‘We need to change the conversation’

A press release about StopSo's awareness campaign highlighting 'the lifelong suffering of sexual abuse victims' led to an interview with Terri van Leeson, a psychologist who is a supporter of the organisation. StopSo focuses on offering preventative therapy seeking to ensure that paedophiles never act on their urges. It's an approach that has been criticised by some…

Terri begins by pointing out that her professional involvement in the area of child sexual abuse is not something she talks about at parties. 'It's not just that can it cause adverse reactions, even among friends. There are very strong confidentiality issues. It's also true that you see things in some of the work I do which you can't dump on anyone else.' It was fascinating, therefore, to talk with her about the subject.

I was immediately struck by Terri's enthusiasm for the demanding work she does. She described working with Category A prisoners – the most dangerous category – as 'phenomenal'. Before talking with her about her role, I asked her to explain her background and how she got interested in forensic psychology.

'I had a difficult childhood. At the age of ten we moved to the USA and, in the end, my mother left me and my brother with my Dad because she was unable to cope with his violence. My brother was damaged by it all and I was exposed to a lot of childhood trauma which, perhaps, explains why I'm fiercely independent but carry a lot of baggage with me. All of this led me to be labelled "thick" at school. I missed out a lot of schooling and this made things even worse when I went to the USA.' How did this resolve itself? 'I pleaded with my Grandma that she would take me in and I could go back to school in England. She was marvellous... and that was when I started realising and proving that I wasn't "thick", after all.'

Terri trained at the Warwickshire School of Nursing and was a staff nurse for five years. 'It got me interested in people's psychology. I realised that I was emotionally intuitive, an ability which is particularly useful in working with prisoners. Nursing work taught me a couple of things. First, that people's outsides and insides don't match. Second that if you get alongside someone and really try to understand them you can help them, whatever the issue, by providing them with enabling therapies.'

So, how did you make the transition into psychology? 'It wasn't a conscious decision. I started a BPS accredited degree in Applied Social Science at the University Coventry when I was still a nurse. It really set me up since it covered basic psychology… some of the sociological ideas helped later. I hadn't written an essay for years, but I became fascinated and read everything I could lay my hands on, in between doing agency work as a nurse. I was a bit manic! I went straight on to a PhD while working as a lecturer for undergraduates in psychology. My PhD was a multi-method study of affect regulation, using both quantitative and qualitative analyses. The latter was really influenced by my social science training.'

Terri had combined lecturing with work as a substance misuse worker, which 'took up a lot of evenings'. Again, Terri's enthusiasm was palpable. 'The role I'd applied for hadn't involved working with offenders in the community, but they were struggling to fill the post. I wasn't sure I wanted to do this, but it blew me away.'

'I am humbled by the client group'
Between 2002 and 2010, when she set up Pathway Psychological Services, Terri worked in a variety of roles in the prison service. Initially she worked near Thetford in a Category C prison – for those who cannot be trusted in open conditions but who are unlikely to try to escape – on areas such as individual work with life sentenced prisoners, risk assessment and training development. In 2009 she moved to the Dangerous and Severe Personality Unit at NHS/HMP Whitemoor, a Category A Prison for those whose escape would be highly dangerous to the public or national security.

I suggested that working with offenders – whether in the community or in category A prisons – must be challenging, exhausting and emotionally draining. 'It's a most fascinating world. You can study it but until you get involved you can't really know whether it suits you and if you can cope with it. No day is ever the same. You're never bored. I am humbled by the client group. Many of them – whether substance misusers, murderers or sex offenders – have faced challenges and survived things when they were children that are difficult to imagine. They are not monsters but human beings who have, at some stage been severely traumatised. Their back stories – particularly those of sex offenders – are often deeply upsetting.'

Did you ever feel in danger? 'Only once. It goes back to my point about being intuitive. I was in a one-to-one with a prisoner when I realised he was about to attack me. Even hitting the panic button would have triggered him. I waited. It seemed like hours but was probably seconds. After the pause I asked a neutral question and he relaxed. In a follow-up session he confirmed what had happened, but was astonished I'd realised it.'

In 2010, Terri set up Pathway Psychological Services Limited, her own consultancy to offer services like expert witness statements and parole board evidence. Terri has mixed supervising, consultancy work in mental health and youth offending, individual interventions and her advisory work with StopSo since then. But there is one constant thread running through it – 'working with sex offenders and particularly those involved in child sexual abuse. Adding it all up I've got 16 years experience in the area.'

To return to StopSo, their emphasis is on providing community therapy to those who feel they might be about to commit a sexual offence or who have committed one. The statistics are staggering. The NSPCC cite police statistics of recorded child sex offences in the UK –64,677 from April 2016-2017. While StopSo have introduced new victim support services and awareness campaigns, their emphasis is on prevention of offending and reoffending. Terri argues that 'one to five per cent of the general population have the capacity to be sexually aroused by a child. We need to understand what that's all about, start a different conversation and begin to focus on prevention as well as treating the problems once abuse has happened. We must ensure that we continue with robust measures and policies about risk, but should talk about these issues in a different way.'

For a while we discussed the extent to which films, novels and TV, have muddied the area in the way they portray serial killers and sex offenders – not to mention the psychologists and law enforcement personnel that deal with them. 'It's understandable from the entertainment industry's point of view but these sorts of portrayals have created a very difficult environment within which to tackle the subject responsibly.'

'You need to examine the stage you're at'
Terri wrote an article in the Spring 2018 New Psychotherapist challenging professionals to get involved in the area. I asked her what some of the issues are. 'Sex offenders, particularly those involved in child sexual abuse, trigger disgust, anger and often a desire for revenge. I'm a Mum so I understand these reactions: I'm careful with my children, given what I've seen and heard. Before you commit yourself to working in this area you need to examine what stage you are in your life and whether you can cope. You must be mature about sexuality and be able to be open about it. Sending disgust signals to the client can be disastrous, whatever they've done. Once you're involved, a supervisor experienced in the area becomes critical. It's a lonely life: as I've suggested, you can't discuss issues with friends or loved ones.'

Given our discussion it seems extraordinary that someone would go to a professional and admit sexual feelings for children. 'People go to GPs, for instance, and are met with the response "get out of here. You're a monster". But many of these people have strong feelings of shame, confusion, fear, self-loathing and self-disgust. Many of them are victims of the sort of horrific abuse that makes them object of pity when they're children, but somehow seems to paint them as monsters as soon as they reach 16 or 18. Many simply don't understand why they have these feelings and they want to talk to someone about them. So that's how StopSo works. Individuals are referred to the organisation by the police, probation, GPs and others. Some individuals self-refer. In turn they're referred on to a local StopSo practitioner.' Are these all psychologists? 'No... local practitioners include probation officers, psychotherapists and sex therapists specially trained in this sort of work. There are very specific issues. The people you treat do not want to sign a contract or have their name recorded, for instance.  Practitioners must understand the law, what is illegal and therefore what must be reported to the police. And – it may sound trivial – record keeping and files need careful consideration. Years ago, the prison service kept files containing explicit material. That has obviously stopped.'

'It's critical you create trust and a sense of safety straight away. Then the issues are very wide. Sometimes it's a question of educating someone that, to give one instance, child flirtation is not an invitation to sex. On the other hand you might work on creating healthier stimuli for sexual fantasy and masturbation.'

Terri typified the situation as follows. 'Sexual attraction to children is listed in DSM-IV as a disorder among all the other syndromes that we treat. Yet we don't have a recognised treatment for it. It's all a bit like saying "stop doing that", being asked for help and answering, "I'm afraid there isn't any."' Given this, I asked Terri what some of the solutions were. 'Robust risk assessment. It's the forensic psychologist's forte and central to what we do in, for instance, parole board work. We need more forensic psychologists working in the community and to get other types of practitioner involved. We need to change the conversation and the understanding of the area and get people to accept that it's a much more pervasive issue in our communities than they think. The police are arresting 400 people a month for accessing obscene material related to children. They have a dreadful job: they see all the horrific aspects of the area but are rarely involved in other aspects. It's no wonder they get angry and disgusted. I feel hugely sorry for them.'

Answering other questions, Terri thought long and hard. When I asked her how she relaxed from this stressful life her answer was immediate: 'Sailing. I'm an avid yachtswoman with a 41-foot yacht moored on a river. Out there when you are at sea you can't think of anything else but sailing.' Real mindfulness.

The anxious profession
During our interview, Terri offered reflections on psychology, based on her various experiences. I asked her to sum them up. 'I think we're an anxious profession, hung up on proving that we're real scientists. I struggle with the biological reductionist mode. Of course scientific method and numbers are important. But you need to consider the existential experience. Different client groups, different psychological approaches and, of course, the different professions you work with teach you different ways of helping people change. You learn that you can't just tell a person how they feel or think and that they need to change. We, as psychologists, can only help people change if they want to change. Then our role is to give them the tools to do it. I don't adhere to one theory, approach or model: treatment models are not the defining factor in the success of our work. In the end, research increasingly shows it's the relationship with our clients that matters.'

And finally, what do you say to an accusation that you're apologising for paedophilia? 'I work with the abused as well and I will never forget some things I have seen and heard. But, in treating the abuser you're preventing potential abuse. More resources, a change of conversation, a focus on prevention would prevent the suffering of so many children and adults. And the way to ensure prevention is sitting alongside people and giving them the tools to make changes. In treating potential abusers I'm protecting the potentially abused.'

For more information on Stopso visit www.stopso.org.uk