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There is a patient in my practice currently who is a sex offender. Not a problem I enjoy working with personally, but he was with me before he disclosed and he benefits from the continued support. He has told me often about his “Sex Offender Group”, which he is mandated to attend weekly, for an indefinite time frame, by the Court where he admitted his sexual offense. There are 20-25 men (mostly) in this group any given week. That alone should concern us about any group treatment. But there is worse. And the problem is the worse is and has been ubiquitous as long as I’ve known.
The “treatment” in this group is based on confrontation. Hard, no crap confrontation. You WILL admit you are a sex offender. You WILL admit you continue to have fantasies and are at high risk for re-offending. And if you don’t admit this, you are a liar, and subject to the ridicule of the god-like group leaders. Who might violate your probation status, or not let you out of group for the rest of your life. And there is no questioning the tactics of these leaders. THEY know you are dangerous and it is their job to break you, get you to admit it and then, of course, make sure you don’t do it again.
This is not all that different than some of the AOD (Alcohol and Other Drugs) treatment that goes on here locally either. And except for those of you who work in more urbane or really enlightened areas, you probably know just the kind of treatment noted above. CONFRONT, CONFRONT, CONFRONT!
The problem? We know it’s largely ineffective. And we honestly don’t even need research to back that up, because our basic psychological understanding tells us that unless someone is motivated to change, they don’t. And fear does not motivate for real. It cows and intimidates and leads to outward behavioral and thought changes. But it doesn’t touch the inside of the soul. Just drives it underground further. And the person doesn’t really change most of the time, they just hide better. If you haven’t read the description of pedophilia by Humbert Humbert in “Lolita”, do so. It is chilling and frankly revolting, but incredibly enlightening into the mind of someone who has a secret and unacceptable behavior they wish to keep and will go to all lengths to protect.
For those who do “change” they tend to become zealots for the system, and believe that this indoctrinated way is the ONLY way to change and any and all other methods are false or lies. So confront, confront, confront. And the systems sustains itself as it reproduces it’s own coterie of new treatment personnel, either (as is true with AOD) from its own original patients, or from those trained who are told “This is the only way”.
What surprises me is that as psychologists (mea culpa too – no throwing stones in glass houses) we have largely left this treatment go out of our hands. We tolerate it. I suspect because most of us don’t want to do it – esp. the sex offender treatment, but I know most of my competent local colleagues don’t want to touch AOD issues. So, it seems these largely ineffective, frankly inhumane treatments go on. The Courts continue to order them, because they have to do something. There are of course much better alternatives. The solution oriented folks have long known about the tenets of Motivational Interviewing and the ideas behind Prochaska’s stages of change lead to all kinds of ways to think about intervention. General harm reduction theory has a lot to say here, and cognitive behavioral tactics have some value and so I know do analytic principles in some cases. There is no assurance that one treatment will work for all, and it still seems necessary to tailor for the individual, but there are more effective and logically sound interventions available. And I know a small number of our colleagues are trying (like the Who’s on the flower head in “Horton Hears a Who”) to be heard. But by the looks of it, it’s not working yet.
So my suggestion and personal pledge? No more passive tolerance. I’m telling people (and have been for a while) that this is not good treatment. I’m not referring to my Certified Addiction Counselor colleagues unless I’m sure they know more than the standard old confrontation method, have competent training and seem like actual decent human beings. If my patients are involved, I inform them of the problems with the treatment and either empower them to leave, or as in the case of my patient above, who can’t and may never leave this treatment, we try to work in an effective way to manage his remaining impulses to sex offend and try to stay as honest as possible about the pain he feels at the loss of his desire and the difficulty inherent in not re-offending.
Join me. Tell people this kind of treatment is outdated and, like refrigerator mother theories for Autism, just plain wrong!
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