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This chapter focuses on the state and public policy from the 1970s through the early 1990s, showing that state apparatus dealing with child sexual abuse was a location of both opportunity and constraint for activists. The chapter analyzes the conditions under which activists engaged with the state, including the growth of child protective services and professional treatment organizations. Tracing legislation and funding, the chapter shows how federal funding for addressing child sexual abuse sometimes supported grassroots and activist organizations, including activist abuse prevention groups, and was an important force in the movement's increasing entry into the mainstream. At the same time, selection processes favored medical and criminal approaches over those of the earlier activists, even while they often mandated community involvement in funded initiatives. The chapter shows the shifting priorities and funding levels over time and links them to larger political shifts and emerging coalitions among activists and professionals from different political perspectives. The chapter also discusses theories of the therapeutic state and argues that the case of child sexual abuse shows that activists resisted the therapeutic state even as they engaged with it.

This chapter returns to the question of activists' engagement with the state, examining the different forms that movement organizations' relationships with state authorities took during the 1990s and 2000s, when the therapeutic state around child sexual abuse was well‐developed, and shows the kinds of access and compromise these relationships brought. It discusses entry of activists into state agencies, movement organizations' professionalization, and increasing funding to provide services to the state, arguing that some groups became part of a para‐state. It traces organizations' use of crime victims compensation funds and activists' attempts to increase criminal and civil penalties for child sexual abuse Finally, the chapter analyzes newer organizations' involvement with public health initiatives to prevent child sexual abuse. Overall, the chapter argues that activists' involvement with the state was shaped by the priorities and pressures of the state, showing the continued power of medical and criminal approaches over others. Yet activists, particularly in the public health wing, continued to bring larger political goals into their work, illustrating the paradoxical nature of social movement outcomes.

This chapter introduces the third context which is key to this book’s analyses of present day welfare encounters, that is, the norms and values from the fields of psychology. This chapter addresses a range of both different and partly overlapping scholarly discussions regarding various ways of identifying the welfare state, such as therapeutic, psychological, maternal or pedagogised alongside discussions of the so-called personalisation and co-production approaches to welfare work. In doing so, the chapter especially draws on the work of Pykett. In emphasising the research on this context, the chapter shows how the roles of welfare workers such as facilitators, coaches and therapists are at play even in welfare areas, which are not traditionally associated with the so-called psy-disciplines (such as psychology, psychiatry, medicine, etc.). The chapter concludes by discussing the agency of welfare workers and citizens and how they each respond to this particular framing of the welfare work.

Therapeutic culture is based on the idea that significant psychological suffering both causes and results from harm to the self. As a result, such suffering is understood as a type of damage that has been inflicted on a person, while therapeutic interventions are considered a response to such harms. Suffering was not always seen this way: In the late eighteenth-century, pain and other types of trouble were understood as a normal part of everyday life. During the nineteenth-century, however, psychological distress and other painful emotions were reconceptualised as something exterior to the properly functioning self. This reconceptualization continues to animate our efforts to help those whom we believe are being harmed. Yet sadly, these efforts also frequently inflict additional types of harm. Perhaps by looking to the past, this essay suggests, we can realize that simply keeping company with those who suffer is all we can, and should, do.

This chapter questions whether the neurological and molecular levels are the most appropriate domains to guide the actions of the State. The reductionism of such thinking creates a form of scientific “tunnel vision” dangerously constraining the direction of future inquiry. The Chapter explores the consequences of the prevailing moral and scientific settlements, demonstrating how these have shifted preferred policy responses towards those that are individualised and increasingly medicalized. A preoccupation with prevention, early intervention and the privileging of certain forms of evidence (that furnished by clinical trials, biological evidence) are squeezing out conversations about different, and potentially more desirable and sustainable, actions to make people’s lives better.