Lisa Rocchio — Direct/Cross/Redirect

LISA ROCCHIO: Good morning.

LISA ROCCHIO: I'm a clinical and forensic psychologist.

LISA ROCCHIO: It's the study of human behavior and thought, both abnormal and normal.

LISA ROCCHIO: Forensic psychology is the application of the science of psychology to a particular legal matter or question.

LISA ROCCHIO: I have a bachelor's degree from Emory University, and I have a master's and a Ph.D. from the University of Rhode Island in clinical psychology.

LISA ROCCHIO: So a doctoral program in clinical psychology, the one I attended, is what's called a scientist practitioner model. So I'm trained in both research methods and the practice of psychology. So through the course of my graduate training, I took courses in assessment methods, ethics, cognition, perception, forensic psychology assessment and treatment. And I also took courses in the specific methods to practice psychotherapy, so individual psychotherapy, marital therapy, for example.

LISA ROCCHIO: I focused on the general practice of clinical psychology, but in particular traumatic stress, forensic psychology, and eating disorders.

LISA ROCCHIO: Traumatic stress refers to any event that overwhelms an individual's ability to cope. At the more severe end, as described in the DSM, which is a manual we use for diagnosis, it's defined as exposure to actual or threatened death, serious bodily injury, or sexual violence.

LISA ROCCHIO: I did.

LISA ROCCHIO: Violence is violence that occurs between one person and another. It doesn't -- it refers to things such as rape, sexual assault, battering, intimate partner violence, childhood sexual abuse, sexual harassment. It doesn't have to involve actual physical violence, but it's the umbrella term that's used to refer to assault and violence between two people or between individuals.

LISA ROCCHIO: Childhood sexual abuse is a term that refers to either attempted or actual engagement with a child, someone under the age of 18, in a sexual manner. So it can involve both physical contact, but it can also involve noncontact, such as exposure to sexual material, for example.

LISA ROCCHIO: Someone under the age of 18.

LISA ROCCHIO: I did.

LISA ROCCHIO: During my graduate studies, I complete -- worked approximately 4,000 hours of supervised clinical hours with hundreds upon hundreds of patients.

LISA ROCCHIO: I did.

LISA ROCCHIO: At the Yale University School of Medicine.

LISA ROCCHIO: So I worked for six months at Yale New Haven Hospital in a partial hospital program with adults. Partial hospital is a program where individuals come in for a higher level of psychiatric care; and they stay during the day, but they go home at night. And I worked there for six months. And then I worked for six months at Yale Psychiatric Institute in both an inpatient program and a partial program with adolescents.

LISA ROCCHIO: I did a postdoctoral fellowship where I worked again under clinical supervision in a private practice setting. I also worked in a partial hospital program and taught classes at the college level.

LISA ROCCHIO: Primarily I was working with individuals who -- women in particular who were chronically suicidal and self-injurious, had multiple problems in life, and the vast majority of whom had quite severe histories of childhood abuse, trauma, and neglect.

LISA ROCCHIO: Yes, it did.

LISA ROCCHIO: I founded an independent practice.

LISA ROCCHIO: So it's an independent group practice that focuses on providing assessment and psychotherapy services to adults, individuals, and children, where I employ other therapists who work for me, and I also maintain an independent forensic psychology practice.

LISA ROCCHIO: I'm the owner and the founder, as well as the clinical director.

LISA ROCCHIO: I'm responsible for hiring all of the clinicians in the practice, for hiring and supervising the administrative and clinical staff, for providing clinical oversight, as well as consultation around clients. I see a full caseload of clients where I provide psychotherapy. And then I also conduct forensic work.

LISA ROCCHIO: I believe it was around January of 1998.

LISA ROCCHIO: So I provide treatment to patients, the vast majority of whom have experienced some form of traumatic stress. A large number have experienced sexual abuse during childhood. I also work with a number of individuals who have been in abusive relationships in adulthood or who've experienced rape and sexual assaults either in childhood or adulthood. And I work with other types of traumatic stress as well; traumatic grief, for example, parents who've lost a child, or people who've been involved in motor vehicle accidents. I've done work with first responders. So primarily traumatic stress, but also individuals coping with problems in living, someone's going through a divorce, someone is going through a life transition, anxiety, depression, that sort of thing.

LISA ROCCHIO: I do.

LISA ROCCHIO: So I work in both civil cases and criminal cases. And I provide expert witness testimony around issues in my area of expertise, as I'm doing today. Sometimes I also conduct psychological evaluations to answer a particular question that's relevant to the legal issue at hand.

LISA ROCCHIO: Sure.

LISA ROCCHIO: So an attorney will hire me and they will ask me -- they'll explain the issue that they need help with. It may be could I come in and talk about a subject that is within my area of expertise. It might be, for example, if somebody has claimed that they've been harmed, say, through childhood sexual abuse, they'll ask me to do an evaluation to determine whether or not the individual has any problems or mental health issues; and if they do, whether those problems and mental health issues are attributable either in whole or part to the abuse that they've alleged. In a criminal case I might be asked to determine what, if any, role an individual's mental health may have had or their traumatic experiences may have had on the crime that they are accused of. Or in sentencing issues I might be asked to do a psychological evaluation and provide information that might be relevant for purposes of sentencing.

LISA ROCCHIO: I would say maybe around 100.

LISA ROCCHIO: The vast majority of the time I'm hired by an attorney. At other times I might be hired by the state. For example, at one point in my career the state of Rhode Island hired me to perform forensic evaluations on children and adolescents who had become involved with the juvenile justice department. But at this point the vast majority of individuals who hire me are attorneys.

LISA ROCCHIO: Sure. So when I'm working in a criminal arena, I might be hired by the prosecution or I might be hired by the defense. And if I'm working in a civil case, again, I might be hired by the person who's working on behalf of the plaintiff or the person who's working on behalf of the defense. As a forensic psychologist, I'm coming in and providing an independent evaluation. So I'll work for all sides of -- all parties of a case.

LISA ROCCHIO: I hold a psychology license in the states of Rhode Island, Massachusetts, and New York.

LISA ROCCHIO: About 30 years now.

LISA ROCCHIO: I specialize primarily in the areas of traumatic stress and interpersonal violence.

LISA ROCCHIO: The same, about 30 years.

LISA ROCCHIO: Yes.

LISA ROCCHIO: Hundreds upon hundreds.

LISA ROCCHIO: For the duration of my career; so since starting doing clinical work and graduate work, again, about 30 years ago.

LISA ROCCHIO: So I worked beginning in my graduate training with teenagers, adolescents ages 12 and up, as well as adults. And then in my private practice setting, I also worked with teenagers and their families. I conducted forensic work with teenagers and their families, as well as with adults and couples. And at this point in my career, I'm working almost exclusively with individuals who are over the age of 18 in both my forensic and clinical practices.

LISA ROCCHIO: I do.

LISA ROCCHIO: I'm on the faculty, the clinical faculty at Brown University School of Medicine.

LISA ROCCHIO: Within the department of psychiatry.

LISA ROCCHIO: Clinical assistant professor.

LISA ROCCHIO: Since June of 2020.

LISA ROCCHIO: I supervise psychiatrists in training, so psychiatric fellows who are learning how to do adult psychotherapy. I also conduct seminars around issues pertaining to trauma and traumatic stress.

LISA ROCCHIO: I have.

LISA ROCCHIO: I do. I'm on the editorial advisory board for the primary journal for the division of trauma psychology within the American Psychological Association. And I also serve as a peer reviewer for a number of other journals when topics come up that pertain to my areas of expertise.

LISA ROCCHIO: So when someone wants to have an article published, they will submit the article to the journal. And then the editors will send that article out to experts in the field to review the article and provide feedback as to whether the article should be accepted, whether significant or minor revisions are in order, or whether the article should be rejected for publication.

LISA ROCCHIO: Yes, many.

LISA ROCCHIO: So there are really two ways that I've given presentations. One is through professional conferences, where you go through a very similar peer review process for professional organizations that are in the field of psychology or national and international traumatic stress organizations. And then I've also given a number of invited addresses where I've been asked to come and provide a lecture or a talk on a topic within my area of expertise.

LISA ROCCHIO: I do.

LISA ROCCHIO: Yes, I do.

LISA ROCCHIO: Sure. I'm currently the president-elect for the division of trauma psychology within the American Psychological Association. I serve on the ethics committee for the American Psychological Association. Within my state psychological association, I've served in various capacities. I've been president; and I'm currently serving there as their representative, their council representative to the national organization of the American Psychological Association.

LISA ROCCHIO: Yes.

LISA ROCCHIO: I'm a fellow of the American Psychological Association within two divisions, the division of trauma psychology and the division of independent practice. And to be awarded fellow status means that I have been recognized as having made unique and significant, unusual contributions to the field of psychology.

LISA ROCCHIO: Through a variety of ways. Through regular peer consultation, talking with other colleagues who are experts in the field, reading the literature. Certainly I learn a tremendous amount from the clients with whom I work, attending continuing education programming, and getting consultation from peers on an as-needed basis.

LISA ROCCHIO: So as part of my licensure requirements and then also because it's a way to keep up to date, I regularly attend continuing education seminars, yes.

LISA ROCCHIO: No, I have not.

LISA ROCCHIO: I do not.

LISA ROCCHIO: No.

LISA ROCCHIO: I'm aware of it, yes.

LISA ROCCHIO: I do not.

LISA ROCCHIO: No, it will not.

LISA ROCCHIO: I'm being compensated for the time spent preparing to testify and the time spent testifying.

LISA ROCCHIO: I'm being paid hourly for my time.

LISA ROCCHIO: No, it depends solely on the time spent.

LISA ROCCHIO: When children are sexually abused, most often it's not done through the use of physical force, but rather through grooming and coercion in the context of a relationship with the child.

LISA ROCCHIO: Usually by people known to the child.

LISA ROCCHIO: I am.

LISA ROCCHIO: Grooming is -- refers to a series of deceptive tactics, strategies, modus operandi that are used by perpetrators for the purpose of engaging a child in sexual abuse.

LISA ROCCHIO: So childhood sexual abuse is a process. And so the -- it doesn't refer to a single event. So understanding in reference to these processes that offenders use to -- in order to facilitate their sexual abuse has been part of the childhood sexual abuse literature since we've been talking about sexual abuse, so the early 1900s -- 1970s, I mean, sorry. Grooming itself, probably since about the 1980s.

LISA ROCCHIO: Okay. Sorry.

LISA ROCCHIO: No, there's not. There's generally consensus around what the process entails and the types -- and the stages that it generally involves, but not one specific agreed-upon definition.

LISA ROCCHIO: So it's usually thought to include behaviors that fall into five general stages: The first having to do with selection and identification of a victim; then obtaining access and -- to the victim and isolating that victim for the purpose of sexual abuse; then engaging in lies and deception and manipulation in order to build a relationship of trust and attachment with the child; then a process of desensitizing the child to both physical touch, sexual content, and sexual touch; and then finally, a process of maintaining control in order to coerce the child into continued sexual abuse and to reduce the likelihood of disclosure.

LISA ROCCHIO: So we know from the literature -- literature both with victims and with offenders -- that offenders typically seek to target someone who they believe they're likely to be able to successfully abuse. They target vulnerable children, vulnerable populations. We also know this because there are certain vulnerable populations that are at much higher risk for being sexually abused.

LISA ROCCHIO: So the second stage involves perpetrators putting themselves in situations where they are likely to have access to children, but also where they're being around children is not likely to be questioned. We often find perpetrators of childhood sexual abuse in positions where there's lots of kids around. It may be as a coach or a teacher, working at a gym, certainly boy scout leader, they put themselves in situations where their involvement and relationship and access to children are not going to be questioned. And then they will begin to isolate that child, the one that they've selected for victimization, in order to have time alone with the child.

LISA ROCCHIO: Okay. So once the perpetrator has access to the child, the next thing that they typically do is engage in a series of deceptive and coercive manipulative behaviors in order to build a relationship of trust, attachment, and dependency. So they will exploit whatever vulnerabilities they've identified in the child, and then put themselves in a position to meet those unmet needs. And that can involve anything from spending time with the child; giving the child special attention; letting the child know that they're unique or special in some way; creating a false sense of family, you know, I'm somebody you can trust, I'm somebody you can rely on; gift giving, sometimes using money or exposing them to things that they wouldn't otherwise have access to. And that generally both increases the likelihood that the child is going to become attached and connected with the perpetrator, but also it increases the perpetrator's power and control over the victim.

LISA ROCCHIO: Gift-giving can certainly be a very powerful inducement and lure in the context of a relationship. Again, especially to the extent that you're working with -- that a perpetrator is attempting to manipulate someone who perhaps has limited access to resources and you start giving them things that -- you know, that they need or that they like. I've, for example, seen examples where a boy scout leader might, you know, give camping equipment or someone else might buy a really special car, if they know that the child is really into cars, or fancy dresses or clothing or jewelry. Anything that might persuade the child, again, that they are special, that they are liked, that they are wanted, that they are important to the perpetrator.

LISA ROCCHIO: I think it can really depend. It can depend on what the gift is, what the meaning of the gift is to the individual. So certainly it wouldn't be unusual, particularly, again, if we're talking about somebody who wouldn't otherwise have access to that item, whatever it may be. They may hold on to it because it's a valuable item, it's something they like, it's something they enjoy. But also victims of childhood sexual abuse are often very, very confused. They're being harmed in the relationship by the sexual abuse, but they also have developed this trust and attachment. So sometimes the gifts can symbolize the positive parts of the relationship and serve to remind the child that it wasn't all bad.

LISA ROCCHIO: So once this relationship of trust and attachment has been established, then the next stage involves a process of desensitization, which means slowly and gradually moving the line, and the perpetrator begins to define what is and is not normal. So with physical contact, for example, they may initially start by normalizing touch. Maybe, you know, touching on the arm, touching on the shoulder, giving hugs. That may escalate to, you know, sitting very close, touching a leg, giving a massage; normalizing the idea that in a relationship, you know, physical contact is happening. And at the same time, they're normalizing sexual material. So they may begin slowly by talking about sex, introducing the topic, telling sexual jokes. That may escalate to maybe showing risque movies, which might escalate to pornography. And then all of that will then escalate over time to combining the sexual activity to sexual touch in the form of sexual abuse.

LISA ROCCHIO: So the fifth stage really is about maintaining the relationship. At this point now there's a dynamic of what's referred to in the literature as entrapment and a dynamic of coercive control whereby the perpetrator wants to maintain the relationship, maintain the power they have over the victim of childhood sexual abuse so that the abuse can continue, but also to the extent that the child remains isolated and under the control of the perpetrator, the victim is far less likely to disclose.

LISA ROCCHIO: Unfortunately, it's very common. Again, because it's occurring in a relationship, oftentimes the perpetrator has continued access and the abuse continues.

LISA ROCCHIO: It can really depend. I mean, we call them stages, but sometimes they occur simultaneously, sometimes they occur, you know, more gradually. So we can be talking about a process of weeks, we can be talking about something that's happening over the course of months or abuse that can continue over the course of many years.

LISA ROCCHIO: I am.

LISA ROCCHIO: Grooming the environment refers to -- it's most relevant to the stages two and three in terms of gaining access and then building trust. It means that the perpetrator is known to often not only develop a relationship of trust with the intended victim, but also with individuals in the victim's lives. So they may, for example, hold themselves out to parents, say, as somebody who's going to be there as a support to the parent, to fill some need that maybe the parent would like to provide for the child, but for some reason is unable to. But, again, it's a series of lies and deceptive manipulations that the perpetrator engages in so that when they spend a lot of time alone with a child, it doesn't raise any sort of suspicion and it increases access. It also increases the child's trust in the perpetrator because now you have other adults perhaps that the child trusts who are kind of conveying that this is -- this is a trustworthy and an okay person to be spending time with.

LISA ROCCHIO: Yes. Perpetrators are really quite skillful. And when they are interviewed, they'll tell you that they can really -- they work hard to pinpoint exactly what it is they need to do in order to win over the trust of a particular individual. So if you're talking about a younger child, maybe it will be camping gear, maybe it will be taking them out for ice cream. If you're talking about an adolescent, it might be fancy clothes, it might be drugs and alcohol. It can really vary.

LISA ROCCHIO: So gift-giving in and of itself is not grooming. What we're talking about is it's part of an entire process. So you have to look at the context in which the gift is giving -- is given, I'm sorry. Obviously we know anyone can give a gift to someone else for perfectly reasonable reasons. But if the gift is being given along with all of these other behaviors where, you know, there's inordinate access, there's deceptive techniques being used to build a relationship of trust, there's isolation of the child, and then desensitization to touch and sexual -- sexual abuse, then the gift-giving is occurring within the context of the grooming process for the purposes of sexual abuse.

LISA ROCCHIO: No. In the social sciences in psychology, we're actually not very good at predicting behavior ahead of time. So, no, we haven't really been able yet to identify grooming as a predictor.

LISA ROCCHIO: Sure. Yeah. On the individual level, for example, when I'm providing treatment and I'm talking with someone who's been abused, we'll be talking about how that abuse came to be. And often they'll be talking about the development of the relationship and how they felt about this person and how it unfolded over time. And then we've also done scientific research that's been done to also identify retrospectively the grooming process.

LISA ROCCHIO: Sure. So there's a lot of research that's been done, for example, with victims, talking with them about what their experiences have been in terms of the childhood sexual abuse that they've experienced. And that's with both people who are talking about the abuse as children or people who are talking about it when they are adults. So there's what -- that would be called kind of the victim literature. But then there are also a number of professionals who do research and work with the offenders. And they do research talking with offenders about what sorts of behaviors they engage in in order to lure and recruit and entrap children in these sexually abusive circumstances. And then finally, you have interviews and research that's done with professionals in the field who work with both victims and perpetrators. So to the extent that you look at the research and you see that what victims tell us has been done to them, and you look at the research at what offenders say that they do, and professionals who say that they see, to the extent that all of those things are very, very similar, that gives us some scientific support for the idea that this is, in fact, a common occurrence.

LISA ROCCHIO: Very high level of consistency with what victims report has been done to them and what offenders say that they do.

LISA ROCCHIO: Hundreds upon hundreds.

LISA ROCCHIO: It's very important.

LISA ROCCHIO: So in the course of treatment for one who's been abused as a child, often the fact that the abuse occurred in the context of a relationship with someone they had come to trust and depend upon is a significant part of what they're struggling with in therapy. They are trying to understand how they could have been fooled. They are trying to look back at the relationship and figure out what parts were real, what parts weren't. Often the fact that there were --

LISA ROCCHIO: No. We know that --

LISA ROCCHIO: The research in particular has looked at what types of vulnerability factors place children at higher risk. And they generally fall into factors pertaining to either the child's characteristics, personal characteristics, issues pertaining to the parents and the parental characteristics, and issues pertaining to the family.

LISA ROCCHIO: So we know that children who have experienced victimization of any kind, whether it's prior child sexual abuse or physical and emotional abuse or neglect are at much higher risk, for example, of being revictimized later. We know that children who have certain kinds of psychological or chronic health difficulties can be certainly at much higher risk for child sexual abuse. We know that children who come from disadvantaged circumstances can be at higher risk, children with cognitive and intellectual disabilities, for example; children who come from -- who are members of minority gender or sexual groups are also at higher risk.

LISA ROCCHIO: To the extent that there's conflict and particularly, to the extent that there's violence between the parents in the home, certainly to the extent that there are financial difficulties within the home, so children, families, parents who have less -- fewer resources, are at higher risk. To the extent that the parents themselves have experienced any form of abuse in their own backgrounds, that also places the child at higher risk. To the extent that the parents are abusive to the child, that puts the child at risk for being abused by others. And there's also research to show that the presence of a stepfather in the home or oftentimes a single parent can, under certain circumstances, put a child at higher risk.

LISA ROCCHIO: Those factors refer to the family functioning in general. So children who have poor attachment, poor connection with other family members are at higher risk. Families where there are other children in the home who are being abused or have been abused are at higher risk. Families who are isolated, for example, those families that have moved six or more times in the course of a child's lifetime, that single factor can place a child at higher risk. So these are vulnerabilities that have been found to be specific to child sexual abuse risk.

LISA ROCCHIO: I am.

LISA ROCCHIO: Attachment really refers to the relationship and connection between two people. The research was initially done looking at the caregiver attachment, so typically the relationship that it develops between a mother and an infant. But it's since expanded to look at relationships between other caregivers and children, as well as adults.

LISA ROCCHIO: So in the context of building a relationship of trust and using coercion and deception and lies in order to manipulate the child, one of the things that offenders are doing is trying to create increased dependency, trust, and attachment. They hold themselves out as somebody who is special to the child, and the child feels often very special, and that there's something unique and important and valuable about their relationship with the perpetrator.

LISA ROCCHIO: I am.

LISA ROCCHIO: Coercive control refers to a strategic pattern of domination for purposes of controlling another individual and getting that individual to either do or not do things that you want them to do or not do.

LISA ROCCHIO: So the whole pattern of the grooming process is designed to create an environment of coercive control, whereby the negative aspects of the relationship, the abuse itself or intimidation or threats, are interspersed with these positive or neutral events which causes the attachment to keep going. It kind of keeps the hope alive that there are positive aspects to the relationship. It causes confusion and difficulty identifying the abuse as wrong on the part of the victim. And it keeps the victim in a state of what's referred to as entrapment and under the power and control of the perpetrator.

LISA ROCCHIO: So what we know, from both my training, research, and the scientific literature, as well as my experience, is that the grooming and attachment and the degree to which the child is close to the perpetrator is very closely tied to adverse outcomes and really can interfere with their ability to identify that what's happening -- even realizing that what's happening to them is abusive or is wrong.

LISA ROCCHIO: Yes.

LISA ROCCHIO: One of the things that we know when we look at when do victims of childhood sexual abuse tell and who do they tell is we know that they are less likely to tell and more likely to have a delay in telling the closer the relationship to the perpetrator.

LISA ROCCHIO: I am.

LISA ROCCHIO: Delayed disclosure really just refers to when does someone tell. So in the case of delayed disclosure in terms of child sexual abuse, we would call disclosure telling delayed when it happens at some point after the abuse has occurred.

LISA ROCCHIO: Yes.

LISA ROCCHIO: We know that younger -- the younger someone is, the more likely they are to delay disclosure; in other words, the less likely they are to tell someone right away about what's happening to them.

LISA ROCCHIO: So when we're talking about children, they are much less likely to disclose. And most children, in fact, we know don't tell anyone about the abuse that they've experienced until adulthood.

LISA ROCCHIO: Not at all, no.

LISA ROCCHIO: There are a number of factors. Delayed disclosure is such a common -- commonly recognized phenomenon within the literature that now we are doing research to try to identify what are the barriers to disclosure because, of course, we would like children to be able to tell their experiences sooner so that they can get access to help and so that the abuse can be stopped. So there have been identified both internal barriers and external barriers to disclosure.

LISA ROCCHIO: So the external barriers are things that are outside the child. So, for example, fear of getting into trouble for an adolescent; in particular, fear that if they tell someone, their freedom is going to be constricted; fear that others are going to judge or blame them; fear often that the perpetrator is going to get into trouble. Again, remembering that they have a close relationship with this person often, and even though the person has been sexually abusing them, there's this sense of loyalty. So those would be examples of the external factors in contrast to the internal factors.

LISA ROCCHIO: So the internal factors have much more to do with the feelings of shame, feelings of guilt, the feelings of self-blame, the feelings of confusion, perhaps not acknowledging to oneself that what's happening is abusive. So those are the kind of emotions that go along with the impact of being sexually abused during childhood.

LISA ROCCHIO: It is.

LISA ROCCHIO: So sexual abuse, in particular, of all kinds is thought to be one of the most underreported crimes. But we certainly know that when we talk -- there are a lot of studies that are done, national studies, interviewing, say, adults, asking about a whole range of experiences that they've had during the course of their lifetime. And that research has repeatedly demonstrated that when people -- when you ask people if they acknowledge that they've been abused, particularly sexually abused, during childhood, and then you ask them if they ever told anyone, a significant number will say no, not until this interview. And then others will say yes, and then they are asked when they've told. And we know from the research that often they don't tell until adulthood.

LISA ROCCHIO: Yes.

LISA ROCCHIO: I'm sorry, can you repeat the question.

LISA ROCCHIO: It's very common in both my clinical and forensic work for individuals to tell me that either they had a significant delay in disclosure, and at times in my clinical work sometimes I am the very first person they've ever spoken about the abuse with.

LISA ROCCHIO: Very common.

LISA ROCCHIO: If and when they choose to disclose, most often they're going to tell a trusted friend. If we're talking about adolescents, they're going to talk to a peer. If we are talking about adults, a trusted friend. Sometimes, as I alluded to when I said that I'm the first person they tell, sometimes it may be in the context of a therapy setting.

LISA ROCCHIO: No. Unfortunately, we know that rape, sexual assault, childhood sexual abuse, again, they are the most underreported crimes. And law enforcement agencies are actually the least likely group to which an initial report or disclosure is made.

LISA ROCCHIO: It's important when --

LISA ROCCHIO: Disclosure is a process that unfolds over time. So individuals will typically begin the disclosure maybe by alluding to what's happened in a general sense or the gist of what's happened. And then it's only over time that they will begin to talk more specifically about what has happened. And even in therapy, oftentimes disclosure of the most intimate or difficult details is something that's very hard and individuals are very reluctant to do.

LISA ROCCHIO: It has to do with the degree to which they feel safe, the degree to which they feel that they are going to be believed. Again, as it's a process that unfolds over time, they may begin to talk about it. And then to the extent that they are getting messages that they are being judged or that they are being blamed or shamed, they may shut down. To the extent that they feel supported and believed, then they may be more likely to continue with that disclosure, again, over time.

LISA ROCCHIO: We know that although all adverse events that occur during childhood can place children at higher risk for adverse outcomes, we know that among those, child sexual abuse in particular increases risk for a very, very high number of various health problems and mental health problems and also increases risk for the severity of those problems.

LISA ROCCHIO: So the closer the relationship between the child and the perpetrator, and the longer the abuse has gone on, the more likely --

LISA ROCCHIO: Trust is central often in the treatment of someone who's been sexually abused, because it's often the part that is most confusing and also causes the most -- the most harm. We know that the more they trusted the individual, then, of course, the more they feel betrayed, the more betrayal there's been. And to the extent that there's betrayal in the relationship, then the individuals are really struggling to a much, much greater degree, often trying to understand what happened, how it happened and why, and what its effect is certainly.

LISA ROCCHIO: Good morning.

LISA ROCCHIO: I do.

LISA ROCCHIO: No.

LISA ROCCHIO: Correct.

LISA ROCCHIO: A statistical analysis, yes.

LISA ROCCHIO: Yes, experts in the field.

LISA ROCCHIO: About certain aspects of the topic, yes.

LISA ROCCHIO: I -- I couldn't answer that. I'm not sure.

LISA ROCCHIO: Which aspect of my opinion are you suggesting? Could you be more specific?

LISA ROCCHIO: I think that there are -- we're actually largely consistent in terms of the literature, both publications by Bennett and O'Donohue and by Dietz.

LISA ROCCHIO: Correct.

LISA ROCCHIO: It typically means I haven't evaluated any of the parties in the case, and I'm testifying about specific subject matter expertise.

LISA ROCCHIO: No, I do not.

LISA ROCCHIO: Correct.

LISA ROCCHIO: Correct.

LISA ROCCHIO: Correct.

LISA ROCCHIO: I don't believe it's that many, but a number of times, yes.

LISA ROCCHIO: They haven't provided me with any details about the case at all.

LISA ROCCHIO: Up to $45,000, yes.

LISA ROCCHIO: Correct.

LISA ROCCHIO: Correct.

LISA ROCCHIO: Correct.

LISA ROCCHIO: Sure.

LISA ROCCHIO: Yes.

LISA ROCCHIO: Correct.

LISA ROCCHIO: I believe I spoke about disclosure.

LISA ROCCHIO: Correct.

LISA ROCCHIO: It can.

LISA ROCCHIO: Is that a question?

LISA ROCCHIO: Could you clarify? I'm not really sure what you're asking.

LISA ROCCHIO: I guess it would depend on the context. That question is so broad, I'm not really sure how to answer it.

LISA ROCCHIO: I am.

LISA ROCCHIO: Yes.

LISA ROCCHIO: I am.

LISA ROCCHIO: I am.

LISA ROCCHIO: Disclose in disclosure when there is a close attachment between the perpetrator and the victim of child sexual abuse, yes.

LISA ROCCHIO: No, I'm talking about the literature that's been done on child sexual abuse, so a significant amount of that literature is conducted by --

LISA ROCCHIO: A significant amount of that literature has been conducted on known and corroborated or admitted --

LISA ROCCHIO: Yeah, that's a summary of what I said. Sure, yes.

LISA ROCCHIO: Some of them can, yes.

LISA ROCCHIO: It would be important though to -- grooming is not a specific behavior. It's a series and a pattern of behavior that's taking into account the entire pattern. So it wouldn't be just a specific individual behavior.

LISA ROCCHIO: Given that in your hypothetical I'm assuming he wasn't taking you there for the purposes of sexual abuse, it would not be.

LISA ROCCHIO: So, the intent around sexual exploitation and abuse is built into the definition of grooming when it's being used in the discussions of child sexual abuse, yes.

LISA ROCCHIO: True.

LISA ROCCHIO: Yeah.

LISA ROCCHIO: Yes.

LISA ROCCHIO: Yes.

LISA ROCCHIO: Again, in the context of a healthy normal relationship, no, that would not be considered grooming.

LISA ROCCHIO: In the context of a healthy normal relationship, no.

LISA ROCCHIO: I do.

LISA ROCCHIO: An alleged or found perpetrator manipulating often the individuals in the child's environment.

LISA ROCCHIO: Yes.

LISA ROCCHIO: Okay.

LISA ROCCHIO: Yes. Perpetrators are quite good at hiding their manipulative behaviors.

LISA ROCCHIO: They can, yes.

LISA ROCCHIO: Perpetrators, you mean?

LISA ROCCHIO: Yes, they can.

LISA ROCCHIO: I do.

LISA ROCCHIO: That's one of the places that the stages of the grooming process is referred to, but it's referred to in multiple other literature.

LISA ROCCHIO: Okay.

LISA ROCCHIO: Yes.

LISA ROCCHIO: I am.

LISA ROCCHIO: Correct.

LISA ROCCHIO: I don't recall where the authors reside, no.

LISA ROCCHIO: I do.

LISA ROCCHIO: Yes.

LISA ROCCHIO: I don't recall the exact number of vignettes as I sit here today, but I do recall that they were using vignettes in that study, yes.

LISA ROCCHIO: Not specifically as we speak here, but I'm happy to review it if you'd like.

LISA ROCCHIO: Sorry.

LISA ROCCHIO: Yes, I do.

LISA ROCCHIO: It's one of them, yes.

LISA ROCCHIO: Yes.

LISA ROCCHIO: So, if your question is: Was one of the vignettes used a non-grooming condition, yes.

LISA ROCCHIO: Yes.

LISA ROCCHIO: So this was one of the predictive studies, yes.

LISA ROCCHIO: Correct.

LISA ROCCHIO: Correct.

LISA ROCCHIO: Correct.

LISA ROCCHIO: The certainty of the behavior?

LISA ROCCHIO: We're not able to reliably predict grooming behavior ahead of time, that is correct.

LISA ROCCHIO: Yes.

LISA ROCCHIO: For a number of reasons, yes.

LISA ROCCHIO: No --

LISA ROCCHIO: Thank you.

LISA ROCCHIO: My name is Juan Patricio Alessi. J-U-A-N. Patricio, P-A-T-R-I-C-I-O. Alessi, A-L-E-S-S-I.