How Trauma Informed Is Our Field? What Clients Vs. Clinicians Say

A robust body of literature demonstrates that individuals who commit sexual offenses (ISOs) have significantly higher rates of trauma compared to the general population (Creeden, 2013; Dierkhising et al., 2013; Grady et al., 2018; Levenson et al., 2014; Levenson et al., 2015; Levenson & Socia, 2016; Yoder & Ruch, 2014; Yoder et al., 2019). Although the research cannot state that trauma causes subsequent sexual violence, the research strongly indicates that trauma has a significant impact on those individuals who have experienced it, including impacting individuals’ neurobiology, cognitive processing, interpersonal relationships, impulse control, physical health, executive functioning, self-esteem, emotional regulation, attachment, and many other areas of functioning (Anda et al., 2006; Creeden, 2013; Johnston et al., 2009; Maniglio, 2011; McDonald et al., 2016; Reckdenwald et al., 2013; Scott, 2004; Spaccarelli et al., 1997).

Given the connection between these consequences of trauma and risk factors associated with sexual offending (Grady et al., 2016), there has been a growing level of interest in integrating trauma-informed care principles (TIC) (Substance Abuse and Mental Health Services Administration; SAMHSA, 2013) into treatment focused on sexual offending (SOTX) (Levenson et al., 2016; Levenson, 2017). Yet it is unclear how and in what ways SOTX therapists are integrating TIC into SOTX in their efforts to reduce the risk of sexual recidivism.

This study’s aim was to explore in what ways SOTX therapists are integrating TIC and/or trauma-based treatments into SOTX. Data were collected through two separate on-line surveys with parallel questions in order to enable comparisons between SOTX clinicians and clients who had completed SOTX. In total, 95 clinicians and 194 clients completed their respective surveys, which included the Trauma-Informed Principles (TIP) Scale (Sullivan & Goodman, 2015), which is a reliable and validated instrument designed to measure from the client’s perspective how well the services they received adhered to TIC principles. In addition, the participants described in what ways trauma was integrated into SOTX through qualitative questions.

Independent t-tests compared clients’ and clinicians’ responses for each item on the TIP Scale. There were statistically significant differences for every question regarding their perceptions of SOTX treatment as trauma-informed (with Bonferroni correction, p < .001; 35 items), with clinicians rating their use of TIC significantly higher than the clients ratings; meaning that although SOTX clinicians believe that they are providing treatment that adheres to TIC, clients do not experience treatment as such. Qualitative data indicated clients were told explicitly not to discuss their childhood traumas and if they were asked about them, there was minimal attention paid to these topics.

The findings indicate that the sexual violence prevention field has not yet fully integrated principles of trauma-informed care or trauma-based treatments consistently into these interventions. To address this issue, trainings for practitioners on trauma should explicitly demonstrate how trauma can be included in offender-based treatments, while considering the unique context and characteristics that these relationships have as they seek to balance client autonomy and public safety. Additional implications will be discussed regarding prevention strategies, including primary and secondary prevention.