Online Abuse: The Offender in Your Pocket

Teresa Huizar: 

Hi, I’m Teresa Huizar, your host of One in Ten. In today’s episode, Online Abuse: The Offender in Your Pocket, I speak with psychotherapist and researcher Anette Birgersson. On the podcast, we’ve examined many aspects about online child sexual abuse: what it is, how it happens, and how children are impacted by it. Now we turn to a different set of questions. What do the multidisciplinary professionals see and understand that others do not?

What did they hear directly from victim-survivors? How do professionals think about their need to move beyond intervention as usual to meet the unique needs of these youth? And what do they see as lacking in caregiver support? And what could be done to fix that? We know that there are system gaps, so the question is, what can we do to better care for these children and their families?

I was moved by the compassion and dedication of the professionals that Anette interviewed. Their insights provide yet another lens through which to view these complex cases. I know you’re going to find this conversation as thought-provoking as I did. Please take a listen.

Hello Anette, welcome to One in Ten.

Anette Birgersson: 

Hi, thank you.

TH: 

So I’m curious about how did you come to this work really looking at multidisciplinary team perspectives on online child sexual abuse?

AB: 

Well it’s a pretty long story. I’ve been a clinician for almost thirty years now. That sounds incredibly long talking about it like that. And I started as a social worker and then I’ve continued to educate myself to become a licensed psychotherapist. So I’ve been working with kids and adolescents from the beginning, harmful sexual behavior and then also when you work with those kids you come into the trauma work and then I kept doing the trauma work and then I’ve also been interested in research the whole time. And the last, I would say, 10 years, online sexual abuse has become so much more common, both when you see the kids that actually inflict harm, but also working with victims. Then we started to see, okay, so what can we do? And now when I’m into research, that was one of the areas that was I was most curious to look into because I see that professional struggles a bit in how to meet and support kids, both the ones that have inflicted harm, but also especially victims that have been sexually abused online.

TH: 

One the things that you noted in your paper was how difficult it is to get a handle on the true prevalence of this. Can you talk about some of the challenges and why the data is a little bit all over the map, depending on the study you’re looking at?

AB: 

Yeah. So I mean, there’s a lot of reasons. We have been working on getting ethics approval to do a lot of different types of studies from interviewing kids and caregivers to doing more kind of survey approach. And it’s really difficult to be able to do that with kids and adolescents that are under fifteen, which means that we always have to rely on older adolescents to report what they have experienced or caregivers.

And the kids that are growing up now, they have a total different experience than the kids that are already eighteen. So it’s really hard to get to actually do the studies that we need to do to be able to talk to the kids that are actually online and are seeing and experiencing these things. And then also I think a lot of kids it’s become a normalized too in their world that they know that if you’re online, you will one of these days be exposed to some things. And most kids are resilient. They don’t engage in conversations and then it’s not a thing. So when you ask about online sexual abuse, it’s not, there are many reasons why kids would say that no, that’s not me. Because maybe they either are resilient and don’t see I mean, it was it didn’t affect me, or if they have engaged in behaviors that have then led to them being victimized in in different ways, the shame and the guilt of having been part of that, feeling complicit in what happened to them also makes them not report. So there’s I think there’s lots of different reasons why we really don’t know how many kids.

TH: 

It’s an interesting thing because for cases that come into Children’s Advocacy Centers or Barnahus or any of the other multidisciplinary models around the world, typically they’re coming in because there’s been a disclosure. But in an online child sexual abuse case, it’s often that something has been discovered that may bring the child in, right? Can you talk a little bit about how that changes the dynamic for the professionals, but also for the child and families, in that this isn’t the child felt ready, the child disclosed, but rather something came up in an investigation, whether it’s a chat or something else that made the authorities aware that there was something that needed to be further discussed with the child.

AB: 

I think we’re trying still to get to interview more kids. We have been allowed to do surveys and in those surveys kids do express how they struggle with both recognizing and wanting to talk about the sexual abuse and how scary it is when the police calls and say, Okay, so we discovered this and many times the kids don’t even know what so what, what chat is it? What in what conversation is this? And then they might have to wait for quite a long time and until they actually get to their forensic interview. And the forensic interviewers say the same. So most of the cases that the forensic interviewers in Sweden see are not self-disclosed. They are found in different types of chats or in investigations.

So they have to do a lot of detective work to even figure out who is this kid and sometimes they have even approached the wrong family. And I mean, it’s the really hard work. So when the kids get to the police forensic interview, there are quite a few kids that don’t even recognize or want to recognize that it’s them. Some talk but not willingly. And some, of course, are super relieved that this is finally out in the open and they get to talk about it.

So the forensic interviews really give us a picture of a very broad variation of reactions from the kids. And why kids don’t disclose. I mean, there is some research around this. the professionals that we met all seem to be thinking that it has a lot to do with the shame and the guilt of being out online, being, you know, curious.

Because this is a part of their sexual exploration online. And that makes it so much harder to talk about because some of it was maybe exciting and some of it was, you know, giving them a lot of confirmation and validation, which they wanted. So then how am I to say when I’ve been part of the game, how am I then to say that I was abused in that situation?

TH: 

I think that, you know, what you’re speaking to is the complexity of this, not only for children as they’re deciding to disclose or being confronted with documentation or whatever the scenario is, but also the real challenge for professionals in engaging these kids in a healthy and good way, given the fact that they walked into a forensic interview room not knowing what the reaction is going to be, whether this is going to be shocking to the child, or whether this is going to be something embarrassing, or whether there will be feelings of relief or feelings of complicity or whatever. And we’ll delve into some more of these perceptions of victims’ reactions to this in a moment. As you were talking, I was thinking that we’re also asking an awful lot of professionals to show up with this broad flexibility about how they’re going to respond to whatever they’re presented with in that time and space. Can you talk a little bit about the particular research questions you were wanting to explore in this study? Because you were really talking in this particular one to professionals, not to the children themselves. So how they perceived the way that these cases worked and various reactions. So what were those research questions?

AB: 

Well, so we wanted to really look into the experiences of the professionals when meeting both the children and adolescents and the caregivers. And we wanted to also look into what were the challenges in the meeting? So giving support, giving interventions, as well as, you know, the system challenges. Were there system challenges?

How does the system take care of these cases? Is that different than other sexual child abuse cases? So we were really interested in looking into what happens when these cases surface and when they are disclosed. And how does the chain of interventions work? Because in other sexual abuse cases, the chain of interventions is pretty clear. You either the police report to social services or social services report to police when this is disclosed and then it’s always taken care of within the Children’s Advocacy Center’s walls. So it always goes to Barnahus, which we call it in the Nordic countries and in Europe, so that the child gets to meet social workers, the forensic interviewers, do the medical interview or examination.

And have all of their connections within the Barnahus to make it really easy. And what we learned from our pilot study, gaps in the system, which we did in cooperation with Childhood Foundation, was that it seemed like these cases didn’t really come to Barnahus at all. And they didn’t go through the normal chain in the support system that we figured they would and we realized that a lot of these cases didn’t even show up at social services or got any support at all. So that’s why we were curious and looking into how do professionals experience the differences between online sexual abuse and other type of cases.

TH: 

So let’s turn to their perceptions about victims for a moment because you were just talking a few minutes ago a little bit about one of the chief ones seemed to be around this sense of complicity that some of the victims had. And can you talk a little bit more about that?

AB: 

Yeah, so I think when talking to the professionals, it’s very clear that they also struggle with this phenomenon in general, because being online is not something that my generation, our generation has learned to handle. We haven’t grown up with this. For us, it’s like, okay, so if someone writes something bad to us, we kind of, you know, I turn it off. I don’t answer. I have like a response system to that.

But I have also not learned how to be social and I have not grown up having part of my life online where, you know, many kids have maybe their only friends and their only friend circles. So it’s very different for kids nowadays. And many professionals struggle with understanding or thinking about online connections as real connections.

I hear a lot of professionals still talk, well, they don’t have any friends in real life. Well, online is real life for kids today and they can have as deep and meaningful conversations and connections online. And I think that sometimes puts a pin in the wheel for us to understand, okay, so this is a really important arena for them and it’s part of normal, everyday life. So the thought of how do I then talk about this without putting more blame? Saying that I think that they should have turned it off, saying that I think that they should have said something, when really we know that kids that have been victimized outside of the internet also have a really hard time to disclose, especially if it’s in, you know, partner violence, or if it’s within our friend circle, or if it’s regarding bullying, for example, it’s really hard to talk about. So I think a lot of this is also around circling around adults’ difficulty to comprehend that this is the real world for these kids. And then the hurdle of how do I talk about this without stigmatizing and adding to the shame and guilt. I think that puts a little hurdle into how you speak about it.

TH: 

Yeah. Well, it’s a very interesting thing because I do think, you know, from other research that children do often have a sense of this themselves, that they self-blame, right? And that’s a really common thing in any type of child sexual abuse. Somehow it must have been my fault. Somehow I must have drawn this toward me. And we know that that is so false. But it’s an interesting point you’re making that in these online cases.

It can be more difficult for the adults to discern that this is the same type of self-blame and it shouldn’t be treated really any different than any other type of self-blame, right? That we should be saying, that’s wrong. It’s not your fault, you know. But because there’s a essentially transcript in many cases or a photo documenting it, I wonder to what extent that documentation component makes it more difficult for people to see that this is erroneous self-blame.

AB: 

Yeah, and I think that’s a big part of it. And I think that’s also one of the things that I mean, obviously the kids and the caregivers struggle with because they don’t know the extent of what’s online and what’s still there and what is getting spread and in what forms and you know, you don’t even want to think about it really. And it’s the same troubles the professionals because okay, so how do I support court and give intervention while this is clearly an ongoing trauma. If an event happens outside of the internet, we have like it’s an event, it happens, and then for most of the time it’s over. It’s ended. It’s an event that we can talk about in past tense, but when it happens online, the event is in past tense, but then the risk of material or pictures or videos spreading makes it into an ongoing thing. So this is kind of an ongoing trauma for the kids. It just keeps repeating. And the fear of I don’t know when this is going to show up. Who have seen it? I meet a new person and in my mind I ask, have they seen those pictures of me online? Because I don’t know in which forums they spread.

And I think that also makes it h difficult for professionals because we have learned that we don’t treat ongoing trauma, but we can. And I think that is one of the things that we have learned the last ten years more about how we can actually still do a lot of interventions and that we could do full treatment even if there is ongoing trauma.

But we need to kind of rethink a little bit of how we do it and then adapt to how we do that.

TH: 

I think one the interesting points that you’re making here and in the paper is about the chronicity piece of this. And also that the offender can reach back out and re-engage in many cases repeatedly as well, even past the point of initial intervention. And someone in the paper described it as always having the offender in their pocket, which I thought was really evocative. in that way. And so I’m curious for you as a clinician.

How do you think about the way in which that changes treatment?

AB: 

So we’re actually writing a paper right now about how do we work with trauma-focused cognitive behavioral therapy and online sexual abuse. And what we can see is what we learned is that when you work with interventions and when you’re going into treatment, so we kind of have to address this in the beginning that this is here. We need to do more psychoeducation and talk about the self-blame and the guilt more in the beginning and give psychoeducation around that. And also talk about safety planning in the beginning because how dependent are the kids on their online connections, right? And how dependent are they on their phone and their devices? So for some kids you actually have to do interventions around that too, because it’s a need that it’s maybe a little bit compulsory. But for most kids we need to talk about how do we work around safety and how do we work on managing if something resurface and how do we work on the communication within the family and with us as the support team, the therapists or social workers whoever are working to support this kid and family. So we kind of need to establish how we’re gonna manage this through the treatment before we go into treatment. And I mean, we’re working with kids and we’re working with caregivers that are in crisis. They have gone through a lot. And we all know that when you’re in a crisis, you don’t really function rationally. So this is something that we need to establish in the beginning and then we have to keep updated through the whole treatment. I mean have it close to us through the whole treatment so that we keep updating, so we keep talking about it. and actually I think it brings very good way of addressing that shame and guilt and feeling of being part of this. because since we need to talk about the safety around it, we need to have you being safe. I think it helps also bring that in, okay, so it’s not just me. I need to have the skills to handle myself and to know what to do if something resurface or something someone approaches me again and have a crisis plan for that. And that kind of connects and I think it strengthens the therapeutic alliance when you do that early.

TH: 

Your paper also notes many of the same themes really dealing with caregivers, that these feelings of not really being competent, that they feel they should have somehow protected their child from this or should have known what they were doing. Can you just talk about the multidisciplinary teen professionals’ perceptions of what struggles caregivers were having?

AB: 

There were a lot of struggles and a lot a very large variety of reactions. So a lot of them said that I mean, of course, when you get a phone call, which is how most of these caregivers get to know about this, you get a phone call from the police saying we need to have you come in for an interview because we have found something online regarding your child. So just for that reaction and shock. And many describe that caregivers, of course, which you can see if you have a just thinking about how a create crisis reaction works, right? Shock. And then you go and you might be a little bit strong in your reactions towards your child, which maybe not strengthen the communication and the possibility for the child or willingness to actually disclose what this might be. So there was a lot of reactions where clinicians or professionals felt like they had to, the beginning was a lot about giving psychoeducation around this is common, this is often a normal part of teenage behavior to explore sexuality online. Your child is one out of many kids that do this and are part of this. We don’t know the extent yet. So like help them just to walk through slowly, both to normalize this situation and behavior, but also help them understand the consequences of the behavior and why kids do this despite the fact that you have talked about this at home and you have given them information about, you know, if someone approaches you online, you should tell me and you should block them. They all know this, all kids know this. But then in that moment when you are 14, 15, you are, because of your puberty and adolescence, a little bit impulsive, risk taking, curious. You don’t think about that in that moment. And that is normal. That is not because your child has difficulties. Sometimes it’s part of that, but most of the time not. And just helping caregivers to slow down and to breathe and understand it sounds a little bit weird to say normalcy of the situation, but it is pretty common and normal situation. But then, of course, your child has had the unluck of ending up with someone that wasn’t safe. And someone that exploited them or used them or coerced them. And this is what we’re gonna look into now and we’re gonna help you understand what happened. So that support to the caregivers seems to be really, really, really important to then also get to have the way in to actually get to meet the child where they are.

Because of course if their caregiver reacts with these big feelings, then the difficulty for the child to also take their place and dare to say something decreases. So we need to balance that so that they feel like it’s okay to actually talk to.

TH: 

I think these big feelings are really fear-based, especially because, you know, parents, as you’re saying, are from a different generation. And so there’s a lot of fear associated with I don’t really understand some of these online environments. I’ve given general warnings about it. You didn’t listen. And now this has happened. And so, you know, it’s sort of like the fear parents feel, I think, when their child darts across the street or something after being told not to.

As you’re saying, it’s a very normal reaction, but it’s also a normal reaction outside of online environments, right? And it’s a natural thing for kids not to listen outside of online environments, right? So one of the things that I noted, and I thought this was a very interesting thread in the comments that people had about the caregivers, because one of them is that they didn’t describe the relationship between the caregiver and the child as poor.

But they did describe that the victims themselves seemed very lonely. And I’m curious what you make of this, that these weren’t somehow terrible, neglectful parents, but yet you had children in part seeking out these online friendships and relationships because they were lonely.

AB: 

Yeah, I think that’s one of the things that we see in general to like if we look at kids that have or say that they have been sexually abused online, and I mean that is such a wide term. It’s like from everything from getting a picture sent to you that you didn’t want to actually having been forced to do sexual things on camera to yourself.

Which is one of the problems with this research because it’s hard to say how many that actually has been through the different things because we use different terminology. But I think one of the things is that that we see is a lot of these kids have a difficulty exploring sexual relationships or crushes or having those normal sexual developmental interactions outside of online and why that is, one part I think is that we see an overrepresentation of developmental conditions in these kids. We see that the LGBTQAI+ community is a group that is overrepresented among these kids online. But then another thing that the professionals also talk about is that even if they don’t see poor relationships within families, they see that the caregivers and kids don’t communicate a lot around feelings and relationships in general. I mean it could be good relationships, but not on the emotional level, very close. So I think there’s a lot of different reasons that they see this and a lot of different things that they also recognize that we need to work more with to help caregivers communicate around this and have a language that and how you actually talk to kids. Even if we can see that a lot of online resources try to help caregivers. You have to talk to your kids about what they do online. Just as if you like you do when they have, you know, friends from school or in the neighborhood, right? But I think to your point about another different rent generation, that parents still struggle with this because they don’t really understand that these services are the same or the same to the kids at least.

TH: 

I’m curious, you know, again, as a clinician, as you’re doing TF-CBT or some other evidence-based treatment, caregiver engagement is a big part of that. And I’m wondering with these kinds of cases, in what ways is that different or enhanced? Because it just sounds like the caregivers are needing a lot of support.

AB: 

Yeah. So I mean, one thing I think many clinicians working with TFCBT or any other type of trauma interventions struggle with is to engage caregivers and to have the kids, especially teenagers, wanting to engage the caregivers because that’s the thing like that’s a big thing too, that they really don’t want the caregivers to be a big part of the interventions because they feel embarrassed and it’s not comfortable. So I think one of the things is that you really need to make sure that you engage a caregiver at least. And if it’s not the biological parent or it might be if they’re not available that you’re actually making big effort into finding someone that could be a stand-in for that parent. So it could be an aunt or it could be a grandparent or it could be someone adult close to the family that you still work on trying to get someone involved. And of course, most of all the caregivers. But if you can’t find someone that can be there and that will keep being close to the child after treatment, because one of the biggest advantages with the TF-CBT, for example, is that you work really hard on increasing and teaching caregivers and kids to have a better communication. You want the caregiver to take the role of the therapist when the treatment has ended. You want them to be able to feel empowered, to feel like a caregiver that knows what to do, that have the skills to actually have a good conversation with your teenager. So even if it feels like the or even if the teenager don’t want to have their caregiver in, if it’s not inappropriate in some way because the caregiver wouldn’t be able to give what we want them to give, try to make it work and try to find ways to work with both. That’s really, really, really important because that will absolutely increase the likelihood of a good outcome of the treatment.

TH: 

It’s interesting as you were talking. I was thinking, it’s not just in these cases. I mean, in daily life, it is hard to have challenging conversations. And sometimes, you know, we haven’t been taught how to have them. And feeling like you’re not sure how to start that, one of the things that was making me think about this is in our work, we’ve been we have a group for caregivers of elderly parents and all the kinds of difficult conversations that come up with their care.

And so we have a psychologist coming in to talk to folks about how to have those conversations. And it just made me think that I think this is a common thread for people in a caregiving relationship is there’s a lot of anxiety and fear around asking the questions that need to be asked about how to know how to even kick off the conversation that you need to have, how to make sure it stays healthy and, you know, that you’re dealing with the failings that rise up out of a challenging conversation. So I think just you know, kind of culturally and universally, we can all use some help in that. So it’s not surprising that these caregivers would need help from a therapist to help guide them in how to kick that off and begin developing their skills.

AB: 

No, absolutely. And I think that’s part of why both the professionals and the caregivers and the kids that we have talked to say that it is important to get to be able to do these interviews at the Barnahus or the Children’s Advocacy Centers because then you know that the caregivers get these conversations, they get the crisis support, they get to help to calm down a little bit and breathe.

They can get these, you know, initial skills and some caregivers needs a lot and others don’t. And some kids get traumatized and some kids don’t. So not all kids get the treatment. And that’s why, you know, being able to get to have these initial conversations with professionals is really important. And I mean the forensic interviewers, they all said that this is I’m not trained to do these caregiver support conversations. I try to and I do the best I can, but it’s so nice when I have the support from the professionals at the Children’s Advocacy Centers to help me do that. And I can focus on my interviewing and then they take care of the caregivers while and give them all the information and talk about, you know, give them the psychoeducation around crisis and talk about, you know, the consequences of online sexual abuse and what they need to worry about and look for. And they can do that while they do their thing. and that’s the perfect thing I think with the Child Advocacy Centers where you have all the professionals and the professionals that actually know each other and support each other and help to build the puzzle so that the family and the child get all the pieces that they need initially because if we can give them that initially, we also know that the likelihood of them ending up in within child psychiatry or having to go to treatment later is decreases a little bit. And not it won’t take away all of it and a lot of the kids still will need help, but it will help them a little bit. So yeah.

TH: 

It was interesting as you were talking. I was thinking that it’s not just in Sweden that multidisciplinary team professionals say, I’m so grateful that there are people who have the different expertise within the disciplines, right? That there are some people who have specialized skills in forensic interviewing. There’s others who are focused on the investigation itself. There are others who are focused on treatment or crisis support and those kinds of things. And I think it’s really the joy of this work is that no one professional has to try to carry it all, you know, for themselves, and that only benefits kids and families. Your study, and you’ve alluded to it here, talked about systems gaps. What do you see? What are you hoping that child abuse professionals take away from this in terms of addressing gaps in the system and improvements that could help kids and families?

AB: 

I’m hoping that online sexual abuse will get to be a part of the target group for all Children’s Advocacy Centers and Barnahus. That it shouldn’t be because like in Sweden, there’s even a specialist police department working with these cases and they are not used to working with Barnahus, which seems so strange. It’s changing and a lot of the even if the structure and the contract and all of that is not in place, they still many still actually do their interviews at Barnahus because they feel like if I have a Barnahus, I’d rather do that and then the Barnahus does pitch in and they do the things. But of course that doesn’t lead to the kid ending up in the system in the same way as it would if it actually was part of the target. So we’re really hoping that more Barnahus include online child sexual abuse into their target group. So, it’s so they actually all the families get to meet all professionals because for example, the medical staff almost never see these cases. And we know that some of the most severe online sexual abuse cases actually also can have physical damages. Even if they inflicted them on themselves under force. But they almost never get to do those kind of meet the physicians at Barnahus. So we hope that and we hope that we can, you know, raise awareness to politicians to also give Barnahus then more resources to actually incorporate this into, as well as for the forensic interviewers, because they need to be part of the Barnahus team and have the same skills in giving the psychoeducation, for example, because if you can give the psychoeducation, even as a forensic interviewer talking about just validate, normalize a little bit before, you also have a better connection when you already go into the interview. And that is some of the things that the professionals did say that it feels good that I know and I feels good that I have the support and the staff, the other professionals at the Barnahus, they help me and we can kind of meet the child together and they give that and I can continue repeating what they say and so it gives a way better connection and gives also a good example of how you can communicate to the family. And that it’s not dangerous to communicate around it.

TH: 

So what else should I have asked you and didn’t or anything else you wanted to make sure we talked about today?

AB: 

I think one of the most important things is that I think professionals today has realized this is as important to address as other types of abuse. It doesn’t give less consequences. It sometimes even gives more severe trauma symptoms depending on what type of online sexual abuse you have been through. And from what we have seen and heard from professionals is that for example, TF-CBT really works. Even if you have an ongoing trauma where pictures are still spreading online, you can still do a full TF-CBT and you can get a really good outcome. You just have to adapt and talk about the safety before and keep that going during the whole treatment. You need to help the child and the caregivers after you have gone through the treatment to find ways and skills to handle the not knowing if this material is spreading and who has seen it. So how do you come to terms with that is just a fact. Sometimes we can actually help kids and families to take down material if they have sent it themselves and they still have that information.

There are tools that some NGOs, for example, and the police can use to take down material, but sadly that’s not for everybody. But even if they can’t, how you still can live with it and how you can do things to manage to live with it. And it doesn’t have to be something that destroys your life or that is up here and very close to you all the time. You can have a really, really good life without trauma symptoms, even though you have gone through this. I think that’s one of the things that is the most important.

TH: 

Anette, for folks who want to hear more about that, and I think it’s so critically important what you’re saying, they’re welcome to join you on Seamless, our conference, and we are so grateful that you’ll be speaking there in more depth to clinicians about these adaptations that you’re talking about. So just really appreciate you coming on to One in Ten to talk about these things. I think that this is a topic that all of us deal with and all the parents, you know, have to be prepared to deal with. So really appreciate you. Thank you.

AB: 

Thank you so much for having me.

TH: 

Thanks for listening to One in Ten. We’re taking our summer break in August and we’ll be back with all new episodes in September. In the meantime, we invite you to enjoy past episodes you may have missed. And for more information about this or any of our other episodes, please visit our podcast website at oneintenpodcast.org.