Therapy

Therapy

 

Some years ago, Martin Seligman, past President of the American Psychological Association, wrote an interesting book with an equally interesting title: "What You Can Change and What You Can't." Any therapy worthy of the name needs to know the difference.

 

K7 "Although there is no 'cure' for the deviancy of sex offenders, there are effective treatment methods that can enable sex offenders to control their deviant cycles and assimilate into their communities. [from FN57:] The concern is the harmful acting on certain urges, not the urges alone."

[In a free society, there can be no such thing as 'thought-crimes.']

A5 [Fred Berlin, M.D., Johns Hopkins professor of psychiatry and 'leading authority on pedophilia,' stated:] "'[A]lthough we can successfully treat it, we cannot cure it...'"

W4 [9] "Langevin and Lang (1985) maintain that 'sexual preference is a powerful and persistent feature of human behavior and there is no evidence that therapy in any form can change it.' (pg. 409). Therefore the goal of therapy must be to help the pedophile manage his urges for sexual contact with children."

[No good can ever come of trying to change someone's sexual orientation; it can only do harm -- and not just to the 'patient.']

[2] "There are many permutations of the interaction of truth or falsity [of any given accusation(s)], denial and admissions, and substantiated or unsubstantiated allegations in people entering sex offender treatment programs. The most difficult is the situation of a person accused who in reality did not do it, denied it, but the accusation is substantiated or the court rules that the abuse had occurred."

[It is also possible that the accused is a minor-attracted person, but nevertheless did not do what he was charged with or convicted of.]

[11] "Treatment for persons accused of child sexual abuse must also consider the situation of an innocent person who is accused. Although denial, minimization, and rationalization are found in actual sexual offenders, there is always the possibility that a person maintaining denial is innocent...[E]ven people who continue to deny abuse after being criminally convicted may, in fact, be innocent. There is no way to know how often this happens, but it does happen, and clinicians providing treatment should not automatically assume that all persons who deny abuse are unmotivated and defensive abusers."

W27 [Patty Wetterling's son, Jacob, was kidnapped back in the 1980s. It would not be until Labor Day weekend of 2016 that his fate would finally become known. Sadly, his remains were discovered in a field not far from his home, after law enforcement officials were led to the scene by the person who murdered him, a man who had been interviewed as a potential suspect shortly after Jacob's disappearance. The following is part of an interview with her (Wetterling speaking):]

[108] "People are [109] also of the mind-set that treatment doesn't work, and that's not right."

E10 [437] "Sex offense-specific treatment of offenders differs from traditional therapy in a number of important aspects...[T]he therapist's primary commitment is to the community at large; safety is paramount."

[This constitutes a conflict of interest, vis-a-vis the patient's own interests.]

T4 [19] [Host (radio show), Ira Glass:] "Right now, if a pedophile shows up in a therapist's office wanting treatment, it puts a therapist in a difficult situation. First, there are no guidelines on how to treat pedophiles who haven't offended. There's a lot of confusion in the field about how to handle them. Also, they're in a tough legal position.

"If a therapist thinks someone poses a threat to a child, they're legally obliged to turn them in, because of mandatory reporting laws. They can lose their license if they don't. So when it comes to counselling a pedophile, therapists have to gauge how likely that person is to act. They're in a sticky situation where they have to make a judgment call about how dangerous someone is."

[20] "Professor Elizabeth Letourneau is one of the top researchers on child sexual abuse in the world. She's done this work for 25 years. She says the great thing about mandatory reporting laws are that they've brought to light lots of crimes against children. But as they got more popular, she saw it affect the number of people reaching out for help.

[Letourneau:] "Self-referrals for help really dried up. And people watched helplines just go silent, because folks were too afraid to reach out for help. The stakes are too high."

[Nowadays, when a minor-attracted person first meets with a given therapist, the latter will often stop/warn him against admitting to any actual sexual activities, which they would then be obliged to report to law enforcement. But as the foregoing indicates, therapists are also obliged to report patients they believe are going to act in such a way. When these reporting requirements were first instituted in the mid-1980s, the number of pedophiles voluntarily seeking treatment plummeted. Therefore, this reporting requirement, in addition to being contrary to the values of a free society, is totally useless in terms of its original intent.]

W4 [4] "These circumstances [ compulsory sex offender therapy] also provide a subtle opportunity for any hostility or pathology in a therapist to affect the therapist's behavior and the process of therapy. The research in sensitivity groups (Lieberman, Yalom, & Miles, 1973) demonstrates the damage a hostile therapist can to do to vulnerable group members. A hostile therapist can cause serious emotional harm to patients. The seductiveness of the powerful level of control available to a therapist can cause the therapist to be destructive and damaging."

[1] "Treating people with disordered behavior patterns as morally defective and requiring a change in moral commitment has a long history...However, moral treatments, such as those currently vended for perpetrators of child sexual abuse, should be labeled for what they are. It is professionally irresponsible to call a procedure therapy, implying it is value-free, when, in fact, it is based upon moral values and pursues goals defined moralistically.

"Psychotherapy is often ordered for child sexual abuse perpetrators...[T]he most common approach has been group therapy that relies heavily upon punitive and hostile confrontation and a nonsystematic blend of psychoanalytic concepts and traditional talking therapy. There is often little or no effort to provide a theoretical base for the program. The result is a procedure that is essentially highly moralistic and reflects the judgmental emotional response of the society rather than an empirically-based healing technique.

"Unfortunately, many current treatment programs for sexual abusers fail [2] to use techniques known through research to be effective."

[7] "[It is often said that the] therapist must be authoritarian and allied with the justice system. Sgroi is often cited to support the demand for therapy to be highly authoritarian. Sgroi (1982) believes that effective treatment can only be accomplished in an authoritative fashion and from a position of power. She believes that anything else invites the abuser to misuse power to suppress the allegation and undermine the child's credibility. The necessary submission to authority in treatment is demonstrated by compliance with the demands of the program for completion of all assignments, attendance, and sobriety. This usually includes meeting stages of performance that show progress through the treatment.

"There is no evidence for the effectiveness of this type of treatment to cure sexual abuse and prevent recidivism. There is no support for the assertion that such therapy is the only right way to treat sex offenders."

T12 "One will rarely, if ever, hear experts characterize their opinions as speculative or subjective, at least not voluntarily. They prefer to speak in the stilted phraseology of clinical judgment, clinical impressions, even clinical intuition, bolstered by their 'many years of clinical experience,' as if the addition of that hoity-toity jargon, clinical -- a word as meaningless as it is pretentious -- somehow elevates their subjective speculations to a higher plane of inellectual validity. It doesn't. This negative judgment is not this writer's clinical opinion; it is what decades of scientific research has documented to be a fact."

"[T]here is a 'vast body of research,' that has demonstrated 'that the validity of clinical judgment and the amount of clinical experience are unrelated.'" [Jay Ziskin, Coping with Psychiatric and Psychological Testimony, 1995.]

T13 "The Hippocratic Oath cautions would-be healers to 'First, do no harm!' Yet, over the centuries, medical and mental healh professionals have, at times with the best of intentions, done enormous harm when they have acted on their unvalidated, subjective beliefs...[A] robust body of social science research, conducted over the span of many decades...has convincingly demonstrated that the opinions of mental health professionals simply cannot be trusted whey then are not supported by research-validated knowledge."

"[O]ne of the darkest chapters in the history of the mental health professions was its treatment -- both literally and figuratively -- of homosexuals. It is a sordid example of the harm produced when a misguided gaggle of 'experts' relies upon subjective 'clinical' judgment that is unsupported by scientific research...[H]omosexuality was designated a mental disorder in DSM-II (APA, 1968). If you were homosexual you were, by psychiatric fiat, mentally disordered. That classification, unsuported by scientific research, was the product of nothing more than the subjective value judgments (also known as biases) of a self-anointed pschiatric elite who presumed to affix the scarlet stigma.

"Stigmas, of course, have consequences -- dire consequences in this instance. In addition to the social alienation and emotional devastation of being labeled 'disordered,' the treatment on offer was as bizarre as it was cruel. The same psychiatric creme de la creme that had branded gay folk mentally disordered used behavior modfication techniques such as administering nausea-inducing substances to cause vomiting at the sight of homoerotic images. They also used electroshock. 'In the more brutal therapy sessions, the shock was delivered directly to the male patient's genitals every time the patient experienced any form of positive response to the slides being shown to him.' J. Scot, 'Shock the Gay Away: Secrets of Early Gay Aversion Therapy Revealed,' Huffington Post, June 28, 2013...Those treatments might be considered paragons of humanity when compared to other curative techniques, some of which were administered involuntarily, such as castration and 'ice-pick' lobotomies. All delivered to the gay community courtesy of 'clinical judgment.'"

H2 [90] "[P]olicymakers should not accept a practitioner's unsupported allegation that something works when the [91] only warrant for this claim is purported clinical experience...Histories of medicine teach us that until around 1890, most of the things physicians did to patients were either useless or actively harmful. Bleeding, purging, and blistering were standard procedures, as well as prescribing various drugs which did nothing...All policymakers should know that a practitioner who claims not to need any statistical or experimental studies but relies solely on clinical experience as adequate justification, by that very claim is shown to be a non-scientifically minded person whose professional judgments are not to be trusted. Further, when large amounts of taxpayer money are expended on personnel who use unvalidated procedures (e.g., millions of dollars spent on useless presentence reports), even a unified front presented by the profession involved should be given no weight in the absence of adequate scientific research showing that they can do what they claim to do."

S36 [285] "[The] perception that sex offenders cannot be rehabilitated is not supported by research, which has found cognitive-behavioral therapy to significantly reduce rates of sexual recidivism." *

W2 [47] "Marshall, Jones, Ward, Johnston, and Barbaree (1991) asked...Can sex offenders be effectively treated so as to reduce subsequent recidivism? In their review of treatment outcome studies, they found that comprehensive cognitive-behavior programs...combined with psychological ad hormonal treatments are effective with child molesters and exhibitionists but not with rapists."

W4 [11] "Relapse prevention is a self-control program designed to teach indviduals who are trying to change their behavior how to anticipate and cope with the problem of relapse. It developed within the area of addictive disorders but has been expanded to sex offenders. It is based on social learning theory and combines behavioral and cognitive interventions."

[9] "We recommend an individually-tailored approach that includes careful assessment of the situation along with the capacities, personality, and behaviors of the individual and a therapy program that uses a broad mix of learning-theory-based treatment techniques to support individual behavior change. Different treatment interventions must be planned for different types of child molesters. Such an approach has the best research support."

[11] "There is sufficient research to conclude that the most effective treatment for child sex abusers is individualized, uses cognitive-behavioral techniques, and is adaptive and flexible."

F8 [323] "[A] number of studies regarding sex offender treatment and recidivism...show that comprehensive treatment of pedophilia has a ninety percent or better success rate." **

W2 [40] "Hall (1995) conducted a meta-analysis (12 studies, N=1,313) and found that 27% of untreated participants recidivated whereas only 19% of treated participants recidivated. Later Alexander (1999), using a quasi meta-analytic framework (79 studies, N=10,988), returned a 13% recidivism rate for sex offenders who participated in a treatment program as compared to 18% for untreated participants. Hanson et al. (2002) reviewed 38 studies of released sex offenders over a 46-month follow-up period and obtained an average sexual recidivism rate of 12% for participating sex offenders and a 17% rate in a comparison group (i.e., treatment dropout, treatment refusal, untreated participants)."

[50] "Alexander's (1999) analysis of nearly 11,000 sex offenders who were subjects in 79 treatment outcome studies found that the rearrest rate was a combined 17.6% for untreated offenders."

C11 [715] "In 1996, a meta-analysis with 11,000 participants found that treatment reduced sexual recidivism rates from 18.7% to 13% *** ...Treatment given to child molesters significantly reduced sexual recidivism rates (14.4% versus 25.8%)..."

J11 [from FN116:] "A meta-analysis of seventy-nine studies of treated and untreated sex offenders found that only 14.4% of treated child molesters (25.8% of untreated child molesters) later recidivated." ****

[What's interesting about the figures from the above three sources is not only that treatment reduces recidivism by up to one-half, but also, that even without treatment, sex offender recidivism is still far lower than that of virtually all other crime categories.]

However, it should also be borne in mind that:

H2 [108] "[T]reatability is irrelevant to determining the dangerousness of a particular offender."

[In other words, even if someone is not untreatable, that does not automatically mean he or she is more dangerous than those who are treatable. Someone who (apparently) fails to respond to treatment may not have gone on to commit any further crimes anyway. The person may simply have a personality that is not amenable to treatment -- e.g., introversion, on the autism spectrum, etc.]

W4 [4] "If an admission of guilt is requried before being admitted into a program, additional complications and potential hindrances to successful treatment are generated. There are no empirical data to demonstrate that a threshold admission of guilt has any relationship to outcomes."

[We already saw that above. And yet, many (often compulsory) programs continue to mandate precisely that.]

L7 [1342] "[M]any sex offenders do not even attend therapy, at the advice of their lawyers, who inform them that the admission of past misdeeds during therapy could make getting out impossible, or even worse, could lead to new criminal charges. In California, for instance, 75 percent of civilly committed sex offenders do not attend therapy."

W4 [7] "Groups [i.e., group therapy] are seen as necessary for all sexual offenders, regardless of their individual personalities and the factors underlying their abusive behavior...Common treatment goals include bringing the perpetrator to the point where he admits all of his abusive behavors, expresses guilt and remorse for them, and is willing to admit and apologize to the victim. These are moralistic goals with no demonstrated relationships to outcomes."

H3 [351] "None of the other clinical presentation variables, such as denial or clinical ratings of low treatment motivation [or length of treatment or empathy for victims], were related to recidivism, except in [one single study out of a total of 61]."

[The solid, consistent findings that denial of the offense and (apparent/alleged) lack of victim empathy are not related to recidivism, pull the proverbial rug out from under many so-called treatment programs, which place a premium on 'taking responsibility' and 'seeing things from the victim's perspective.']

H8 [1157] "The effects were not significant for child molester attitudes..."

[1158] [from Table 2: The following were not significantly related to sexual recidivism: 'sexual abuse during [one's wn] childhood,' 'lack of victim empathy,' 'denial of sexual crime,' 'low motivation for treatment at intake,' and 'poor progress in treatment (post).']

[1159] "A review of the core treatment targets of sexual offender treatment programs...suggests that most programs direct considerable resources toward characteristics that have little to do with recidivism (e.g., offense responsibility, victim awareness, and empathy)."

H3 [356] "A negative clinical presentation (e.g., low remorse, denial, low victim empathy) was unrelated to sexual recidivism..."

[353] "Contrary to popular belief, being sexually abused as a child was not associated with increased risk [of sex offense recidivism]."

H8 [1156] "According to Cohen (1988), d values of .20 are considered 'small,' those of .50 'medium,' and those of .80, 'large.' The value of d is approximately twice as large as the correlation coefficient [ r ] calculated from the same data." [ d and r values are statistics commonly used in the social sciences to calculate the closeness of the relationship between two variables.]

"The general category of sexual attitudes was...significantly related to sexual recidivism, but the effect was small ( d =.17)."

[1157] "The strongest predictors of sexual recidivism were those related to sexual deviancy ( d =.30) and antisocial orientation ( d =.23)."

[1158] [from Table 2: Selected Predictors of Sexual Recidivism: The following had small and medium predictive value: 'any deviant sexual interest,' 'psychopathy checklist -- revised,' 'general self-regulation problems,' and 'employment instability.']

"The present results indicate that the factors that initiate sexual offending may not be the same as the factors associated with persistence...The prototypical sexual recidivist is not upset or lonely; instead, he leads an unstable, antisocial lifestyle and ruminates on sexually deviant themes."

[1159] "Evaluations of treatment progress showed little relationship to recidivism, with an average d of .14."

H3 [351] "Failure to complete treatment was a moderate predictor of sexual offense recidivism."

[The following is an excerpt from a publisher's synopsis of the book 'Deviant Justice':]

L8 "Apart from exposing the unscientific, often anti- scientific testimony of so-called 'experts' in favor of sex offender [civil] commitment, 'Deviant Justice' also takes aim at so-called 'treatment' in sex offender commitment facilities, not intended or able to 'ready' anyone for release, but instead purely as a means to thwart release.

"As the author points out, such treatment is deeply perfused with anti-sexuality-- and it invariably miscasts pedosexuality as if it were an addiction ('relapse prevention' therapy).

"It proceeds on the false premise that all atypical sexual attractions ('deviance') must be extinguished or somehow magically converted to an 'acceptable' sexuality before release is authorized. This, of course, is no more possible than the recent attempt to 'treat' homosexuals to turn them into heterosexuals.

"And such treatment also falsely presumes that any 'deviant' attraction is inherently an irresistible impulse that will, with certainty, result in future sex crimes -- defying the experience of millions for whom pedosexuality is experienced only through visual media and fantasy.

"'Lawyer X' [the author of 'Deviant Justice] cites un-degreed quacks as supposed 'therapists,' repeated failed experimentation substituted for treatment, attempts at 'brainwashing,' demands that one give up forbidden 'thinking error,' serial demotions in treatment levels as a way to thwart progress toward release, and plethysmography [penile-response assessment] and misuse of polygraph testing to justify such demotion."

[Also see Pedophilia section -- esp. 'T11' (Sylvia Tanner).]

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* (See Craig, Browne & Stringer, 2003; Hatch-Maillette, Scalona, Huss, & Baumgartner, 2001; Lowl & Schucker, 2005; McGrath, Cumming, Livingston, & Hoke, 2003.)

** [FN43:] See interview with Robert McGrath, President of the Board of Directors, Safer Society Foundation, Inc. and Consultant to Vermont's Dep't of Corrections and Nat'l Institute of Corrections, in Brandon, Vt. (Dec. 2, 1996).

*** [from FN169:] Gordon C. Nagayama Hall, Sexual Offender Recidivism Revisited: A Meta-Analysis of Recent Treatment Studies, 63 J. Consulting & Clinical Psychol. 802 (1995).

**** Lisa C. Trivits & N. Dickon Reppucci, Application of Megan's Law to Juveniles, 57 Am. Psychol. 690, 699 (2002).