ‘something deeply
worrying about girls’ wellbeing’ (p. 8).
Contact: Adjunct Professor Rosalyn Shute, PhD, School of Psychology, Flinders University, South Australia.
In this paper I ask why girls are especially prone to
internalising problems, and why their mental health and
wellbeing become compromised in adolescence. I propose
that a feminist perspective is crucial for addressing girls’
mental health, but that clinical child and adolescent
psychology lacks a feminist influence. I suggest some
reasons and some ideas for incorporating feminism into
clinical practice.
Why do girls internalise?
In clinical psychology practice, our focus is on assessing
whether a girl’s emotional symptomatology is at a clinically
concerning level (compared with other girls), without
necessarily reflecting on why it is normative for girls to
express distress in an internalising fashion. To do so leads
into the sticky territory of ‘sex differences’ (innate, ‘natural’
and hard-to-shift) versus ‘gender differences’ (socially
determined and therefore potentially more open to change).
Observed differences between male and female behaviours
abound, such as toy and career preferences, girls’ greater
empathy, and boys’ greater physical aggressiveness and
competitiveness (Fausto-Sterling, 2012). Much scientific and
popular literature boosts the notion that such differences
[email protected]
14
are innate, having an evolutionary basis related to sexual
selection pressures. For example, Archer (2012) believes that
the appearance of a sex difference in toddler aggression
militates against a socialisation explanation. Evolutionary
theories assume that genetically-determined prenatal hormonal
differences organise male and female brains differently,
resulting in sex-differentiated behaviour. Regarding internalising
behaviours, one view is that they evolved as a submissive
display, particularly among females, to reduce conflict with
more dominant individuals in order to solicit social support
in adversity (Vigil, 2009). Such evolutionary explanations are
favoured within psychology’s current ‘biologising’ paradigm.
Fathers, mothers, peers, toy manufacturers, teachers, mass
media, school clothing rules – all reinforce the message
that girls’ place is to be pretty, subordinate, indoors, and
relational (with mixed messages about being both sexy
and modest), while boys should be noisy, outdoors, tough,
active, and competitive (e.g., Emolu, 2014; Pomerantz,
2007). In adolescence, ‘policing’ of gender boundaries by
male and female peers continues, through ‘sexual bullying’
(Duncan, 1999; Page, Shute, & McLachlan, 2015). Those not
conforming to gender prescriptions are at risk of poor family
relationships, peer victimisation and reduced wellbeing
(Roberts, Rosario, Corliss, Koenen, & Austin, 2012).
However, evidence for an assumed gene-hormonesbrain-behaviour developmental path is largely absent
(Fausto-Sterling, 2012), and simplistic ‘nature’ or ‘nurture’
explanations of sex differences are no longer tenable as our
understanding increases of dynamic systems and epigenetics
in development. It is now clear that the brain is very plastic,
developing in response to experience (Karmiloff-Smith, 2012),
and that psychological outcomes result from a complex
cascade of interactions between genetic, hormonal and
environmental factors (Crick & Zahn-Waxler, 2003; Tremblay,
2010; Zahn-Waxler et al., 2008). How boys’ and girls’ brains
turn out depends largely on how they ‘spend their time’ (Eliot,
2009, p. 16, original emphasis); both spend large amounts
of time (in the West) learning literacy and numeracy, and
their cognitive abilities are similar (Hyde, 2005), whereas life
lessons about emotional expression are heavily gendered
from birth (Eliot, 2009). Sex may play some role in the
complexity of interactions between genes, hormones and
environment that constructs the brain, but brains are highly
variable, with no identifiable ‘male’ and ‘female’ versions (Joel
et al., 2015). We can further note that the Trivers-Bateman
sexual selection paradigm, on which evolutionary theories of
behavioural sex differences have long depended, has been
subject to recent critique (Gowaty, 2013).
Boys and girls are socialised to deal with distress differently
(De Pauw & Glass, 2009; Eliot, 2009). Boys start out rather
more emotionally expressive than girls, but this steadily
declines over childhood and adolescence (Eliot, 2009).
Mothers of baby girls are significantly more likely to ignore
infant expressions of anger (Manstead, 1992) and to believe
that their baby can be ‘naughty’ and ‘manipulative’ and
therefore needs discipline (Arnott & Brown, 2013). Older
girls may be unwilling to express anger as it can express
dominance and upset relationships (Chaplin, Cole, & ZahnWaxler, 2005). Rather than girls having evolved to internalise,
they may simply learn that internalising responses are
approved and more effective in societies where they are
subordinate. One feminist analysis suggests that the extreme
manifestation is the young woman with anorexia nervosa,
‘withered, silent, frightened, withdrawn, self-hating, slowly
disappearing … revealing that what our culture demands of
us is nothing less than our self-eradication’ (Lester, 1997, p.
481, cited in Edwards, 2007).
Overall, innate sex-differentiated behavioural biases appear
to be few, and include newborn boys’ greater irritability
(probably resulting from their relatively immature physiology),
girls’ slightly faster verbal development, and boys’ greater
propensity for rough-and-tumble play and preference for
toys that move (Eliot, 2009). Any initial slight sex differences
are greatly magnified – fortified, to use Fausto-Sterling’s
(2012) term – by socialisation into gender roles. The power
of culture is shown by a demonstration that it can even
moderate male aggressiveness in non-human primates
(Sapolsky & Share, 2004). Differences in sex stereotyping
across cultures (Gneezy, Leonard, & List, 2009) and time
(Wood, Desmarais, & Gugula, 2002) also suggest the
importance of socialisation. Theories such as Gender
Schema Theory conceptualise how gender-related social
messages become internalised as a central aspect of identity
and influence behaviours and preferences (e.g., Bem, 1993).
Western societies use baby congratulations cards, nursery
decoration, toys and clothes in a sex-stereotyped fashion
that portrays boys as active and girls as quiet and pretty (e.g.,
Emolu, 2014; Fausto-Sterling, 2012). Parents of newborns
see girls as more delicate, less strong and finer-featured,
(Karraker, Vogel, & Lake, 1995) and mothers overestimate
their infant sons’ crawling abilities and underestimate their
daughters’ (Mondschein, Adolph, & Tamis-LeMonda, 2000),
despite the lack of any objective sex differences. Maternal
reports of greater aggressiveness in toddler boys, on
which the ‘innate’ argument depends, must therefore be
treated with caution. In early childhood centres, little boys’
aggressive dominance of girls tends to be dismissed as
‘conflict’ by teachers and ignored, while physical retaliation
by girls is immediately quashed (Main, 1999).
Are we in a post-feminist era?
While there are various versions of feminism, most challenge
patriarchy (a system of male power and privilege). Since
the 1960s the primary aim of western feminism has been to
achieve gender equality. Despite many gains, the ‘girl child’ still
has lower status than the boy, in both post-industrial societies
and the ‘majority world’ (developing countries); persistent
discrimination occurs in multiple forms, such as rape, cultural
preference for sons, denial of education and limited food
resources, genital mutilation, and expectations to undertake
unpaid and unrecognised labour (United Nations, 2000).
Numerous examples of inequality in the West can be found.
Boys gain peer status through denigrating ‘anything that
smacks of femininity’ (Martino, 1997, p. 39). Boys influence girls’
behaviour more than the reverse (e.g., Serbin, Sprafkin, Elman,
& Doyle, 1984). Girls experience more of all types of childhood
abuse than boys (Keyes et al., 2012). Pre-pubertal girls are
being increasingly sexualised (APA, 2007a). Girls’ maths
performance is reduced by the simple (inaccurate) suggestion
of male superior ability (Beilock, Rydell, & McConnell, 2007).
A scientist’s CV with a female name is rated lower than an
identical one with a male name (Moss-Racusin, Dovidio,
Brescoll, Graham, & Handelsman, 2012). Women experience
greater psychological distress than men in gender unequal
workplaces (Elwer, Harryson, Bolim, & Hammarstrom, 2013).
Women are seriously underrepresented in public positions
of power – for example, only 3% of the top Australian
corporations have a female Chief Executive Officer (Australian
Bureau of Statistics, 2012).
It is nevertheless often asserted that the West is now in a
post-feminist phase. Certainly, many young women reject
the feminist label. However, post-feminist discourse has
been challenged as based on a narrow neo-liberal view
that girls’ recent educational success demonstrates the
achievement of equality (Ringrose & Renold, 2012). Indeed,
Journal of Psychotherapy and Counselling Psychology Reflections
in an anti-feminist backlash, boys’ educational ‘failures’
have become a matter of increasing concern (the ‘boy turn’),
spawning a ‘gender equity’ movement that regards boys
and girls as having different, gender-stereotypical learning
needs – compromising gender justice and ignoring cultural
privilege (Keddie, 2009).
While girls have been encouraged to believe they can be
anything they want, there is a catch: they must also reach
hyper-feminine, consumerism-boosted standards concerning
thin and sexy bodies and behaviours (the ‘post-feminist
masquerade’ – McRobbie, 2008). ‘Girl-power’ as expressed
through ‘raunch culture’ and ‘feminist’ pop divas is one
indication. However, feeling sexually emboldened is not the
same as being empowered (Lamb, 2010), and this version of
empowered girl-/womanhood hides the forces of patriarchy
that promote it (McRobbie, 2008).
Nevertheless, there is resistance to characterising girls as
cultural ‘victims’. For example, Ringrose and Renold (2012)
re-cast girls’ fantasies of male-free futures and of violence
against harassing males as survival mechanisms in the face
of subordination, rather than as escapist pathology. I do not
wish, either, to define girls by victimhood, and recognise that
they may use a range of strategies to negotiate their position
in the social world, but we need to acknowledge that their
declining wellbeing in adolescence indicates that their coping
resources are often being strained to breaking point. While
some will present (or be presented) for clinical psychology
services, many receive no help (Girlguiding, 2015).
I propose that feminism needs to be woven into clinical
psychology, as Angelique (2012) suggested for community
psychology. Following Foucault, she maintains that power is
inherent in all social discourse, though often unrecognised,
and perpetuated by dominant institutions (note: these
would include the universities that educate psychologists
and the health care systems within which they operate).
Power systems normalise power differentials and they
become internalised, such that, for example, women
blame themselves for being sexually victimised. Angelique
proposes challenging the status quo to bring an analysis
of gender and other marginalised identities to bear on
psychology scholarship and practice. She adds that ‘women’s
lived experiences constitute the foundation for feminist
knowledge’ (2012, p. 78).
Adolescent girls’ lives: a feminist
approach
So what are adolescent girls telling us about their lives that
may help us to understand their realities? A recent survey
commissioned by Girlguiding in the UK is informative, with
self-harm, smoking and mental health/depression being girls’
top three wellbeing concerns, closely followed by eating
disorders (Girlguiding, 2015). The issues worrying them
include gender stereotypes, sexism, employment prospects,
violence, cyberbullying and pornography, as well as a lack of
support for dealing with mental health problems.
Pre-teen girls in the survey display gender stereotyped
beliefs about male and female attributes and interests, and
generally have stereotypical career aspirations, although
most nevertheless think boys and girls equally capable with
equal life chances. Many of the older girls, though, believe
they must fit the mould of slimness, heavy make-up and high
heels to stand a chance in the job market. The finding that
young girls believe they can do everything, while older girls
are less sure and feel the press towards hyper-femininity,
is in accord with McRobbie’s (2008) notion of the postfeminist masquerade. These recent findings also reflect
15
the United Nations’ observation that, ‘[i]n some parts of the
world, improved educational opportunities for young women
and an increased awareness of their position have built up
expectations of greater equality and partnership in both
professional and family life – which may be frustrated by
encounters with the realities of the labour market and male
behaviour’ (UN, 2003, p. 265).
The Girlguiding (2015) report found that girls and young
women face a daily barrage of sexism: observing sexist jokes
and comments, trivialisation of violence against females,
and lack of coverage of women’s sports. Appreciation
of the link between sexism and inequality in society is
greater in older girls, who express strong concern about
readily-available Internet pornography, most believing
that it gives negative messages about consent, sexual
violence and intimate relationships. Australian girls concur:
‘Growing up in a pornified landscape, girls learn that they
are service stations for male gratification and pleasure’
(Tankard Reist, 2016, n.p.). Three-quarters of the surveyed
UK girls report being affected by sexual harassment. When
asked if they could change one thing, the commonest
themes are a reduction of media gender stereotyping,
freedom from violence and harassment, and creating
greater awareness of wellbeing and mental health issues.
The concerns of these girls about sexual harassment and
violence are consistent with a vast body of research from
fields such as sociology, education and women’s studies
(less so from psychology). As girls grow older, compared
with boys they experience more intrusive and intimidating
sexual harassment (Hand & Sanchez, 2000). Subjection to
psychological aggression from boys (such as name-calling
and rumour-mongering) undermines their sense of safety at
school (Shute, Owens, & Slee, 2008, 2016) and they may be
afraid of entering certain areas (e.g., Owens, Shute, & Slee,
2005). Harassment has serious negative effects such as
health impacts (Gruber & Fineran, 2008) and a desire to leave
the school (Bayliss, 1995; Owens et al., 2005). It tends to be
overlooked that the most extreme school violence, in the form
of school shootings in the USA, is almost always perpetrated
by boys against girls who have rejected them (Klein, 2006).
Such male harassment is clearly a stressor, and some
researchers have suggested that adolescent girls’ higher
rates of depression than boys result from their greater stress
exposure (Shih, Eberhart, Hammen, & Brennan, 2006).
Difficulties in relationships with female peers can also
contribute, in the context of girls’ more intimate friendship
groups, with rumour-mongering, exclusion and so forth
potentially having serious consequences such as suicidality
(e.g., Owens, Shute, & Slee, 2000). One might justifiably ask
how this fits into a feminist framework, and I have two points to
make here.
Firstly, it has been suggested that girls help to generate such
interpersonal stressors themselves, by virtue of their greater
investment in relationships, as well as reacting more strongly
to interpersonal difficulties (e.g., Hammen, 1991; Rudolph,
2002; Shih et al., 2006). It is further suggested that girls react
more strongly to interpersonal stressors and the problems of
others as they are more inclined to put others’ needs before
their own (Cyranowski, Frank, Young, & Shear, 2000). Although
doubtless unintended, such individualistic attributions
‘blame the victim’, who has received a lifetime of unrelenting
messages to be submissive, self-sacrificing and caring. This is
reminiscent of the moves in the 1980s to include ‘masochistic
personality disorder’ in the DSM-III-R, which would have
pathologised women trapped in abusive relationships (Butler,
1999). Girls’ (and, indeed, boys’) attitudes and behaviours
towards interpersonal relationship difficulties need to be
considered in sociocultural and developmental context.
Volume 1, Number 2, September 2016
16
The second point about girl-on-girl interpersonal stress, in
relation to feminism, is that this often includes sex-based
harassment similar to that experienced from boys, such
as being called a slut or demeaned for being overweight
(Duncan, 1999; Jamal, Bonnell, Harden, & Lorenc, 2015;
Owens & Duncan, 2009; Owens, Shute, & Slee, 2000).
Attacks on one’s sexual reputation or appearance are
central to peer ‘gender policing’ (Duncan, 1999). This is
one source of body image pressure (media ‘ideal’ body
representations being another), which fosters increased
body shame, appearance anxiety and disordered eating,
with girls more affected than boys (e.g., Slater & Tiggemann,
2010), and anorexia nervosa having very high mortality
(e.g., Sullivan, 1995). But why would girls, as well as boys,
treat their female peers like this? Popular commentary that
‘girls are mean’ is no explanation. Berdahl (2007) theorises
that ‘sexual harassers derogate others based on sex to
protect or enhance their own sex-based social status, and
are motivated and able to do so by a social context that
pervasively and fundamentally stratifies social status by sex’
(2007, p. 641). In other words, within a patriarchal context,
girls as well as boys are part of the game of struggling to
maximise their status within a system that demands that one
be a ‘good boy’ or a ‘good girl’.
These social pressures may be compounded by a sharp drop
in peer and adult support for adolescent girls that bolstered
their resilience when younger (Sun & Stewart, 2007).
Difficulties in both family and peer relationships contribute
to the gender difference in internalising symptoms, and may
have an additive negative effect on girls’ wellbeing (Telzer
& Fuligni, 2013), at a time when they face many (culturallydetermined) developmental tasks. These include forming
more mature relationships with male and female peers,
accepting one’s physique, fulfilling gender roles, developing
a value system and making future career and family plans
(Havighurst, 1953), as well as further developing a sense of
self (Kroger, 2004). While adolescence is a time of increasing
autonomy, adolescent girls’ mental health is still boosted by
family emotional support (Cyranowski et al., 2000), so a drop
in this, in the face of the challenges of adolescence, may
further undermine wellbeing. This situation is echoed by the
recent Girlguiding (2015) survey participants, who feel that
adults do not understand the pressures they face.
In sum, I suggest that the nature of girls’ mental health
problems reflects their subordinate position in a patriarchal
society, the pressures of which increase in adolescence,
resulting in lower wellbeing, both in comparison with
younger girls and adolescent boys. I therefore advocate
taking a feminist stance in psychological practice.
Clinical child/adolescent psychology
and feminism
Clinical theorising and practice with women have been
strongly influenced by feminism over the years. A prime
example is the successful action against the aforementioned
proposal to include ‘masochistic personality disorder’
in the DSM (Franklin, 1987). Feminists also critiqued
‘mother-blaming’, such as attributing schizophrenia
to ‘refrigerator mothers’. However, in my sixteen
years (from 1991) in Australian universities as a clinical
psychology teacher, practitioner and postgraduate course
coordinator, and psychology department head, I never
gained any sense of a feminist influence on clinical work
with girls. Course accreditation at both undergraduate
and postgraduate levels mandated the inclusion of
intercultural and Indigenous issues, but not gender.
In recently preparing a chapter on feminism for a book on
developmental psychology theories (Shute & Slee, 2015), my
literature search identified few links between clinical child/
adolescent psychology practice and feminism. Expanding my
search to the sociological literature and to systemic/family
therapies was barely more fruitful: not only was feministbased inquiry largely limited to adult women, but even those
critiques faded out during the 1990s (Goodrich & Silverstein,
2005). There are several possible reasons.
First is psychology’s strong positivist inheritance, which views
the researcher as an objective truth-seeker. Evolutionary
psychologists sometimes critique feminist contributions
by distinguishing between ‘what is’ (that which can be
objectively studied) and ‘what ought to be’ (a separate,
moral issue). This approach fails to acknowledge the
philosophical, historical, cultural and individual influences on
the choice of research topics, participants and methodology,
the interpretation of results, and publication selection
processes. In particular, there is male bias in the history
of developmental psychology, a field which provides (or
should provide) an invaluable evidence base for clinical child
psychology. Classical examples are Freud’s Oedipal theory
of development and the Piaget/Kohlberg studies which saw
female morality as incomprehensible or inferior to that of
males. A more recent example is psychology’s neglect of
sexual harassment in school peer victimisation research
(Shute et al., 2016). Subtle biases such as the predominant
use of masculine metaphors in developmental psychology
have also been described (Scholnick & Miller, 2000).
Critical analyses of developmental psychology exist (e.g.,
Burman, 2008; Shute & Slee, 2015), but are not mainstream.
Psychological studies that aim to improve children’s
lives (such as by developing anti-bullying initiatives, or
intervening early in disabilities) are seen as praiseworthy,
while feminist-inspired work that explicitly aims to reduce
girls’ disadvantage risks being rejected from scientific
discourse as in the realm of ‘what ought to be’. Furthermore,
many psychologists’ dismissiveness of qualitative research
as ‘not scientific’ places psychology in a disciplinary bubble,
ignorant of useful perspectives that fields such as sociology
and women’s studies may bring to bear on social factors
that impact on young people’s mental health.
A second reason for the lack of feminist influence on
clinical child and adolescent psychology is psychology’s
overwhelming individual focus. The clinical use of age
norms makes it easy for us to ignore the fact that an
adolescent girl’s mental health problems are occurring
against a background where her female peer group as
a whole is experiencing a drop in wellbeing. Providing
an individual diagnosis suggests that the problem is
inherent in her and is medical in nature. Butler (1999, p. 21)
claimed that the DSM diagnostic project was always
intended to progressively exclude non-biological systems
of explanation. Diagnostically-based university clinical
psychology courses and hospital record-keeping systems
sideline broader perspectives on mental health such as
those afforded by positive psychology, feminism and
developmental theories. In fact, other than recognition
that boys and girls tend to have different mental health
presentations, gender seems to be largely overlooked in
clinical practice.
One might expect a different situation in the literature on
systemic therapies. Feminist theorising has profoundly
influenced family therapy, by introducing the notions of power
and gender hierarchy, and giving voice to women (Gladding,
1998). This feminist push does not seem to have had much
influence on clinical work with girls, exceptions including
feminist approaches to eating disorders (Edwards, 2007;
Journal of Psychotherapy and Counselling Psychology Reflections
Maine, 2009). Carr’s (2014) otherwise excellent summary of
the evidence base for systemic therapies for a broad range of
children’s psychological problems makes no mention of gender.
A third possible reason for the absence of feminism from
clinical child psychology is the ‘post-feminist’ era that
we are assumed to be in. Despite the lack of an explicit
feminist thrust in developmental psychology, in recent
years there has been a burgeoning of research into girls’
issues, such as female aggression and body image (Eagly,
Eaton, Rose, Riger, & McHugh, 2012). This may signify the
successful mainstreaming of some women’s and girls’
issues into psychological research, although patriarchy is
not generally invoked. However, if ‘post-feminism’ is taken
to mean that girls’ issues have been ‘fixed’ – as in the ‘boy
turn’ educational discourse – then the evidence presented
in the present paper clearly indicates that this is not so.
Girls’ mental health is strongly influenced by social issues
that are far from resolved, and ceasing to ‘name’ them
risks making them invisible, including in therapist training
programmes (Goodrich & Silverstein, 2005). Interestingly,
a summary of mental health issues among Canadian youth
which highlighted the importance of taking a public health
approach by addressing social inequities, referred to
‘whiteness’ in terms of ‘privilege’ but to ‘gender’ in terms
of ‘differences’ (De Pauw & Glass, 2009); this suggests a
reluctance to acknowledge the effects of patriarchy.
A quarter of a century ago, the following was written:
Clinical psychology often has perpetuated a
discourse of self-contained individualism. … it is
built on a mechanistic, rationalistic, biological model
of humankind. Moreover, in recent decades, the
mental health field has been undergoing a sweeping
re-medicalization …, prompted by technological
innovations …, pressures to cut costs, and the
resurgence of conservatism in national politics and
public policy. Clinical psychology has not escaped
these trends … (Marecek & Hare-Mustin, 1991, p. 530)
Unfortunately, with regard to clinical child/adolescent
psychology, it seems that not much has changed even though,
almost a decade ago, the American Psychological Association
(APA) drew up guidelines for practice with women and girls.
What would feminism look like in clinical
child and adolescent psychology?
The APA’s (2007b) guidelines contain much wisdom and
remain relevant. They are culture- and gender-sensitive,
and also acknowledge other social dimensions impacting
on women and girls, such as class, race, sexuality and
disability/ability. They entail an understanding of gender
role socialisation (this applies to males as well, although
discussing that is beyond the scope of this paper). I offer the
following suggestions for practice, the first four coming from
the APA guidelines.
6.Use a systemic approach to case formulation that
incorporates an understanding of social justice and power
hierarchies, whether in family, individual or multisystemic
therapy (see Bowling, Kearney, Lumadue, & St. Germain,
2002).
7. Ask ‘Who benefits and loses?’ questions, interrogating ‘the
everyday and the particular’ to help differentiate individual
hassles from those that can be understood in a broader
sociopolitical context of oppression (Angelique, 2012).
8. Consider feminist group therapy with adolescent girls
(Bowling, Zimmerman, & Daniels, 2000).
9. Gain support from other psychologists to explore how
systems and practices are affected by taken-for-granted
gender assumptions, and how these might be addressed (for
an example from the teaching profession, see Keddie, 2010).
10.Link with schools which promote a feminist agenda.
11.Consider a focus on self-compassion (Bluth & Blanton,
2015), such as when one ‘fails’ to meet socially prescribed
standards of femininity.
12.Be educated about addressing bullying, including sexist
cyberbullying (e.g., Cross, Campbell, Slee, Spears, &
Barnes, 2013).
13.Promote media literacy (e.g., awareness of airbrushed
body photographs) in therapy.
14.Draw on girls’ strengths (e.g., their interpersonal focus is a
strength as well as a weakness).
Such practice suggestions need to be developed, evaluated
and integrated into clinical child/adolescent psychology texts
and courses, which should be explicit about societal power
structures and feminism (see Ball et al., 2013, re teaching
feminism in psychology).
We may be at something of a watershed in gender issues in
the West, with same-sex marriage a reality in many countries,
gender diversity and fluidity increasingly being publicly
discussed and, in Australia, the removal of the requirement
to specify gender as male or female on a passport. Facebook
now offers over fifty gender identity options! These matters
are always fiercely contested, as conservative forces
seek to retain what they see as the natural order of things
concerning male and female roles in society (Australian
Broadcasting Corporation News, 19.02.2016). But now
may be an ideal time for a new feminist thrust. By taking
greater account of gender socialisation and oppressive and
privileged forces in society, clinical child and adolescent
psychologists have an opportunity to play a major role in
ensuring that the changing social landscape is one that
promotes the wellbeing of all our young people, whatever
their sex or gender identity.
References
1. Avoid over-diagnosis or under-diagnosis based on sex
stereotypes.
American Psychological Association (2007a). Report of the APA
Task Force on the Sexualization of Girls. Accessed 3.02. 2016
at http://www.apa.org/pi/women/programs/girls/report.aspx
2.Be alert for trauma, such as abuse, rather than applying
stigmatising diagnoses such as borderline personality
disorder.
American Psychological Association (2007b). Guidelines for
psychological practice with girls and women. American
Psychologist, 62(9), 949-979.
3.Look for contextual factors rather than endogenous factors
underlying mental health problems.
Angelique, H. (2012). Embodying critical psychology in community
psychology: Unraveling the fabric of gender and class. Journal
of Community Psychology, 40, 77-92.
4.Listen - therapists interrupt female clients more than males.
5.Resist diagnosis in favour of case formulation (British
Psychological Society, 2011).
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Archer, J. (2012). Sex differences in the development of
aggression from early childhood to adulthood. Accessed 8.02.
2016 at http://www.child-encyclopedia.com/aggression
Volume 1, Number 2, September 2016
18
Arnott, B., & Brown, A. (2013). An exploration of parenting
behaviours and attitudes during early infancy: Association
with maternal and infant characteristics. Infant and Child
Development, 22(4), 349–361.
Australian Broadcasting Corporation, 19.02.2016. Gender on
the brain: Male and female brains are not that different,
study shows. Accessed 27.02.2016 at http://www.abc.net.au/
news/2016-02-19/gender-on-the-brain-male-and-female-brainsstudy/7179088
Australian Bureau of Statistics (2012). Women in leadership.
Accessed 24.02.2016 at http://www.abs.gov.au/AUSSTATS/
[email protected]/Lookup/4102.0Main+Features30Dec+2012
Ball, L.C., Bazar, J.L., MacKay, J., Rodkey, E.N., Rutherford, A., &
Young, J.L. (2013). Using psychology’s feminist voices in the
classroom. Psychology of Women Quarterly, 37(2), 261-266.
Bayliss, M. (1995). It just shouldn’t happen: The sexual harassment
of schoolgirls by their male school peers. In P. Camilleri & K.
Allen-Kelly (Eds.), Welfare and the diversity of practice in North
Queensland. Proceedings of Practical Diversity Conference
9–10 Sept 1995, pp. 55–71. Townsville, Queensland: Centre for
Social and Welfare Research, James Cook University.
Beilock, S.L., Rydell, R.J., & McConnell, A.R. (2007). Stereotype
threat and working memory: Mechanisms, alleviation, and
spillover. Journal of Experimental Psychology: General, 136(2),
256–276.
Belfer, M. L. (2008). Child and adolescent mental disorders:
The magnitude of the problem across the globe. Journal of
Child Psychology and Psychiatry, and Allied Disciplines, 49,
226–236.
Bem, S.(1993). The lenses of gender: Transforming the debate on
sexual inequality. New Haven, CT: Yale University Press.
Berdahl, J.L. (2007). Harassment based on sex: Protecting
social status in the context of gender hierarchy. Academy of
Management Review, 32(2), 641-658.
Bluth, K., & Blanton, P.W. (2015). The influence of self-compassion on
emotional well-being among early and older adolescent males
and females. Journal of Positive Psychology, 10(3), 219–230.
Bowling, S.W., Kearney, L.K., Lumadue, C.A., & St. Germain, L.R.
(2002). Considering justice: An exploratory study of family
therapy with adolescents. Journal of Marital and Family
Therapy, 28(2), 213-223.
Bowling, S.W., Zimmerman, T.S., & Daniels, K.C. (2000).
‘Empower’: A feminist consciousness-raising curriculum for
adolescent women. Journal of Child and Adolescent Group
Therapy, 10, 3-28.
Cross, D., Campbell, M., Slee, P.T., Spears, B., & Barnes, A. (2013).
Australian research to encourage school students’ positive
use of technology to reduce cyberbullying. In P. Smith and G.
Steffgen (Eds.), Cyberbullying through the new media: Findings
from an international network. London: Psychology Press.
Cyranowski, J.M., Frank, E., Young, E., & Shear, K. (2000).
Adolescent onset of the gender difference in lifetime rates of
depression. Archives of General Psychiatry, 57, 21–27.
De Pauw, L., & Glass, J. (2009). Girls take action on mental health:
Gender and the mental health of young Canadians. Canadian
Women’s Health Network, 11(2), n.p. Accessed 10.02.2016 at
http://www.cwhn.ca/en/node/41609
Duncan, N. (1999). Sexual bullying. London: Routledge.
Eagly, A.H., Eaton, A., Rose, S.M., Riger, S., & McHugh, M.C.
(2012). Feminism and psychology: Analysis of a half-century of
research on women and gender. American Psychologist, 67(3),
211-230.
Edwards, E. (2007). Are eating disorders feminist? Power,
resistance, and the feminine ideal. Paper presented at the
Perspectives on Power Conference. Quest 4. Accessed
28.05.2014 at http://www.qub.ac.uk/sites/QUEST/
JournalIssues/
Eliot, L. (2009). Pink brain blue brain. Boston: Houghton Mifflin
Harcourt.
Elwer, S., Harryson, L., Bolim, M., & Hammarstrom, A. (2013).
Patterns of gender equality at workplaces and psychological
distress. PloS One, 8(1), e53246. doi:10.1371/journal.
pone.0053246.
Emolu, E. (2014). Play, toys, and gender socialization. Journal Plus
Education, 11(2), 22-30.
Fausto-Sterling, A. (2012). Sex / gender: Biology in a social world.
New York: Routledge.
Finch, L., Hargrave, R., Nichols, J., & van Vliet, A. (2014). Measure
what you treasure: Well-being and young people, how it can
be measured and what the data tell us. New Philanthropy
Capital. Accessed 28.05.2014 at http://www.thinknpc.org/
publications/measure-what-you-treasure/
Franklin, D. (1987). The politics of masochism. Psychology Today
21(1), 52-57.
Girlguiding (2015). Girls’ Attitude Survey 2015. Accessed
1.03.2016 at http://new.girlguiding.org.uk/latest-updates/
making-a-difference/girls-attitudes-survey-2015
Gladding, S.T. (1998). Family therapy: History, theory and practice
2nd edn. Upper Saddle River, NJ: Prentice Hall.
British Psychological Society (2011). Response to the American
Psychiatric Association: DSM-5 development. London: British
Psychological Society.
Gneezy, U., Leonard, K.L., & List, S.J. (2009). Gender differences
in competition: Evidence from a matrilineal and a patriarchal
society. Econometrica, 77(5), 1637-1634.
Burman, E. (2008). Deconstructing developmental psychology.
London: Routledge.
Goodrich, T.J., & Silverstein, L.B. (2005). Now you see it, now you
don’t: Feminist training in family therapy. Family Process, 44(3),
267-281.
Butler, P. (1999). Diagnostic line-drawing, professional boundaries,
and the rhetoric of scientific justification: A critical appraisal of
the American Psychiatric Association’s DSM project. Australian
Psychologist 34(1), 20-29.
Carr, A. (2014). The evidence base for family therapy and systemic
interventions for child-focused problems. Journal of Family
Therapy 36(2), 107-157.
Chaplin, T.M., Cole, P.M., & Zahn-Waxler, C. (2005). Parental
socialization of emotion expression: Gender differences and
relations to child adjustment. Emotion, 5, 80-88.
Crick, N., & Zahn-Waxler, C. (2003). The development of
psychopathology in females and males: Current progress
and future challenges. Development and Psychopathology,
15, 719–742.
Gowaty, P.A. (2013). A sex-neutral theoretical framework for
understanding sex roles. In Fisher, M.L., Garcia, J.R., & Chang,
R.S. (Eds.), Evolution’s Empress: Darwinian perspectives on the
nature of women. Oxford: Oxford University Press, pp. 85-112.
Gruber, J.E., & Fineran, S. (2008). The impact of bullying and
sexual harassment on middle and high school girls. Violence
Against Women, 13(6), 627-643.
Hammen, C.L. (1991). The generation of stress in the course of
unipolar depression. Journal of Abnormal Psychology, 100(5),
55–561.
Hand, J.Z., & Sanchez, L. (2000). Badgering or bantering?
Gender differences in experience of, and reactions to, sexual
harassment among U.S. high school students. Gender and
Society, 14(6), 718–746.
Havighurst, R.J. (1953). Human development and education. New
York: Longman.
Journal of Psychotherapy and Counselling Psychology Reflections
Hyde, J.S. (2005). The gender similarities hypothesis. American
Psychologist 60(6), 581-592.
Jamal, F., Bonnell, C., Harden, A., & Lorenc, T. (2015). The social
ecology of girls’ bullying practices: Exploratory research in two
London schools. Sociology of Health and Illness, 37(5), 731-744.
Joel, D., Berman, Z., Tavorc, I., Wexlerd, N., Gabera, O., Steind,
Y., … , & Yaniv Assaf, Y. (2015). Sex beyond the genitalia: The
human brain mosaic. Proceedings of the National Academy of
Science of the United States of America, 112(50). doi:10.1073/
pnas.1509654112.
Karmiloff-Smith, A. (2012). Perspectives on the dynamic
development of cognitive capacities: Insights from Williams
syndrome. Current Opinion in Neurology, 25, 106–111.
Karraker, K.H., Vogel, D.A., & Lake, M.A. (1995). Parents’ genderstereotyped perceptions of newborns: The eye of the beholder
revisited. Sex Roles, 33(9/10), 687-701.
Keddie, A. (2009). National gender equity and schooling policy in
Australia: Struggles for a non-identitarian feminist politics. The
Australian Educational Researcher, 36(2), 21-37.
Keddie, A. (2010). Feminist struggles to mobilise progressive
spaces within the ‘boy-turn’ in gender equity in schooling
reform. Gender in Education, 22(4), 353-368.
Keyes, K.M., Eaton, N.R., Krueger, R.F., McLaughlin, K.A., Wall,
M.M., Grant, B.F., & Hasin, D.S. (2012). Childhood maltreatment
and the structure of common psychiatric disorders. British
Journal of Psychiatry, 200, 107-115.
Klein, J. (2006). An invisible problem: Everyday violence against
girls in schools. Theoretical Criminology, 10, 147–177.
Kroger, J. (2004). Identity in adolescence. Hove: Routledge.
Lamb, S. (2010). Feminist ideals for a healthy female adolescent
sexuality: A critique. Sex Roles 62, 294-306.
Main, N. (1999). Children’s perpetration of violence in early
childhood centres: Beyond conflict. Paper presented at the
Children and Crime: Victims and Offenders Conference,
convened by the Australian Institute of Criminology, Brisbane,
June 1999. Accessed 4.03.2016 at www.aic.gov.au/media_
library/conferences/children/main.pdf
Maine, M. with Davis, W., & Shure, J. (Eds.) (2009). Effective
clinical practice in the treatment of eating disorders: The heart
of the matter. New York: Routledge.
Manstead, A.S.R. (1992). Gender differences in emotion. In A. Gale
& M.W. Eysenck (Eds.), Handbook of individual differences:
Biological perspectives. Chichester: Wiley, pp. 355-387.
Marecek, J., & Hare-Mustin, R.T. (1991). A short history of the
future: Feminism and clinical psychology. Psychology of
Women Quarterly, 15, 521-536.
Martino, W. (1997). ‘A bunch of arseholes’: Exploring the
politics of masculinity for adolescent boys in schools. Social
Alternatives,16(3), 39–43.
McRobbie, A. (2008). The aftermath of feminism: Gender, culture
and social change. London: Sage.
Mondschein, E.R., Adolph, K.E., & Tamis-LeMonda, C.S. (2000).
Gender bias in mothers’ expectations about infant crawling.
Journal of Experimental Child Psychology, 77, 304–316.
Moss-Racusin, C.A., Dovidio, J.F., Brescoll, V.L., Graham, M.J., &
Handelsman, J. (2012). Science faculty’s subtle gender biases
favor male students Proceedings of the National Academy of
Science of the United States of America, 109(41). Accessed
24.02.2016 at http://www.pnas.org/content/109/41/16474.
abstract
Owens, L., & Duncan, N. (2009). ‘They might not like you but
everyone knows you’: Popularity among teenage girls. Journal
of Student Wellbeing, 3(1), 14-39.
Owens, L., Shute, R., & Slee, P. (2000). ‘Guess what I just
heard…’ Indirect aggression among teenage girls in Australia.
Aggressive Behavior, 26, 67-83.
19
Owens, L., Shute, R., & Slee, P. (2005). ‘In the eye of the beholder
...’: Girls, boys’ and teachers’ perceptions of boys’ aggression to
girls. International Education Journal, 5(5), 142–151.
Page, E., Shute, R., & McLachlan, A. (2015). A Self-Categorization
Theory perspective on adolescent boys’ sexual bullying of girls.
Journal of Interpersonal Violence, 30(3), 371-383.
Pomerantz, S. (2007). Cleavage in a tank top: Bodily prohibition
and the discourses of school dress codes. Alberta Journal of
Educational Research, 53(4), 373-386.
Ringrose, J., & Renold, E. (2012). Teen girls, working-class
femininity and resistance: Retheorising fantasy and desire
in educational contexts of heterosexualised violence.
International Journal of Inclusive Education, 16(4), 461-477.
Roberts, A.L., Rosario, M., Corliss, H.L., Koenen, K.C., & Austin, S.B.
(2012). Childhood gender nonconformity: A risk indicator for
childhood abuse and posttraumatic stress in youth. Pediatrics.
doi:10.1542/peds.2011-1804
Rudolph, K.D. (2002). Gender differences in emotional responses
to interpersonal stress during adolescence. Journal of
Adolescent Health 30S, 3-13.
Sapolsky, R.M., & Share, L.J. (2004). A pacific culture among wild
baboons: Its emergence and transmission. PLOS Biology 2(4),
534.
Scholnick, E.K. & Miller, P.H. (2000). Engendering development:
Metaphors of change. In P.H. Miller and E.K. Scholnick (Eds.),
Toward a feminist developmental psychology. New York:
Routledge, pp. 241-254.
Serbin, L.A., Sprafkin, C., Elman, M., & Doyle, A.B. (1984). The early
development of sex differentiated patterns of social influence.
Canadian Journal of Social Science, 14, 350–363.
Shih, J.H., Eberhart, J.K., Hammen, C L., & Brennan, P.A. (2006).
Differential exposure and reactivity to interpersonal stress
predict sex differences in adolescent depression. Journal of
Clinical Child and Adolescent Psychology, 35, 103-115.
Shute, R., Owens, L., & Slee, P. (2008). Everyday victimization
of adolescent girls by boys: Sexual harassment, bullying or
aggression? Sex Roles, 58, 477-489.
Shute, R., Owens, L., & Slee, P. (in press, 2016). High school girls’
experience of victimization by boys: Where sexual harassment
meets aggression. Journal of Aggression, Maltreatment and
Trauma.
Shute, R.H., & Slee, P.T. (2015). Child development: Theories and
critical perspectives. Hove: Routledge.
Skrzypiec, G., Askell-Williams, H., Slee, P., & Rudzinsky, A. (2014).
IB middle years programme (MYP): Student social-emotional
well-being and school success practices. Adelaide: Flinders
University Centre for Student Well-being and Prevention of
Violence.
Slater, A., & Tiggemann, M. (2010). Body image and disordered
eating in adolescent girls and boys: A test of objectification
theory. Sex Roles, 63, 42-49.
Sullivan, P.F. (1995). Mortality in Anorexia Nervosa. American
Journal of Psychiatry 152, 1073-1074.
Sun, J., & Stewart, D. (2007). Age and gender effects on resilience
in children and adolescents. International Journal of Mental
Health Promotion, 9(4), 16-25.
Tankard Reist, M. (2016). Growing up in Pornland: Girls have had it
with porn-conditioned boys. Accessed 8.03.2016 at http://www.
abc.net.au/religion/articles/2016/03/07/4420147.htm
Telzer, E.H., & Fuligni, A.J. (2013). Positive daily family interactions
eliminate gender differences in internalizing symptoms among
adolescents. Journal of Youth and Adolescence, 42, 1498–1511.
Tremblay, R.E. (2010). Developmental origins of disruptive
behaviour problems: The ‘original sin’ hypothesis, epigenetics
and their consequences for prevention. Journal of Child
Psychology and Psychiatry, 51(4), 341–367.
Volume 1, Number 2, September 2016
20
United Nations (2000). The girl child. Accessed 23.02.2016 at
http://www.un.org/womenwatch/daw/followup/session/presskit/
fs12.htm
United Nations (2003). The situation of girls and young women.
Chapter 9 in United Nations World Health Youth Report, pp.
248-269. Accessed 23.02.2016 at http://www.un.org/esa/
socdev/unyin/documents/ch09.pdf
Vigil, J.M. (2009). A socio-relational framework of sex differences
in the expression of emotion. Behavioral and Brain Sciences,
1-54. doi:10.1017/S0140525X09991075
Wood, E., Desmarais, S., & Gugula, S. (2002). The impact of
parenting experience on gender stereotyped toy play of
children. Sex Roles, 47(1/2), 39-49.
World Health Organization (2016). Key findings from the
2013/2014 cross-national HBSC study. Accessed 16.03.2016 at
http://www.euro.who.int/en/
Zahn-Waxler, C., Shirtcliff, E.A., & Marceau, K. (2008). Disorders
of childhood and adolescence: Gender and psychopathology.
Annual Review of Clinical Psychology, 4, 275-303.
21
THE POETRY OF SELF-HARM, SUICIDE AND
OPPRESSION: THEORETICAL AND CLINICAL
EXPLORATIONS OF SELF-HARM AND SUICIDE
Terence Nice
Abstract
Youth self-harm and attempted suicide are national and international issues that are
positively related to completed suicide. They have a major impact upon the lives of
young people and their families and represent a significant drain upon the economic
and clinical resources of the National Health Service (NHS). This article examines the
relationship between poetry, self-harm and suicide in the context of literary analysis and
the psychotherapeutic relationship. A single poem is taken from a supportive internet
website and is presented for analysis and reflection. The analytical position adopted seeks
to illustrate and illuminate the complex intentions and often paradoxical motivations of
those young people who self-harm and attempt suicide. It is argued that poetry can be a
significant communication to the self and to the m/other. It provides a unique window into
the minds of young people offering clinicians and practitioners the opportunity to consider
the dark despair of the suicidal mind. A clinical scenario is described to support this. The
article also introduces the construct of sexual oppression and how sexual violence, namely
war rape, is used to dominate, subjugate and annihilate the other.
Keywords: Self-harm, suicide, poetry, sexual oppression
Introduction
In this article, I would like to explore the themes of self-harm
and oppression through the poetry of those individuals who
feel suicidal and compelled to self-injure. I will discuss the
case of Holly (pseudonym) aged sixteen years old to illustrate
the power of words and how one might begin to transform
self-destructive attacks against the body into creative
artistry through feeling, thinking and reflective expression.
Bion’s concepts of projective identification (Bion, 1959) and
containment (Bion, 1962) are utilised in order to offer some
theoretical scaffolding to Holly’s case. Holly has given me her
written consent to describe and use her clinical material. Her
case illustrates the poetical dimensions in clinical work when
in moments of rupture and repair, words can reach out and
make positive connections and deep contact (Whitehead,
2006). Human poetry is in the inter-subjective bonds and
relational connections that exist between the self and others.
Violent global conflicts and sexual oppression attack these
connections through the systematic brutalisation of the other.
Researchers suggest that once a person has self-harmed the
likelihood of him or her dying by suicide increases by fifty to
a hundred fold over a twelve month period with one in fifteen
committing suicide within the first nine months of the first
episode (NICE, 2011). According to Hawton et al. (2012) the
Contact:Dr Terence Nice, Lecturer in Psychological Therapies, Centre for Professional Practice, University of Kent
United Kingdom has the highest rate of self-harm in Europe
with four hundred episodes per one hundred thousand people.
It is proposed that poetry provides a piercing window into the
complex intentional and motivational systems of suicidal young
people and adults. It gives voice to those who are desperate to
be heard, whether in the face of persecution or injustice or by
society’s evocation of shame, guilt and stigma. Works of poetry
can convey a quality of intellect and emotion that illuminates
states of suffering and despair that would otherwise be lost or
confined to the self.
Poetry captures essences, meanings or mind-states that
orthodox statistics or quantitative research studies neglect. The
pre-eminence of meaning, whether in terms of its construction
or deconstruction, has been celebrated by writers, clinicians
and researchers, via the mediums of language, discourse and
narrative (Foucault, 1965, Labov, 1972; Bruner, 1990; White,
1989; Angus & Mcleod, 2004). It is not my intention to proffer a
narrative analysis or a systematic deconstruction of the poem
cited. It is simply to take a poem posted on the internet and
to thematically unpack it from the perspective of curiosity and
self-reflexivity. I believe poetry can offer us a specific type of
knowledge regarding self-harm and attempted suicide.
For thousands of years, suicide has attracted the interest of
philosophers, writers, poets and clinicians. In ancient archives,
[email protected]
22
philosophers and writers have reflected upon what it means
to end one’s life by one’s own hand. In Plato’s Apology of
Socrates, Socrates reflects upon the course of his life and his
approaching death with dignity and bearing, finally deciding
to end his life by suicide. In Hamlet, Shakespeare poses a
universal question ‘to be or not to be’ and Hamlet is caught
between enduring the sufferings of life and accepting the
finality of death. This universal conflict is echoed In the Myth
of Sysyphus, as Camus describes ‘suicide’ as one of the
fundamental questions of the human condition. I have taken
suicide to mean ‘(a) the intentional killing of oneself; (b) a
person who commits suicide (COD, 2004) and self-harm ‘as
any act of self-injury carried out by an individual irrespective
of motivation. This commonly involves self-poisoning with
medication or self-injury by cutting’ (NICE 2011).
Contemporary poets such as Sylvia Plath, John Berryman,
Albert Caraco, Anne Sexton, to name but a few, ended their
lives by suicide. Berryman’s poignant outpourings at his father’s
suicide is captured in this extract taken from his book of verse,
The Dream Songs (145)
‘he only, very early in the morning,
rose with his gun and went outdoors by my window
and did what was needed.
I cannot read that wretched mind, so strong
& so undone. I’ve always tried. I–I’m
trying to forgive
whose frantic passage, when he could not live
an instant longer, in the summer dawn
left Henry to live on.’
In this verse, there is a disjunction in the words, ‘he only’ which
emphasises the singularity of the act and the inexorable force
that carried off Berryman’s father to do ‘what was needed’.
There is an implicit evocation of the violence to come…‘rose
with gun’, but it is mingled with intimacy in passing by
Berryman’s window. Berryman wrestles to understand ‘that
wretched mind’ paradoxically ‘so strong and so undone’. His
poignant struggle is set against the culmination of ‘frantic
passage’ as his father completes the lethal deed ‘in the
summer dawn’. Berryman’s protagonist-persona, Henry is
abandoned and left to live on. Throughout his life, Berryman
struggled to resolve his father’s suicide and jumped to his own
death off the Washington Avenue Bridge in Minneapolis on
January 7th 1972.
Holmes (2010) asserts that poetry and psychotherapy have
a common resonance. He celebrates the significance of
metaphor, simile and structure, citing Coleridge’s definition
of poetry in finding ‘the best words in the best order’. Poetry,
like psychotherapy, provides a medium for heightened states
of emotional intensity, empathic attunement and a reciprocal
search for meaning. For Holmes ‘if sorrow can be given words,
feelings shared and objectified, their power to distress or
overwhelm is mitigated’ (Holmes, 2010; p.87). It is the act of
thinking about feelings, which facilitates mentalisation and the
capacity to repair. Freud (1926) understood the magic of words
for in the beginning they were one and the same thing. It is the
power of the word that reveals the majesty of the unconscious.
Surprisingly, Freud did not systematically collate his thoughts
on suicide or self-harm into a systematic theoretical model, but
preferred to subsume them under the death instinct (Thanatos)
remarking…’analysis has explained the enigma of suicide in
the following way: probably no one finds the mental energy
to kill himself unless, in the first place, in doing so, he is at the
same time killing an object with whom he has identified himself
and in the second place, is turning against himself a death
wish which has been directed against someone else’ (Freud,
1920; p.147).
The common resonance elicited between poetry and
psychotherapy as maintained by Ogden (1999) and Holmes
(2010) can be both embodied and disembodied; embodied
in the sense that words as sounds resonate within us leaving
a physical or unconscious trace – perhaps as a poetical
moment or as a mother’s words of love as she draws her
baby close. Stern (1977, 2010) understood the musicality of
this inter-subjectivity, inventing a language that understood
the contours, rhythms and patterning of the m/other-infant
dance. The musicality of poetry can be understood as a
meeting of minds, a traversing bridge of inter-subjectivity
based in metre, stanza, rhyme and rhythm. Equally, words
can become disembodied voices of hate and self-loathing
designed to injure, undermine and damage the self. As Holly
said to me: ‘words can be cruel; they are knives that cut
the skin and lacerate the mind’. I will discuss Holly’s case
in greater depth after the analysis of the following poem. I
believe Poem I offers unique insights into what is going on
in the minds of those who self-harm and attempt suicide.
I refer to the author as ‘the poet’ in order to offer ethical
anonymization, despite this poem being available for public
scrutiny on the internet.
Poem I
It calls me closer, it calls me near
“Just once and it’ll be over”
Death whispers in my ear
Irresistible is its sweet entice
Staring down, which one to slice,
I observe my previous tries
My unseen hurt and earlier cries
No peace in my mind, no peace in my head
The quiet intelligent me, long since fled
Anger and rage consumes me
My mind’s demons bursting to be free
The walls of my cage finally cave
“Just be still, just be brave”
I slash down with an improvised knife
“Forget this world, forget my life”
Blood oozes and drips down the drain
A slight tingle but no real pain
A calmness comes over me
My last attempt please, it’s got to be
“Screw everyone, that’s made me into this”
The very same people who I’m going to miss
Tears stream down my cheek,
My head feels heavy, I get dizzy and legs go weak
Darkness surrounds me, I get a glimpse of the abyss
I embrace the darkness, then hear a shriek...
A dark enchantment
The opening lines offer a dark enchantment; it is not the
loving mother who is calling the poet nearer, but death
personified as a chilling, but enticing voice to self-harm.
The urge is strong and bears the marks of ‘previous tries’ in
the context of ‘unseen hurt and earlier cries’. This is a mind
without peace with ‘demons bursting to be free’ as though
something dark and menacing is about to be unleashed.
There is a psychological collapse as the poet surrenders to
the desire to slash. It is enacted with an improvised knife
suggesting that this is a destructive state of mind that has
suddenly taken control of the poet. It is accompanied by
a desire to forget and escape from the world of the living.
Bodily damage is the perceived solution to the poet’s dark
enchantment.
Journal of Psychotherapy and Counselling Psychology Reflections
The wounding
The ‘slashing down’ produces blood that ‘oozes and drips’.
The symbolic notion of life blood is elicited as life itself
seems to drain away. The poet is in a shut-down, dissociated
state of mind, as there is ‘a slight tingle but no real pain’.
Muscular tension and bodily stress is discharged giving way
to a calmness and perhaps a re-personalisation. The poet
pleads that this may be the last attempt that some peace or
equilibrium may return. The poet’s anger erupts into a twisted
declaration of anger and pain towards his or her love objects.
It is juxtaposed with an acknowledgement that these are the
‘very same people I am going to miss’. The poet attempts to
repair the splitting of love and hate by accepting that these
powerful affects are contained within the same set of objects or
figures and that annihilating them will only serve to deepen the
poet’s sense of loss and despair.
The depressive void
A reflective moment that reaches out to the other invokes a
depressive void in the poet…’tears stream down my cheek’.
This may or may not be related to the excessive splitting or the
force of the poet’s destructive feelings in imagining that those
that are loved have been damaged by the poet’s outpourings.
This depressive void becomes projected into the body – ‘I
get dizzy and legs go weak’. The mind is overwhelmed by
powerful affects and psychological forces. It ceases to maintain
integrity, containment and function. The body becomes the last
beacon of orientation as darkness surrounds the poet and the
dark abyss is glimpsed. Darkness is embraced but interrupted
by a shriek; it is an intrusive force that may revoke the poet’s
depressive void or in some strange way, be part of it. In my
mind, it resonates with Edvard Munch’s ‘The Scream’.
Holly – a clinical scenario
Holly is a young woman of sixteen years who entered
psychotherapy because of her self-harm, suicidal ideations and
past history of serious life threatening behaviours, including
overdosing and drinking bleach. At the age of fifteen years old,
Holly spent a brief period in an inpatient hospital unit before
being discharged home to live with her mother and her younger
sister. Holly’s mother and father separated when Holly was ten
years old, but presently they are still wishing to be supportive,
loving and understanding of her. Holly believes that they would
have both been better off not having children as, in her own
words, “I stole their lives – I was a mistake I shouldn’t have
been here’’. Developmentally, she describes an environment,
whereby “I took in all the bad and there was no good to
balance it out’’.
Holly is a sensitive and intelligent young woman who presented
with significant self-cutting particularly along her left arm, which
bears the scars of multiple lacerations and gaping wounds. Her
arm has the appearance of fish shaped gouges, which seem
to swim across her arm against a weather-beaten background.
Holly has a dramatically poor sense of self, dismissing her
value and goodness through the mechanisms of sarcasm,
self-disgust and self-hatred. She would invite me to affirm these
self-attributed qualities, a position which I sought to resist and
actively interpret. Underpinning her self-hate, is a deeper bodily
depressed state, which Holly describes as a dark cloud that
passes through her like a dark force or wave; sometimes for
days, occasionally for months. She tells me that it is like being hit
by a wave that knocks her sideways into the water. Underwater,
she surrenders to the darkness and the abyss, struggling to
breathe, feel or care. I think to our mutual surprise, Holly has
begun to find the words to describe these states, articulately,
23
philosophically and poetically. In the micro-transactions of our
relationship something that has remained nameless, is slowly
emerging from deep waters and taking form.
This inter-subjective evolution of form can be felt, but not
named. It resonates with Bion’s concept of the containing m/
other that receives the infant’s unbearable projections (beta
elements) metabolises them and gives them back in a palatable
and digestible form (alpha elements). These are poetical
moments in which self and other are attuned, connected and in
deep contact.
By virtue of these m/other administrations, psychological and
bodily, the m/other provides a space for the internalisation of
a containing object. The m/other object provides the infant
with a capacity to bear the ‘nameless dread’ (Bion, 1962) and
facilitates the joy of being, feeling and thinking in the context
of an intentional stance (Dennett, 1983) and emerging self. In
contexts, where there is a significant failure in containment,
the infant has to auto-contain itself developing a pseudo-self
to entice the depressed or absent m/other into vitality and
action. Failure to do so, may lead to the development and
internalisation of a dead mother complex (Green, 1999) and
depressed states in adolescence and adulthood.
From the inception of once weekly psychotherapy, Holly and
I established a productive therapeutic alliance and working
therapeutic relationship. Holly responded favourably to the
therapeutic conditions of stability, constancy and continuity.
Within the context of a secure base (Bowlby, 1988) Holly was
able to trust me with some deep and perplexing feelings
regarding her injuries, including her self-cutting and suicidal
ideations. It would be disingenuous to suggest that there
was a poignant poetry to her dark and despairing places.
Holly would swiftly refute and dispatch such ideas. Holly’s
dark places represent disgusting poisons that are painful and
acidic. These injured aspects of Holly give birth to toxic fears
that such poisons may leak out uncontrollably causing havoc,
injury and damage to others, including me. When the primary
love object is poisoned or lost, the damaged self may demand
atonement through the act of self-laceration. The poetry comes
in the transitional space (Winnicott, 1971) between Holly and I
and in her courage in finding the words to begin the process of
transforming her destructive impulses into creative productions.
This process is never easy or effortless as in some sun-soaked
idealised transference, but it twists and turns through splitting,
ruptures, repairs, identifications and projective mechanisms
(Klein, 1946). Yet, our psychotherapy was more than a complex
interaction of word productions; it was a meeting of minds
embodied in the physical presence of self/other relations. The
human unconscious is a relational force that seeks out the other.
It is manifest in old bonds and new attachments, with conflicting
psychic and somatic tensions which permeate the therapeutic
encounter. In her dark places, Holly’s ‘internal saboteur’
(Fairbairn, 1952) reigns supreme preserving the idealised other
at a monumental cost to the self. The self is punished for not
being ‘good enough’ or able enough to secure the love and
vitality of the self and the m/other. Holly’s loss is experienced
as a depressive void or physical emptiness that is embodied
in her throat and chest. It is this depressive void that Holly and
I are therapeutically engaged in addressing. Moving from the
micro-elements of psychotherapy to the macro-elements of
systematic subjugation and violence, I wish to explore suicide in
the context of human experience and the pity of war.
Sexual violence and oppression
In drawing together psychoanalytic themes under the umbrella
of self-harm and suicide (Perelberg, 1999) I am struck by
the fact that there may be moments in all of our lives when
the dark enchantment of oblivion and suicide beckons us
Volume 1, Number 2, September 2016
24
all. Such thoughts or impulses may not always be available
to consciousness and therefore denial, repression and
omnipotence can become defences engineered to protect
ourselves from such feelings. Consequently, psychological
pain and personal suffering becomes the domain of the other;
since we expel it, export it and project it into objects, other than
ourselves. Our sufferings become the dark monsters that hide
in the shadows and speak no words.
Bion, W. R. (1959). Attacks on Linking. The International Journal of
Psycho-Analysis. 40.308.
Human experience has also demonstrated that some dark
monsters are not the stuff of dreams, but real and haunting
traumas of chronic abuse and maltreatment that wreak havoc
upon the mind and leave enduring scars upon the body. The
Syrian conflict is testament to this as are other violent conflicts
around the world. The use of sexual violence as a weapon of
subjugation, terror and cruel domination, leaves in its wake
an army of traumatised and often suicidal people. Systematic
rape is the method of domination and oppression. Often, it
is followed by mass murder to preserve the anonymity of
the perpetrators. Laureate Jody Williams, Co-chair of the
International Campaign to Stop Rape and Gender Violence in
Conflict passionately declared:
Dennett, D. C. (1983). Styles of Mental Representation. Proceedings
of the Aristotelian Society; 213-26: London: Aristotelian Society.
‘We said after the Holocaust we’d never forget; we said
it after Darfur. We probably said it after the mass rapes
of Bosnia and Rwanda, but maybe that was more of a
“we shouldn’t forget,” since there was so much global
guilt that we just sort of sat back and let similar tragedies
occur since and only came to the realization later -- we
forgot. Could we have forgotten that the unfolding human
catastrophe in Syria exists before it’s even over?
(Williams J as cited by Wolfe L, 2013; p.6).
Concluding thoughts
It is estimated by the World Health Organisation (WHO, 2016)
that over 800,000 people die by suicide every year, with over
6,000 suicides happening each year in the UK (ONS, 2014). It
is reported that one in four people will suffer a mental health
disorder at some point in their lives (MHF, 2016). Poetry can be
one way of transforming dark enchantments and depressive
voids into works of healing and creativity, which alleviate
suffering and despair. In our work together, Holly and I have
given words to the dark places and depressive voids that
are filled with the corrosive feelings of self-hate and selfobliteration, seeking to repair the litany of fractures of self and
self/other relations.
Poetry has an epistemological value, which invites us to enter
the interior world of the other to discover important constructs
in the minds of young people and adults. It invites us to listen
in a different way that touches the sorrows of us all, fostering
empathic and intersubjective bridges that unite self and other in
the deep infinity of time, humanity and space.
Acknowledgements
I would like to acknowledge the contributions of Holly and
her family who have been so generous in allowing me to use
Holly’s material. I would also like to thank Dr Maria Luca for
her support and encouragement.
References
Angus, L. E., & Mcleod J. (2004). The Handbook of Narrative
and Psychotherapy: Practice, Theory and Research. London,
Thousand Oaks, New Delhi: Sage Publications.
Berryman, J. (1972). Selected Poems 1938-1968: The Dream Song
(145) London: England. Faber and Faber Ltd.
Bion, W. R. (1962). Learning from Experience. London: Heinemann.
Bowlby, J. (1988). A Secure Base: Clinical Applications of
Attachment Theory. London: Routledge.
Bruner, J. S. (1990). Acts of meaning (Vol. 3). Cambridge
Massachusetts. London. England: Harvard University Press.
Concise Oxford Dictionary (2004). Oxford. Oxford University Press.
Foucault, M. (1965). Madness and Civilisation: A History of Insanity
in the Age of Reason, trans. R. Howard. New York: Pantheon.
Fairbairn, W. R. D. (1952). Psychoanalytic Studies of the Personality.
London & New York. First published by Tavistock Publications Ltd
in collaboration with Routledge and Keegan Paul Ltd.
Freud, S. (1920). The Psychogenesis of a Case of Homosexuality in
a Woman: SE 18: 145-172.
Freud, S. (1926). The Question of Lay Analysis in the Essentials of
Psychoanalysis: Sigmund and Anna Freud: Vintage Books. 2005.
Green, A. (1999). The Dead Mother in The Work of Andre Green.
London & New York: The New Library of Psychoanalysis: Ed.
Elizabeth Bott Spillus.
Hawton, K., Saunders, K. E., & O’Connor, R. C. (2012). Self-harm and
suicide in adolescents. The Lancet, 379 (9834), 2373-2382.
Holmes, J. (2010). Exploring in Security. London & New York:
Routledge.
Klein, M. (1946). Envy and Gratitude and Other Works 1946-1963.
London. Published by Vintage Books, Melanie Klein Trust 1975.
First published by Hogarth Press 1975.
Labov, W. (1972). Language in the Inner City: Studies in the Black
English Vernacular: Philadephia: University of Pennsylvania
Press. USA.
MHF. (2016). Mental Health Foundation: Mental health statistics UK
and worldwide: Retrieved 07/03/16 from: https//www.mentalhealth.
org.uk/statistics/mental-health-statistics-uk-and-worldwide
NICE. (2011). Self-harm in over 8s: Long Term Management: Nice
guidelines National Institute for Health and Care Excellence:
[CG133] Retrieved [online] 21/03/16.from: https://www.nice.org.uk/
guidance/cg133/chapter/introduction
Ogden, T. H. (1999). ‘The music of what happens’ in poetry and
psychoanalysis. The International Journal of Psychoanalysis,
80(5), 979.
ONS (2014). Office of National Statistics. Retrieved [online] 21/03/16
from: https:www.ons.gov.uk
Perelberg, R. J. (1999). Psychoanalytic Understanding of Violence
and Suicide: London & New York: Routledge.
Stern, D. N. (1977). The First Relationship. Cambridge:
Massachusetts, London. England. Harvard University Press: New
edition (2002).
Stern, D. N. (2010). Forms of Vitality. Oxford & New York: Oxford
University Press.
White, M. (1989). Selected Papers. Adelaide. Dulwich Centre
Publications.
Whitehead, C.C. (2006). Neo-psychoanalysis: A paradigm for the
21st century. The Journal of the Academy of Psychoanalysis and
Dynamic Psychiatry, 34(4), 603.
Winnicott, D. W. (1971). Playing and Reality. London & New York
Tavistock/Routledge Publications.
Wolfe, L. (2013). Syria has a massive rape crisis. The Atlantic.
Retrieved [online] 22/05/16: http://refugeessp.ca/wp-content/
uploads/2016/01/27.www-theatlantic-com.pdf.
World Health Organisation. (2016). Retrieved [online] 19/05/2016
from: http://www.who.int/mental_health/prevention/suicide/
suicideprevent/en/
25
THERAPY WITH VICTIMS OF ABUSE WHO
HAVE GONE ON TO OFFEND
Andrew Smith
Abstract
The paper explores issues related to providing therapy to sexual offenders who are
also victims of sexual abuse. The question of whether or not victims of sexual abuse are
more likely to go on to abuse others is addressed, followed by an exploration of ways
in which being a victim of sexual abuse can make the person more vulnerable to repeat
victimisation and pro-offending sexual tendencies. The challenges faced by therapists
working with this particular client group are outlined, focusing on client victim issues,
the therapist’s empathy over-spilling into collusion, and related avoidance of offence
focused work. Qualitative data from probation officers working in a rehabilitative context
with sexual offenders is cited, usefully informing the challenges faced by therapists.
A fictionalised case study is presented, regarding a middle aged man who was
sexually abused as a teenager and proceeded to sexually offend as an adult. Practice
illustrations, taken from the case study, include strengths-focused techniques and
questions which can assist in the therapeutic, rehabilitative task.
Keywords: Perpetrators, sexual abuse, therapy, victims
Introduction
The majority of victims of sexual abuse do not go on
to sexually offend. The lazy belief that this is the case
constitutes discrimination and repeat victimisation. However,
many individuals who commit sexual crime have suffered
from trauma and attachment problems, including sexual
victimisation. If their sexual abuse is accompanied by other
forms of neglect and mistreatment, particularly violence, this
can make them more likely to sexually abuse others. It is
argued that people who sexually offend do so because of a
combination of factors. Sexual abuse can become normalised
and/or eroticised. Some victims can also become abusers to
compensate for lost power. Such dysfunctional phenomena
can create pathways toward offending. Issues influencing
whether the therapist predominantly engages with the client
as victim or as offender are explored, illustrated by qualitative
data from probation officers working in a rehabilitative
context with sexual offenders. A case study demonstrates
how therapists can interact with both parts of a client’s history
and identity, providing a corrective therapeutic experience to
the disempowerment of abuse. It is contended that if clients
can learn to tolerate and cope with traumatic symptomology,
developing self-compassion to offset shame, this can clear
the way to a greater degree of insight into risk triggers and
empathy for victims against whom the clients have offended.
Contact:Dr Andrew Smith, private therapist and trainer
Are victims of sexual abuse more likely to
go on to abuse others?
The situation seems to be that most people who have
been sexually abused do not go on to abuse others in
the same way, although many individuals who sexually
offend have also themselves been victims of sexual abuse.
A meta-analysis of 1717 offenders found that around
28.2% of sex offenders reported a history of childhood
sexual abuse (Hanson and Salter, 1988). Another metaanalysis found that those who offended sexually against
children were over three times more likely to have been
sexually abused than general offenders (Jespersen et
al., 2009). Cross sectional studies conducted at Great
Ormond Street Hospital and the Institute of Child Health
found that although being a victim of sexual abuse was
a risk factor, it was exposure to a set of interlinked,
highly stressful abusive life experiences (emotional and
physical neglect and particularly being a victim of or
witnessing violence), in addition to a lack of compensating
nurturing factors, which made the perpetration of
sexual abuse far more likely (Bentovim et al, 2009).
The unthinking belief - that if an individual has suffered sexual
abuse s/he will almost inevitably sexually abuse others - is
clearly not warranted and can constitute a form of repeat
victimisation. The victim has to cope, not only with the sexual
abuse itself, but also with this added discrimination. Being
sexually abused, like all other human experiences, is different
[email protected]
26
for each person. The impact and consequences of sexual
abuse would seem to significantly depend upon the life and
subjective experience of the individual concerned.
Certainly, trauma of all kinds, including sexual abuse, can
adversely impact on pro-social functioning, even negatively
impacting on neurodevelopment (Creeden, 2009). However,
it is important not to be pessimistically deterministic. With
regard to victims of sexual abuse, many do not only go on
subsequently to ‘survive’, but can go on to ‘thrive’ (Dolan,
1998). Some others reject even this notion of ‘thriver’ status,
not wanting to be labelled as a ‘victim’, a ‘survivor’ or a ‘thriver,’
but as a complex human being, not defined by abuse, and
certainly not by the erroneous belief that if you are a victim of
sexual abuse you will go on to sexually offend.
Causal links between being sexually
abused and sexually abusing others
Undoubtedly, many individuals who commit sexual abuse have
trauma and attachment issues in their background, including
having been sexually abused (Howitt, 1995: Smallbone, 2005).
These trauma and attachment issues can render an individual
more vulnerable to committing a sexual offence. There are
various reasons for this.
Being sexually abused can alter a person’s sexual arousal
template. When researching the fantasies of adult male
survivors of child sexual abuse, Bramblett and Darling (1997)
found that their abuse may have contributed to the prevalence
of sexual thoughts and fantasies about sexual contact with
male children and adolescents. Hence, the memory of
being sexually abused might become sexualised, leading
to re-enactment, so that the victim becomes the perpetrator
(Hudson Allez, 2014).
Hudson Allez (2014) cites ‘opponent process theory’ (Solomon,
1980), whereby the unpleasant effect of sexual abuse
gradually wears off, and is eventually replaced by pleasant
effects. This process by no means occurs with all victims
and part of the deleterious consequences of sexual abuse
is victims feeling guilty that they may have enjoyed aspects
of the abuse, which can consolidate notions that the abuse
was somehow their fault, notions often inculcated through the
grooming process employed by the offender.
The phenomenon of individuals being drawn back to the site
of past trauma in destructive ways can also be seen in the
Freudian description of ‘repetition compulsion’ and ‘destiny
neurosis’ (Freud, 1920), where the individual is caught up in
destructive, repetitive patterns. Fenichel (1946) posited two
reasons for such re-enactment. Individuals can seek a sense
of mastery, control or understanding by revisiting sites of
trauma. This process can be seen to offer an explanation as to
why internet offenders who have themselves suffered abuse
insist that they searched for children being sexually abused
out of curiosity rather than a search for sexual pleasure. The
second reason provided by Fenichel has crossovers with
the above ‘opponent process theory.’ The individual seeks
to reduce the terror of the experience by familiarisation,
repeating it in different contexts, until fear turns into pleasure.
A person being beaten as a child and then developing a fetish
for spanking can be seen as an example of this process.
Within an arguably still patriarchal society, convention and
valued notions of maleness are associated with strength and
exercising power over others. The position of male victim does
not sit comfortably with this. Hence, male victims of sexual
abuse can turn into perpetrators: motivated, in part, by the
impulse to claw back power, repositioning themselves more
favourably within the patriarchal continuum (Woods, 2003).
If a person has been raised in a culture where there is
intergenerational sexual abuse, whether or not he has
himself been abused within this culture, sexual abuse can
become normalised. In such cases, it is only when the
individual leaves his family of origin, and has corrective
experiences in a wider world that he comes to view sexual
abuse from a normative perspective i.e. that it is morally
wrong and harmful.
This maturing process is by no means straightforward.
In order to come to view sexual abuse as abnormal and
harmful, the individual has to come to terms with the fact
that family members and loved ones have acted in sexually
harmful ways. This can have a profound impact on the
individual’s sense of identity and threaten notions of family
loyalty. It is well-documented that family members often
refuse to believe victims when they disclose abuse, and can
scapegoat victims rather than face the stigma and shame
that sexual abuse has occurred in the family (Finkelhor,
1979). Denial can be particularly entrenched if the family is
dependent on or fearful of the abuser.
Victims are also prevented from recognising and integrating
abusive experiences because of identification with
the abuser. This is a way of surviving the abuse, which
Fonagy (2006) describes as “taking the perspective of
the malevolent other” (p.103). Consequently, there can
be powerful motivations for victims to deny, minimise or
normalise sexual abuse. This can lead to the retaining of
offence-permissive attitudes and behaviour, rendering the
perpetration of sexual abuse more likely.
Finkelhor and Brown (1985) proposed a traumagenic
model, which depicts four negative effects of sexual abuse:
traumatic sexualization, betrayal, powerlessness, and
stigmatization. The first of these categories - traumatic
sexualisation – explains how child victims of sexual abuse
can develop in sexually inappropriate ways. For instance,
if a child is valued for her or his body, sex can become
commoditised and individuals objectified, phenomena
associated with sexual offending. As well as leading
to avoidance of sex, sexual victimisation can also lead
to promiscuity and involvement in sexual risk-taking
environments (Smallbone et al., 2008), factors associated
with sexual crime.
The impact of being sexually abused can include classic
trauma symptomology: nightmares, flashbacks, depression,
heightened state of depression, anxiety and hypervigilance. Traumatic sexual abuse can lead to dysfunctional
neurodevelopment, resulting in compromised capacity to
deal with negative affective states. Inappropriate sexual
behaviour such as sexually disinhibited behaviour and sexual
offending can be evidence of lack of emotional regulation,
itself stemming from the traumatic impact of sexual abuse
(Creeden, 2009).
When working with victims of sexual abuse who are also
perpetrators, neurodevelopmental damage may render
traditional talking therapies ineffective. Traditional talking
methods can be augmented by a range of holistic methods:
body-mind approaches; mindfulness; breathing techniques;
EMDR; promoting positive lifestyle. These interventions are
commonly used by therapists, and are transferable to people
at risk of sexual offending.
As already noted, each individual’s experience of sexual
abuse is different, and many victims of sexual abuse can go
on to lead happy, constructive lives. However, in the author’s
clinical experience, the following factors are aggravating
features, often leading to higher levels of trauma.
Journal of Psychotherapy and Counselling Psychology Reflections
• If the abuse was prolonged.
• If the victim was very frightened by the abuse.
• If the victim felt/feels unprotected from further abuse, and
living in a state of fear.
• If the abuse was carried out by a trusted family member the
victim relied upon for security (e.g. a parent figure).
• If the abuse was particularly invasive i.e. oral sex,
intercourse.
• If the victim was not believed by family members, and
blamed for causing trouble.
• If the victim was made to feel responsible for the abuse.
• If the victim was particularly vulnerable, with existing
emotional and welfare problems.
Trajectories of repeat sexual
victimisation and sexual offending
There is research to suggest that if you are a victim of
sexual abuse, you are more likely to suffer repeat sexual
victimisation (Smallbone et al., 2008). The same phenomenon
is apparent with victims of domestic abuse (Farmer and
Callan, 2012). One explanatory theory is that victims of sexual
abuse can become caught up in repetitive and compulsive
life patterns beyond their awareness and rational control, as a
reaction to trauma. Such theories are outlined above.
Whilst not discounting these theories, all of which provide
valuable insights, the trajectory the author frequently comes
across with regard to repeat victimisation and victims going
on to sexually offend, often has a tragic, socio logic about
it. Parallels can be found with violence. Violence more
frequently occurs in chaotic criminal sub-cultures, where
victims are also likely to be perpetrators. Violence and sexual
abuse occur in all strata of society, although the ecological
systems in which the person is embedded significantly affect
behaviour (Bronfenbrenner, 1979).
If a child experiences sexual abuse, s/he is likely to suffer
from a range of negative emotional consequences, as
described above. Based on my clinical experience, it would
seem that it is at the formative stage of early adolescence,
when a child leaves the relatively protected environment
of a small primary school for the harsher environment of a
larger senior school, that a victim chooses, consciously or
unconsciously, which peer group to gravitate to, or perhaps
has to make do with whichever group will accept him. It is
well documented that victims of sexual abuse underachieve
academically (Boden et al., 2007), and this is one reason why
a victim may find it difficult to integrate with pro-social groups
at formative stages of development.
Pro-social groups are likely to consist of individuals who
are relatively secure, who have likely suffered no significant
abuse, and have parents who provide encouragement,
appropriate supervision and consistent boundaries.
Consequently, there is a greater probability that these young
people will have the stability to focus on their studies and
a virtuous circle is created when they receive the resultant
positive strokes with regard to academic achievement and
general conduct. Children and young people in such prosocial groups are more likely to be confident and have good
self-esteem, and therefore be able to establish appropriate
dating and courtship patterns in early adolescence.
The opposite can happen to many boys who have been
sexually abused. Victims of sexual abuse often find it difficult
to relate to this ‘good-kid’ group. If you have experienced
significant sexual abuse, perhaps including intercourse, it
27
is going to be difficult to relate to those typically getting
excited about first dates, holding hands, kissing and petting
etc. It is easy to feel like ‘spoiled goods’ by comparison.
Hence, victims of sexual abuse can gravitate to peer
groups consisting of other psychologically damaged and
disadvantaged individuals, where they instinctively feel
comparatively better about themselves.
These groups, however, tend to involve themselves in more
risky behaviour: teenagers gathering in public places at night
without supervision, participating in drinking, drug taking,
and anti-social or criminal behaviour. In addition, victims of
sexual abuse can use alcohol and drugs to self-medicate
in order to blank out traumatic memories and emotions.
Alcohol or drugs lead to further risk taking behaviour as
inhibitions are lowered. Victims of sexual abuse have often
been groomed to view their bodies as commodities, believing
their physicality is the prime aspect of selfhood that is of
value. Suffering low self-esteem, a pattern of promiscuity
can develop, where casual sex is sought for the promise of
affirmation. When damaged individuals interact with each
other in such risk taking milieux, pro-social sexual boundaries
can be casually broken, leading to acts of sexual abuse.
Victims of sexual abuse and other traumas and disadvantages
who end up in the care system, particularly females, traverse
a similar trajectory. These young people can be very
vulnerable to the sort of sexual exploitation which has come
to light in Rotherham (Jay, 2015) and other areas of the UK.
Of course, being a victim of sexual abuse can also lead
to retreating from the world. Rather than becoming risk
taking and sexually promiscuous, victims can become risk
and conflict avoidant, rejecting their sexuality by making
themselves sexually unattractive or avoiding social situations
where appropriate courtship rituals are practised and
developed. This retreat from mature relational life can lead
to social skills and intimacy deficits. Some victims of sexual
abuse who adopt this avoidant pathway can be at danger,
as adults, of forming inappropriate emotional and sexual
relationships with children, as children are easier to impress
and can appear less threatening and judgemental. They
can consequentially develop an emotional congruence
with children, distortedly viewing themselves as children or
viewing children as fellow adults, which can form offence
permission giving ‘schemas’ or ‘implicit theories,’ noted by
Ward and Keenan (1999): viewing children as sexual beings or
objects; perceiving sex with children as causing no harm.
Working with victims of sexual abuse
who have become sexual offenders
There are two traps the therapist can fall into when working
with this client group. The first is to focus on victim issues
exclusively, never getting around to dealing with offending
issues. Having said this, what a therapist focuses upon
depends on the presenting problem the client brings to
therapy. If a sex offender wants therapy just to deal with victim
issues and there is no mandate from statutory authorities to
address sexual offending, then this would seem legitimate.
The therapist could be simply client-centred, working within
the client’s motivational framework. Once victim issues are
acknowledged and addressed, the client may then be at the
stage to look at his offending, either with the current therapist
or sometime in the future.
However, it can be easier for the therapist to exclusively
address victim issues for a number of other reasons. Some
therapists may choose to work with sex offenders because
of an ideological stance that sex offenders are discriminated
against and, unlike almost any other client group, their rights
Volume 1, Number 2, September 2016
28
and needs are overlooked. Thus, the therapist may attempt
to redress the balance by focusing on what the client has
suffered rather than the suffering the client has caused.
Most therapists are also simply more used to dealing with
victim issues than issues of sexual offending, having had
long experience of working with clients who have been
emotionally, physically and sexually abused.
The line I take with regard to offenders having victim issues
is to give clients ample opportunity to discuss any possible
traumatic reactions to abuse whilst not insisting (no matter
how subtly) that there must be traumatic symptomology to
discuss. The following strengths-focused questions can help
with regard to discussing historical abuse:
• From what you’re saying, I feel there could be more to this.
Am I on the right track?
• Would it help to talk about this?
• Would you like to say more about what happened?
• Do you want me to ask you more about that?
• What would help you to talk about this?
• Would you see this behaviour as abuse?
• If you talk about this today, what support is around for you
when you leave here?
• How can you be supported when you leave here?
• Would it be helpful to agree a word or a signal when you
want to stop talking or want me to stop asking questions?
• What were the challenges for you whilst the abuse was
occurring?
• What were the short-term challenges for you after the
abuse stopped?
• What was the worst thing you had to cope with when you
were abused?
• What were the long term challenges for you after the abuse
had stopped?
• What were the qualities in you that made you survive the
abuse?
• What were the qualities in you that made you move on and
prosper?
• Is this helping, or do we need to do something else or talk
about it in a different way?
As with all strength-focused questions, the above need to
be used with clinical judgement and softened with empathic
responses, especially with regard to this delicate issue. Most
therapists will have developed their own ways of working with
abuse victims.
The second trap is for the therapist to play scant regard to
victim issues, especially if the client has been mandated to
seek therapy in order to address their offending. There are
a number of common concerns. One is that by addressing
an offender’s victim issues, this is somehow letting his own
victims down. Such an issue might be particularly pertinent
for therapists with long experience of working with victims
and witnessing the harm caused by sexual abuse, first hand.
Working with offenders who are also victims can be a difficult
emotional juggling act, often resulting in therapists and
practitioners feeling conflicted. The following comments from
probation officers, collected in doctoral research I completed
in 2009, illustrate such dilemmas:
One probation officer reflected that he does not always
address the issue.
The honest answer is, not always. I come back to the
rapport, and how much they will tell you about in the
first instance. It’s a difficult - I think it’s quite a difficult
area. My personal view would be is that; I would try to
encourage them to go to counselling themselves, away
from the supervision arena. I mean, you can’t divorce
their behaviour against others. You can’t disconnect it,
totally, clearly from what they are doing to other people
and from what has happened to them.
(Probation Officer 3)
The above statement obviously highlights a need for
increased therapy provision in this area as an adjunct or in the
absence of statutory treatment provision for sex offenders.
Another probation officer stated the following:
I think it’s a very difficult area, because it’s...there’s all
sorts of judgements tied up in that, aren’t there, and your
relationship with the person; how well you think the person
is responding to treatment, what you think the risks might
be with the person. You know, I guess sometimes you think,
this guy has committed so many horrendous offences
over the past twenty years, I’m not really interested in
talking about his experiences of him being victim. I’m not
sure how helpful, in that case, it’s going to be to his risk
management, um, and was his experience of being a
victim almost positive (a rationale) in that he has then gone
off and spent the last twenty years, creating more and
more victims? Then, again, that’s something, I suspect I,
and others, have not had a great deal of guidance on,
and you do that by the seat of your pants really. But on
the other hand, you can’t blank people’s experience of
abuse out entirely, I think, you have to acknowledge it.
(Probation Officer 1)
Therapists, like probation officers, may also worry about
colluding with offenders by focusing on victim issues,
especially if a client is in denial or minimises the sexual abuse
he has perpetrated, or is narcissistically focused on the impact
his offending has had on himself rather than the harm and
consequences to others. This issue was commented upon by
probation officers, including the dangers of empathy spilling
over into collusion, creating a sort of moral slippage. A theme
emerged of officers needing to hold onto themselves, putting a
buffer between themselves and the offender, for fear of being
contaminated or polluted by the sexual crimes committed.
I think that my immediate response to sexual offending,
certainly the heavier end of it ... it’s almost trying to think
the unthinkable, isn’t it, trying to put yourself... and then
of course if you do start thinking that, you know, the
slippage things about standards and morals almost...
but yeah, I think particularly with sex offenders, the
tendency for any suggestion of any sort of collusion is
obviously guarded against and I just think I have to be
so careful that, you know, that I don’t nod in the wrong
place, or say ‘yes’. In fact all I’m trying to hear is what
they’ve got to say, and it is, isn’t it, the slippage thing, is
sort of, because I like to think, you know, that I depend
upon it really. It’s not there but for the grace of God go I.
It’s kind of like, no this is quite different.
(Probation Officer 6)
We have to have a debriefing afterwards, where we did
say what we thought about. We did say I just want to
have a wash ... It isn’t physically want to wash. I wanted
to cleanse myself.
(Probation Officer 12)
Journal of Psychotherapy and Counselling Psychology Reflections
Case study
Mike was raised in a family with loose sexual boundaries.
He had never known his father. His mother had intermittent
drug and alcohol problems, and he and his sister (two years
older) often had to take responsibility for feeding themselves
and getting themselves off to school. Their mother was never
proactively abusive, and was emotionally demonstrative.
However, she was neglectful and she and her children’s
lives were marked by frequent house moves and general
chaos. Mike’s mother had many partners, with some staying
around for short periods of time. Most of them were relatively
disinterested in the children, and occasionally the children
witnessed one or two of them being domestically abusive
to their mother. Often they would overhear their mother
having sex with these men. A frequent visitor to the house
was Mike’s maternal grandfather, who lived on his own.
He was kind to both children and took a special interest in
Mike, taking him on trips to London to watch Millwall play,
the football team Mike supported. When Mike turned 14, his
grandfather started to abuse him on one of these trips. They
shared the same double bed to save costs, and Mike woke
up to find his grandfather fondling his private parts. Nothing
was said about this the next day and the abuse continued in
this way, every three months or so, when they would travel
to London to watch a match. The abuse stopped after Mike
reached 16, when he lost interest in football. Mike and his
grandfather never spoke about the abuse, and Mike told
nobody about it. When Mike was 17, he left home after the
latest row with his mother. He lived on the streets for a while,
and prostituted himself occasionally with older men for money
over a six month period, before he found a place in a hostel
and was resettled into his own flat. Mike worked as a chef up
until his early 40s, having many relationships with women,
some his own age but many younger. He also used to drink
heavily, and most of his relationships were volatile; in a couple
of them he was violent. When he was 41, he moved in with a
woman five years his senior. She had a 13-year-old daughter,
Abbie. Mike began fondling Abbie when she was around
15. Mike was going through a period of unemployment
and drinking more than usual. The abuse happened in the
evenings, when his partner was out working in a care home.
The abuse happened on three occasions until Abbie told her
mother, who informed the police and ended her relationship
with Mike. Mike served an 18-month prison sentence, but
refused to attend a prison group-work programme, insisting
that Abbie had seduced him and when he wanted to end
the relationship, she said he had abused her, out of spite.
Mike insisted he was not a sex offender, as Abbie was only
just below the age of consent, and she knew what she was
doing. After he was released, he eventually found another
job as a chef in a hotel, living in accommodation that went
with the job. He is now in a relationship with a waitress, Claire
(29), who works at the same hotel. He has told Claire about
the abuse he suffered and his conviction against Abbie. She
wants him to attend therapy to sort out his problems, before
she decides whether or not to take the relationship any
further, as she eventually wants to settle down with a partner
and have children.
Mike told the therapist that he was not guilty of any sexual
crime because Abbie had seduced him. He stated that Abbie
was 15 when the fondling began and that she was sexually
experienced. Mike said that although he was innocent of
any wrong doing, he felt he had to tell Claire about what had
happened with Abbie, as he did not want there to be any
secrets in the relationship. He added he now wanted to have
therapy about the sexual abuse he had suffered, as Claire
thinks this is a good idea.
29
Mike was not acknowledging that, even if Abbie had been
seductive, he was the older adult, in a position of parental
responsibility. At the age of 15, Abbie was still under the
legal age to give consent to sex. She would not have had
the emotional maturity to make a choice to embark on a
sexual relationship with an older male, especially a male
in a relationship with her mother. Mike appeared to give
little thought to the likely negative emotional impact such a
relationship would have had on mother and daughter.
The therapist noted how shifting blame onto a younger victim
is a classic form of denial, as is Mike saying the victim disclosed
sexual abuse out of grievance. By raising these possibilities,
doubt is cast on the victim’s account - a form of double
victimisation. This can consolidate existing self-punishing
thoughts, which often accompany being sexually abused i.e.
‘there is something wrong or bad about me.’ The therapist
acknowledged to herself incipient feelings of hostility towards
Mike because of this blame shifting, and made a mental note to
take these feelings to supervision if they continued.
The therapist was also unsure about Mike’s motivation. He
seemed to be attending therapy at the behest of his partner,
rather than because of any self-generated motivation. This was
not necessarily a problem for the therapist, as she knew that
clients often attend therapy because somebody else wants
them to - a loved one or the authorities for instance – and
motivation can change from extrinsic to intrinsic over time.
The therapist reminded herself that there would be plenty of
time to explore the various issues, relating to blame shifting,
if therapy continued. However, she considered it productive
to start in a strengths-focused way by looking for something
she could genuinely compliment Mike on, avoiding colluding
with denial, but affirming any emerging signs of safety. One
sign of safety was that Mike has told Claire about his own
abuse and previous conviction against Abbie, even though
he appears to blame the victim.
Therapist: Mike, I’m impressed that you told Claire
about your conviction. A lot of men I work with avoid
this difficulty, and leave it until they are married or
their partner is pregnant, or the authorities inform their
partner of previous convictions.
Mike: Well, I had to didn’t I? I wanted her to know what
she was getting into.
Therapist: You didn’t have to tell her. You also say
you told her about being a victim of abuse by your
grandfather. That was brave too.
Mike shrugged his shoulders in a bashful way but it was
clear that he was pleased. The therapist was careful not to
underestimate the difficulty most clients who have been
convicted of sexual abuse experience in coming to therapy.
Beneath surface bravado, intellectualising and blame shifting
there is often much self-hatred. The therapist knew that to
help Mike move beyond such shame management narratives,
she must communicate unconditional regard for him as a
person, despite his sexual offending and denial. The therapist
reminded herself that resistance from blame shifting is like
resistance from crime generally – it’s a ‘zig zag’ process
(Burnett, 2000). The client comes in and out of responsibility
taking, dependent on how secure and held the client feels
on a session to session, moment to moment basis, within the
therapeutic relationship.
The therapist was aware that denial is no longer considered
a straightforward risk factor, and is often a sign of pro-social
shame (Ward and Maruna, 2007). The reality was that Mike,
like many sex offenders, might never admit to his guilt because
of the stigma and consequences of being viewed as a sex
Volume 1, Number 2, September 2016
30
offender or, even worse, a paedophile. However, she knew that
there are other ways that sex offenders can be encouraged to
take responsibility for their offending, without having to perform
the confessional act.
Bronfenbrenner, U. (1979). The ecology of human development.
Cambridge, MA: Harvard University Press.
One way for Mike to begin to take responsibility was to start
to explore with the therapist the impact of his grandfather’s
sexual abuse of him and, perhaps as importantly, his mother’s
neglect. The therapist would then be able to chart how these
adverse and traumatic experiences had influenced his life
course and behaviour towards others, in some of the ways
described earlier. The therapist took the view that empathy
and compassion for the suffering caused by one’s actions to
others starts with empathy and compassion for the suffering
caused to one’s self.
Creeden, K. (2009). How trauma and attachment can impact
neurodevelopment: Informing our understanding and treatment
of sexual behaviour problems. Journal of Sexual Aggression,
15(3), 261-273.
This journey begun by the therapist exploring with Mike the
abuse and neglect he suffered, using the sort of strengthsfocused questions listed above. As stated elsewhere, most
therapists are familiar with dealing with victim issues and
will have their own preferred practice, and the process is no
different with a person who has sexually offended. Once this
victim work was complete, the therapist was then able to move
on to specific offence-focused work, addressing the following
common treatment goals for offenders:
Farmer, E., & Callan, S. (2012). Beyond violence: Breaking cycles of
domestic abuse. London: The Centre for Social Justice, available
online at www.centreforsocialjustice.org.uk/publications/beyondviolence-breaking-cycles-of-domestic-abuse
• Raising the client’s awareness of feelings, thoughts,
behaviour and circumstances prior, during and after the
offending incident/s.
• Helping the client to manage the above triggers of sexual
offending.
• Assisting the client to meet social, sexual and relational
desires and needs in pro-social rather than anti-social ways.
Conclusion
The majority of victims of sexual abuse do not go on to commit
sexual offences themselves. However, most individuals
who have sexually abused others have also been victims of
some sort of abuse or maltreatment, including sexual abuse.
Therapists should reflect, with the help of supervisors, if there
are issues in their own lives or value base unconsciously
influencing them to give too much or too little attention to
victim issues in the lives of offenders with whom they work.
Therapists often have to be able to accept that, just because an
offender wants his own victim issues acknowledged, this may
not lead him, at least publicly, to acknowledge that he also has
victims. Nevertheless, becoming more in touch with their own
victimhood may render clients more willing and able to connect
with the sexual harm caused to others, even if this is never
expressed publicly. This maturing and humanising process
could possibly contribute to decreased risk of re-offending.
References
Bentovim, A. (2009). Growing up in a climate of trauma and
violence: Frameworks for understanding family violence.
In A. Bentovim, A. Cox, L. Bingley Miller & S. Pizzey (Eds.),
Safeguarding children living with trauma and family violence
(pp. 14-74). London: Jessica Kingsley Publishers.
Boden, J.M., Horwood, J., & Fergusson, D.M. (2007). Exposure
to childhood sexual and physical abuse and subsequent
educational achievement outcomes. Child Abuse and Neglect,
31(10), 1101-1114.
Bramblett, J.R. Jr., & Darling, C.A. (1997). Sexual contacts:
Experiences, thoughts, and fantasies of adult male survivors of
child sexual abuse. Journal of Sex and Marital Therapy, 23(4),
305-316.
Burnett, R. (2000). Understanding criminal careers through a series
of in-depth interviews. Offender Programs Report, 4(1), 1-16.
Davin, P.A. (1999). Secrets revealed: A study of female sex
offenders. In P. A. Davin, J.C.R. Hislop & T. Dunbar (Eds.),
Female sexual abusers: Three views (pp. 1-134). Brandon, VT:
Safer Society Press.
Dolan, Y. (2000). Beyond survival: Living well is the best revenge.
London: BT Press.
Fenichel, O. (1946). The psychoanalytic theory of neurosis. Available
in 50th Anniversary Edition (1996). London & New York: Routledge.
Finkelhor, D. (1979). Sexually victimized children. New York: Free Press.
Finkelhor, D., & Browne, A. (1985). The traumatic impact of child
sexual abuse: A conceptualization. American Journal of
Orthopsychiatry, 55, 530-541.
Fonagy, P. (2006). The mentalization-focused approach to social
development. In J.G. Allen and P. Fonagay (Eds.), Handbook of
Mentalization-Based Treatment (pp.53-100). Chichester: Wiley.
Freud, S. (1920). Beyond the Pleasure Principle. Available in
Dover Thrift Edition (2015). Dover Publications.
Hanson, R.K., & Slater, S. (1988). Sexual victimization in the history of
sexual abusers: A review. Annals of Sex Research, 1(4), 485-499.
Howitt, D. (1995). Paedophiles and sexual offences against
children. Chichester: Wiley.
Hudson Allez, G. (2014). Adults with a sexual interest in children.
In G. Hudson Allez (Ed.), Sexual diversity and sexual offending:
Research, assessment and clinical treatment in psychosexual
therapy (pp. 233-250). London: Karnac Books.
Jay, A. (2015). Independent Inquiry into Child Sexual Exploitation
in Rotherham. Retrieved from Rotherham Metropolitan Borough
Council website: http://www.rotherham.gov.uk/downloads/
file/1407/independent_inquiry_cse_in_rotherham
Jespersen, A. F., Lalumière, M.L., & Seto, M.C. (2009). Sexual abuse
history among adult sex offenders and non-sex offenders: A
meta-analysis. Child Abuse and Neglect, 33(3), 179-192.
Rich, P. (2009). Understanding the complexities and needs of
adolescent sex offenders. In A.R. Beech, L.A. Craig & K.D.
Brown (Eds.), Assessment and treatment of sex offenders: A
Handbook (pp. 431-452). Chichester: Wiley.
Smallbone, S.W. (2005). Attachment insecurity as a predisposing
and precipitating factor for young people who sexually abuse.
In M.C. Calder (Ed.), Children and young people who sexually
abuse: New theory research and practice developments (pp.
4-16). Lyme Regis: Russell House.
Smallbone, S., Marshall, W.L., & Wortley, R. (2008). Preventing
child sexual abuse: Evidence, policy and practice. USA and
Canada: Willan Publishing.
Solomon, R.L. (1980). The opponent-process theory of acquired
motivation: The costs of pleasure and the benefits of pain.
American Psychologist, 35(8), 691-712.
Ward, T., & Keenan, T. (1999). Child molesters’ implicit theories.
Journal of Interpersonal Violence, 14, 821-838.
Ward, T., & Maruna, S. (2007). Rehabilitation: Beyond the risk
paradigm. London and New York: Routledge.
Woods, J. (2003). Boys who have abused: Psychoanalytic
psychotherapy with victim/perpetrators of sexual abuse.
London: Jessica Kingsley Publishers.
31
BOOK REVIEWS
Kahr, B. (ed) (2016) with illustrations by Alison Bechdel
Tea with Winnicott
London: Karnac
Review by Anne Power
This book provides an introduction to Winnicott and his
work through the conceit of a posthumous interview.
From the opening scene when the curtain opens on this
piece of theatre, the reader is effortlessly and enjoyably
engaged whilst absorbing a thorough introduction to
Winnicott and his work. Many times, I had to remind myself
that I was reading a work of fiction – the figure that Kahr
creates is so convincing and so coherent, it is easy to
forget that the two men never met. Both the boyish and
the serious aspects of Winnicott’s character are conveyed
throughout the interview; he is delighted, in an unpompous
way, with news that Kahr brings of the popularity of his
writings and he is concerned and deeply saddened to
hear that the life of Masud Khan, one of his most famous
analysands, had unravelled in a destructive tragedy.
The book brilliantly succeeds in its aim of providing an
overview for trainees, but will probably give even more
pleasure to older therapists who already feel they know
Winnicott a bit and who may enjoy spotting anecdotes they
have read, as well as the pleasure of picturing Winnicott
speaking with Brett about the most familiar papers. There
were moments where I wondered if the politeness and
the tea pouring could become too much, but the dose of
charm was just right, and most importantly, the shadow
side of Winnicott and his work – the possible manic
work level, the eccentric boundaries and the disaster
of Masud Khan’s life were addressed squarely. Being
one of those who has always speculated about sibling
rivalry between Winnicott and Bowlby, I was delighted
that Kahr pressed Winnicott on this - especially as he had
interviewed the real John Bowlby and asked him the same
question. My impression was that, at this point, Winnicott is
appropriately depicted as responding a little defensively.
A great pleasure in this book is that much of what is
presented feels familiar but much detail is new. What
on one level is playful and might be considered as lighthearted, is actually a brilliant vehicle for very serious
and nuanced reflection. We know we can trust Kahr as a
Historian and this is definitely not ‘historical fiction’, more
like fictionally presented history. The extensive index adds
to the usefulness of this book, whilst micro-biographies of
everyone mentioned in the text allow at-a-glance information
on Winnicott’s family members, colleagues and friends.
It is good to know that Karnac will be publishing further
volumes in which Kahr converses with other luminaries
of the profession. Because the genre works so well we
might wish that other scholars could present historical
figures in this engaging way, but unless they could match
Kahr’s level of knowledge and insight the result would
not be dependable. In this volume we benefit from thirty
years of preparation and immersion in Winnicott. Kahr
has not only researched all Winnicott’s published and
unpublished archive, he has interviewed over 900 people
Contact:Anne Power, Psychotherapist and Visiting Lecturer, Regent’s University London
Fleur Brennan, Integrative Therapist
who knew Winnicott during his life. From this exposure to
the man, and the thousands of his letters read, Kahr has
seemed to recreate the syntax and rhythm of his voice,
giving the reader the sense of having a ring side seat as
Winnicott reminisces. Perhaps most importantly was the
close friendship Kahr formed with Joyce Coles who had
been Winnicott’s secretary from 1948 until his death in
1971. After tracking her down Kahr worked closely with her
over several years and was thus able to absorb Winnicott’s
personal story very directly, as well as being entrusted with
personal and clinical material from Winnicott’s practice.
In pioneering this genre, Kahr is upholding the Winnicottian
emphasis on the value of play and creativity. Winnicott was an
innovator in so many ways, including being the first shrink on
the wireless and I imagine this piece might work beautifully on
the radio – perhaps with Brett Kahr playing himself.
Power, A. (ed) (2015)
Forced Endings in Psychotherapy and
Psychoanalysis: Attachment and Loss in Retirement
Hove: Routledge
Review by Fleur Brennan
This is a sensitive and perceptive book that focuses on the
final professional farewell psychotherapists must one day
make to their clients, their practice and their way of life. It
does so with such a light touch that this often taboo subject
becomes compulsive and instructive reading.
Anne Power uses her considerable experience as an
attachment based therapist to explore the vagaries of
endings forced by external factors. Supervising the work
of a retiring colleague prompted Power’s interest in the
attachment issues raised for the clients going through this
forced ending. This led her to explore the broader subject
of retirement which would eventually become a challenging
developmental stage for her, as it will for all of us engaged
in psychotherapy. Her book examines not only the effect
on clients of a forced ending, but also what it means to the
therapists themselves.
Power has drawn on the personal accounts of 13 therapists
who had to impose an ending on clients, some due to
illness, sabbatical, house move or maternity leave, and
the majority because of retirement from work. The retirees
she placed in four groups: the Classic, who had carefully
planned retirements soon after the age of 70; the Younger,
aged 61 to 68, who were motivated more by external
factors, such as the needs of a partner, family commitments
or developing other interests; those forced to retire through
ill health, aged 70 to 75, and two in an older group, both
aged 88 at retirement. Power explores also the experiences
of two therapists who took maternity leave, two taking a
sabbatical and one who lightened his workload by taking
one week off in every five.
The author’s reflexive style, monitoring her own deepest
responses to her interviewees, brings their experiences
vividly on to the page, evoking in me, at times, an almost
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32
visceral response which prompted a salutary re-evaluation
of my previously imagined professional path. This could
have made for an uncomfortable read, but the absorbingly
individual, and yet often similar, experiences of the
interviewees, combines with a wealth of detail about
their emotional reactions to their journeys, to provide a
masterclass in negotiating this inevitable life-stage.
Addressing the knotty problem of knowing when to stop,
Power found it fraught with difficulty, since even most
professional psychotherapy organisations have no guidelines
regarding retirement. As for grasping the nettle of telling a
colleague it is time to retire, Power’s research showed that
this was perhaps the strongest taboo of all. She discusses
the risk of being seen as the envious attacker (and, indeed
it could be an envious attack) or because of the pressures
of a decades-long friendship, compassion for suffering
colleagues, or the thought, “there but for the grace of God
go I” (2016 p. 50). On the following page, she describes
turning the patient “into a caretaker-hostage”, who dare not
leave because of the wound this would inflict on the therapist
who is clinging to life through her work, or another appalling
prospect: reliance on patients to indicate the need to retire.
I found her discussion of patients expressing their concerns
about their therapists’ health to the therapist both helpful and
informative.
The process of closing a psychotherapy practice parallels
many of the stages of grief, including ambivalence. Power
tells of the internal struggles faced by therapists winding
up their practices, with one referring to the phone “almost
burning her fingers” (2016 p. 49) as she explained to a
would-be client that she was not available. For the patient,
too, grief can often be evoked. As Murray Parkes (1972)
eloquently observed, grief is the cost of commitment and
the price we pay for love. Clients’ responses are equally
powerful. Responses to the news of an impending ending
of therapy ranged from flight, some not able to face the
ending at all, to incredulity, one declaring: “I can’t believe
it…. It makes no sense. Could you be telling me this…. as a
joke, a cruel one, to test my reactions?” (2016 p. 57).
I loved reading this book, for the insights it gave me, not
only into other people’s experiences, but also for shining a
light on my own practice, my deepest defences, and sheer
lax habits that have crept up. I have up-dated my clinical
will, aware that, as I am a cyclist, eat oysters occasionally
and cross the road, my end may come sooner than I plan.
Reading these chapters challenged my deepest defences
of denial, omnipotence and narcissism among others,
revealed by the surprise I felt at having been stimulated to
look so deeply at the subject I had been ducking and diving
to avoid. In thinking of my own final retirement, I can’t avoid
using that qualifier ‘final’, which does resonate with my
denial around the ending of my life as I know it. But I have
now alighted on a retirement date sufficiently far into the
future that I can attend to the tasks this book recommends
in the extremely useful concluding check-list. These contain
questions indicated by Power’s study, including how to
gauge whether we need to retire, how to plan practice
closure, and how to work with clients’ responses to the
abandonment. Power prompts us to examine our own
feelings about endings, including the extent to which we
have engaged with our own feelings about ageing and
death, and the function of our work in our internal world.
Such questions speak to the very essence of our beings as
therapists, and as human beings, and are enabling to the
reader in their reflexive positioning.
Power reports that the retired therapists in her sample seemed
to have achieved a positive and constructive experience,
despite the challenges, which reflect all the great issues of life
at any stage, brought into sharp focus by a growing awareness
of the shortness of time as retirement or forced endings
loomed. With this awareness in mind, I would recommend
anyone scrupulous about their professionalism to read this
valuable book. I hope they gain as much from it as I did.
References
Parkes, C. M. (1972). Bereavement: Studies of Grief in Adult
Life. London: Tavistock
33
ANNOUNCEMENTS
Psychotherapy & Counselling Psychology
Reflections Research Centre
3rd Annual One-Day Conference
Organising committee
Dr Maria Luca
Professor John Nuttall
Keynote Speakers
Sexual oppression and
its impact on mental
health and well-being:
implications for psychology
and psychotherapy
Saturday 29 October 2016
09:30 - 17:00
Registration: 08:30 - 09:30
Regent’s University London
Inner Circle, Regent’s Park, London NW1 4NS
Professor Brett Kahr
Promiscuous virgins and
celibate whores: traumatic
origins of the erotic tumour
Professor Martin Milton
From ‘fag’ to ‘fab’: sexual
identity, minority stress and
psychological distress
Speakers
Dr Terence Nice
‘Hear my suffering and see
my wounds’: tales of selfharm, attempted suicide and
sexual oppression
Candice Rakusin
Communication and
knowledge about sex in
Jewish marriage
Dr Andrew Smith
Therapy with victims of abuse
who have also sexually
offended
Dr Rachel Thomas
Sexual oppression and
complex trauma: from asylum
seekers to dissociative
disorders
Please book online store.regents.ac.uk
Enquiries to Shirley Paul [email protected]
34
Psychotherapy & Counselling Psychology Reflections Research Centre
4th Annual One-Day Conference
PSYCHOSOMATIC CLINICAL PRESENTATIONS
AND IMPLICATIONS FOR EMBODIED, RELATIONAL
PSYCHOLOGICAL THERAPY APPROACHES
Saturday 10 June 2017
09:30 – 16:30
Regent’s University London,
Inner Circle, Regent’s Park,
London NW1 4NS
Organising committee
Dr Maria Luca
Professor John Nuttall
Keynote Speakers
Professor Helen Payne
The BodyMind Approach: supporting people with medically unexplained
symptoms/somatic symptom disorder
Nick Totton
Embodied symptoms as problems and as solutions
Professor Manos Tsakiris
The relational body: perceiving and representing one’s body in relation to significant others
Speakers
Dr Katharina Lederle
An understanding of the science of sleep and how sleep may affect mental health
Manuel Toren and Dr Maria Luca
The persecutory character of irritable bowel syndrome
Further details will be published at store.regents.ac.uk
Enquiries to Shirley Paul [email protected]
Journal of Psychotherapy and Counselling Psychology Reflections
35
Conference
INTEGRATION INTO PRACTICE
THE HEART OF INTEGRATIVE PSYCHOTHERAPY:
PUTTING THEORY INTO PRACTICE
February 4 2017
National Council for Voluntary Organisations Society Building
8 All Saints Street, London N1 9RL
At this conference key figures from all the British integrative psychotherapy training programmes will join
with UKAPI in offering a day exploring what is at the heart of integrative psychotherapy. We will focus on
both current, contemporary, exciting developments in the field as well as the challenges we face.
The conference will include experiential workshops in which practitioners will offer an insight into the way
their integrative model influences their practice.
Visit www.ukapi.com for further details and to add your name
to the mailing list for regular updates.
Recruitment
Journal of Psychotherapy and Counselling Psychology Reflections (JPCPR)
NEW BOOK REVIEWS EDITOR
JPCPR is seeking to appoint a New Book Reviews Editor. This is an exciting opportunity for anyone wishing
to support the journal to undertake editorial responsibility by receiving books relevant to the fields covered
by the journal from publishers and arranging book reviews for publication.
JPCPR is a bi-annual professional journal for counsellors and psychotherapists, counselling and clinical
psychologists and is free to view at regents.ac.uk/reflections
The journal encourages submissions of papers covering:
• The contributions from and debates between different theoretical approaches to psychotherapy and
counselling psychology
• Contemporary issues in psychotherapy and counselling psychology in public, private and voluntary settings
• Research on the practice of psychotherapy and counselling psychology from different theoretical
perspectives
• Reviews of books of particular importance to the field of psychotherapy and counselling psychology
Enquiries and applications should be submitted to the editor, Dr Maria Luca, at
[email protected]. Please include a covering letter explaining how your experience,
qualifications and interests are relevant for this position, attaching a copy of your CV. Closing
date for applications: 15 November 2016.
Volume 1, Number 2, September 2016
36
SUBMIT YOUR RESEARCH
JOURNAL OF PSYCHOTHERAPY
AND COUNSELLING PSYCHOLOGY REFLECTIONS
Reflections Research Centre
Papers are welcomed for the next issues of the Journal, to be published in January and September 2017
The Journal encourages submission of papers covering:
• The contributions from and debates between
different theoretical approaches to psychotherapy
and counselling psychology
• Research on the practice of psychotherapy
and counselling psychology from theoretical
perspectives
• Contemporary issues in psychotherapy and
counselling psychology in public, private and
voluntary settings
• Review of books of particular importance to the
field of psychotherapy and counselling psychology
SUBMIT YOUR MANUSCRIPT: [email protected]
Enquiries can be made to Dr Maria Luca, Editor, at [email protected]
GUIDELINES FOR SUBMITTING A PAPER TO THE JOURNAL
OF PSYCHOTHERAPY AND COUNSELLING
PSYCHOLOGY REFLECTIONS (JPCPR)
In preparing your submission, please refer to the style guide below.
Please make sure your full contact details are visible on the outside
of all documents you are sending to Editors.
Papers are accepted for consideration on condition that you will
accept the following conditions. We ask authors to assign the rights
of copyright in the manuscript they contribute.
We welcome submissions on any topic within psychotherapy and
counselling psychology that considers the remit of the journal and
that it is inclusive of the academic community at large.
Contributions to JPCPR must report original research and will be
subjected to review by referees at the discretion of the Editorial Office.
We welcome new or recent books which are relevant to the focus
of the journal and which you consider would be useful to review
for readers.
Journal policy prohibits an author from submitting the same
manuscript for consideration by another journal and does not allow
publication of a manuscript that has been published in whole or in
part by another journal.
Important note: Manuscripts must adhere to the ethical guidelines
for both research and practice of UKCP, BPS, HCPC & BACP.
1. Guidelines
2. Infographics
• Referencing: All manuscripts should follow the referencing guidelines
in the 6th edition referencing system of the Publication Manual of the
American Psychological Association at: www.apastyle.org/manual/
• All graphics must be supplied in their original format, either as digital
artwork or statistical data.
• Language: Papers are accepted only in English. British English
spelling and punctuation is preferred. Non-discriminatory language is
mandatory. Sexist or racist terms must not be used.
• Abstracts: Structured Abstracts of no more than 250 words are
required for all papers submitted. Authors should supply three
to six keywords.
• Headings: Section headings should be concise.
• Word count: A typical manuscript will be 1,500-2,500 words, including
references. Longer contributions of 3,500-6,000 words, (27-30
double spaced pages including references) may be published where
inclusion of data (e.g., excerpts from interviews) warrant it. Papers that
greatly exceed this will be critically reviewed with respect to length.
Authors should include a word count with their manuscript. The word
count (which includes all text including the abstract, manuscript, notes,
tables, figures, etc.) should appear at the end of the manuscript.
• Font: All manuscripts must be typed in 12-point font in Arial and
double-spaced throughout including the reference section, with wide
(3 cm) margins. All pages must be numbered.
• Manuscripts should be compiled in the following order:
• Title of manuscript
• Author(s) name(s) and title(s)
• Abstract
• Keywords (no more than six)
• Correspondence/contact details including author(s) affiliation(s)
You are welcome to include graphs, tables and diagrams in your
submission, but the following must be observed when supplying
information:
• Any graphics copied from the internet and cited from other
publications are not acceptable on their own.
• Graphics files must be supplied separately to text. Please do not
embed graphics in the text file.
• Figures should be numbered in the order in which they appear in the
paper (e.g. figure 1, figure 2). In multi-part figures, each part should be
clearly labelled (e.g. figure 1(a), figure 1(b)).
• Each figure should include a title caption and full source e.g. Figure
1 The incidence of mental health issues in the UK adult population,
World Health Organisation, Report on World Mental Health Issues,
2013
• The filename for the graphic should be descriptive of the graphic, e.g.
Figure1, Figure2a.
• Avoid the use of colour and tints for purely aesthetic reasons.
3. Reproduction of copyright material
As an author, you are required to secure permission if you want to
reproduce any figure, table, or extract from the text of another source.
This applies to direct reproduction as well as “derivative reproduction”
(where you have created a new figure or table which derives
substantially from a copyrighted source).
4. Copyright and authors’ rights
• Table(s) with caption(s) (on individual pages)
It is a condition of publication that authors assign copyright or license
the publication rights in their manuscripts, including abstracts, to the
Psychotherapy and Counselling Psychology Reflections of Regent’s
University London. This enables us to ensure full copyright protection
and to disseminate the manuscript, and of course the Journal, to
the widest possible readership in print and electronic formats as
appropriate. Authors are themselves responsible for obtaining
permission to reproduce copyright material from other sources.
• Author(s) biographical outline (50 to 100 words)
5. Proofs
• Main text
• References
• Acknowledgements
• Appendices (as appropriate)
• Please supply in a separate file information about your research
interests/specialisations - up to five.
• Two separate manuscripts must be submitted.
• The first version must be a complete version containing all the
above together with confirmation in a separate file confirming that
the manuscript is not under consideration or submitted to another
journal. Use the following statement:
I confirm that the manuscript submitted, title:…. is not under
consideration or submitted to another journal.
• The second version must be entitled ‘For blind review’ and must not
contain the author(s)’ name(s) or contact details or any identifiable
author(s) information (refer to APA guidelines). This will allow for the
second version to be sent anonymously to reviewers.
Manuscripts will be copy-edited for journal house style. Authors will
receive page proofs for checking. At this point, no substantial changes
can be made to the paper. It is essential that proofs are checked and
returned within 48 hours.
6. Submission details
All submissions should be made online to [email protected]
7. Disclaimer
Regent’s University London and the Editors make every effort to ensure
the accuracy of all the information (the “Content”) contained in its
publications. However, any views expressed in this publication are the
views of the authors and are not the views of the Editors or of Regent’s
University London. Responsibility for confidential material and consent
obtained to use in publications is that of the authors.
Journal of Psychotherapy
and Counselling Psychology Reflections
Volume 1 • Number 2 • September 2016
Editor: Dr Maria Luca
Managing Editor: Professor Helen Cowie
Guest Editorial.................................................................................................................................................................................................... 2
Supporting Survivors: A Strategic Model to Address Rape Culture in Universities
Shaheen Shariff and Alyssa Wiseman.......................................................................................................................................................... 5
Adolescent Girls’ Declining Mental Health: Where is the Feminist Perspective?
Rosalyn H. Shute................................................................................................................................................................................................ 13
The Poetry of Self-Harm, Suicide and Oppression: Theoretical and Clinical Explorations of Self-Harm and Suicide
Terence Nice....................................................................................................................................................................................................... 21
Therapy with Victims who have gone on to Offend
Andrew Smith..................................................................................................................................................................................................... 25
Book Reviews..................................................................................................................................................................................................... 31
Kahr, B. with illustrations by Alison Bechdel (2016). Tea with Winnicott. London: Karnac.
By Anne Power............................................................................................................................................................................................................................................... 31
Power, A. (2015). Forced Endings in Psychotherapy and Psychoanalysis: Attachment and Loss in Retirement. Hove: Routledge
By Fleur Brennan.......................................................................................................................................................................................................................................... 31
Announcements............................................................................................................................................................................................... 33
Psychotherapy and Counselling Psychology Reflections Research Centre
3rd Annual One-Day Conference on 29 October 2016
Sexual oppression and its impact on mental health and well-being: implications for psychology and psychotherapy......................... 33
Psychotherapy and Counselling Psychology Reflections Research Centre
4th Annual One-Day Conference on 10 June 2017
Psychosomatic clinical presentations and implications for embodied, relational psychological therapy approaches.......................... 34
UKAPI
Conference on 4 February 2017
Integration into practice: the heart of integrative psychotherapy: putting theory into practice............................................................... 35
New Books Reviews Editor ............................................................................................................................................................................. 35
Call for Papers .................................................................................................................................................................................................36
ISSN 2054-457X