An Education about Asexuality

I saw ACE: What Asexuality Reveals About Desire, Society and the Meaning of Sex by Angela Chen mentioned on the list serve for the Association for the Treatment of Sexual Abusers (ATSA).  As a clinician who works nearly entirely with clients with some type of problematic sexual behavior, I was keen to read this book.  In years of doing this work, I had not been exposed to any work specifically about asexuality.  In all honesty, I had been exposed to truly little relating to asexuality.  If I dig back into the recesses of my brain for work in college and graduate school, I cannot recall the topic being brought up.  In CSAT training, there was talk of sexual anorexia, but nothing about asexuality. 

First, I need to admit that I am guilty of saying that sexuality is a part of being a human being and everyone has a sense of sexuality.  In our work with problematic sexual behavior and sexual offending, don’t I say that our work is to find out what their sense of healthy sexuality is?  Yes, I do.  And I have not given too much thought to whether or not my clients are asexual.  They do not really bring it up but neither do I.  So, the first thing I need to say about this book is that it made me take a very hard look at my own assumptions about sexuality and the work I do.  As a sex positive therapist, I am incredibly open about all types of sexuality.  I have never not believed in asexuality; I just never gave it too much thought.  If it did nothing else, this book made me a better therapist for making me investigate my own assumptions and challenge myself to be better.

This book is also a great way to introduce a person to the preferred language around sexuality that includes asexuality.  Again, owning my ignorance, I had not heard the term allosexual.  Someone who is allosexual experiences sexual attraction to another person.  This contrasts with someone who identifies as asexual, meaning they have a persistent lack of sexual attraction to any gender.  This book also introduced me to the term demisexuality.  A person may identify as demisexual if they do not experience sexual attraction to another person unless they have formed a strong emotional bond with them.  My clients had spoken of this before, but I (we) never named it. 

This book also makes the reader take a hard look at their assumptions.  Many people might assume that if a person is asexual, that they do not then feel romantic love and are never in relationships.  This delve into asexuality provides us with the reality.  Many people who identify as asexual find romantic love, have great relationships and can even be kinky!  The nuances of these relationships are many and require honesty and communication between the parties.  But don’t all relationships require this anyway? 

The only downside to this book for me (and it is a small matter) is that, at times, it feels a bit preachy.  However, if I look at how our culture ignores, talks about or judges asexuality, I can understand how the author could end up writing in this tone for some of the book.  When you are part of a community that has been basically invisible, you want to be heard and heard authentically.

I highly recommend this book to anyone who works in therapy or sexual education.  Particularly this book is important for those of us who work with clients with sexual issues of any kind.  It can help us be better at our work and meet our clients where they are without judgement.

Book Review: Prodependence: Moving Beyond Codependency

Rob Weiss’s latest contribution to the recovery community is his book Prodependence:  Moving Beyond Codependency.  This book, and the philosophy of prodependence are an alternate take on the idea of codependency that has been rampant in the addiction recovery movement for decades. 

Codependence has been defined as “a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition, such as an addiction (Merriam-Webster).  In the recovery community the spouse, partner or family of someone suffering from an addiction is often labeled a codependent.  This term came into the recovery lexicon in the 1980’s and became part of everyday language.  A codependency diagnosis was rejected by the APA for the inclusion into the DSM but the “diagnosis” has persisted and there are 12 step meetings for Codependents (CODA)

Rob Weiss’s argument in putting forth the concept of Prodependence is that it codependence is not helpful to the family members of those in active addiction or in recovery from addiction.  Family members loved ones or care givers of people with addictions, in the codependency model, are often told that they are part of the problem as opposed to just trying to cope with a very difficult situation. 

Prodependence is as term to describe “attachment relationships that are healthfully interdependent, where one person’s strengths support the vulnerabilities of another and vice versa, with this mutual support occurring automatically and without question.” (p53.)  Rob prefers this concept as it celebrates a loved one’s desire to help the addict in their life without shame or blame. 

Prodependence looks at the behaviors of the partners or family members of an addict as attempts to maintain or restore healthy attachment and not as enabling.  Treating prodependence is similar to treating co-dependence in terms of encouraging healthy boundaries and self care.  However, it differs by being a strength based, attachment driven model that values loved ones of an addict.

Another key idea behind the concept of prodependence is the idea that a person with an addiction has an attachment disorder and needs healthy attachment to truly heal from their addiction.  Encouraging prodependence, treating addicts and their loved ones with kindness, empathy and respect, can help repair earlier attachment traumas and aid healing. 

Another key difference between prodependence and codependence is that prodependence looks at addiction as an intimacy disorder. As opposed to the older idea of tough love, intimacy disorders are treated with the pursuit of healthy, intimate and ongoing connection.

While suggesting that codependence may be an outdated concept is risky, it does not feel groundbreaking.  This book and the idea of prodependence feels like the natural conclusion when you take into account what we now know from the research about attachment, intimacy and shame.  As Johann Hari suggests in his Ted Talk from a number of years ago, “What if all we were taught about addiction is wrong?”  Perhaps, instead, we should treat people with addictions and their families and loved ones without shame and blame.  We might get farther modeling healthy attachment and boundaries combined with compassion and empathy instead.

The Truth About Halloween and Sex Offenders

Halloween is at the end of this week.  Those of us who work in the field know that this is the time of year that probation officers ask us if we have made sure all of our clients have a plan for Halloween and know they are not to participate in the holiday. Luckily, the area of the country where our practice is located does not ask for more than for our clients to not participate in the holiday.  In other parts of the country, things are much different. 

For example, here is a little summary of the news in the past week regarding sex offenders and Halloween.

The Patch, a news source all over the country, posted multiple articles providing detailed maps of the location of all of the registered sex offenders in their target areas.  A town in Indiana performed a Halloween crackdown sweep of Sex offenders who failed to register.  A news source in Ohio posted an article on how to keep your children safe from sex offenders on Halloween. 

In Georgia, the Butts County Sheriff’s Office places warning signs in front of the homes of anyone on the sex offender registry for Halloween.  Several people on the registry sued the Sheriff’s office and recently lost the lawsuit.  The court ruled that this practice did not violate their rights. 

In some states, registered offenders who are still on probation or parole are provided with a list of Halloween requirements that may include:  being home after a certain time, not answering the door to children, not handing out candy, not having outside lights on, and having a sign on your door that specifically states you are not giving out candy. 

We can all agree that sex crimes against children are profoundly serious and something that everyone should work to prevent.  The question arises as to whether Halloween is a higher risk day than any other day of the year.  To answer this question, Chaffin et a. (2009) conducted a study that analyzed child sex crime rates on Halloween.

The authors analyzed child sex crime victims from 1997 to 2005.  The data came from up to 30 states.  They looked at a span of days that included Halloween as some locations have trick or treat events before or after the actual date of Halloween.

There was a total of 67,307 abuse reports during the Halloween time frame over the 8-year period.  The results of the analysis indicated that for the children who were abused on Halloween, 73% were female and 27% male.  They were abused primarily by male offenders (94%) who had an average age of 24 years old.  The main result of this study was that the distribution of sexual offenses against children during the Halloween time period did NOT significantly differ from all other days of the year. 

The authors of this study also looked at other crimes committed during the Halloween time period.  The most common types of crime during Halloween are theft, destruction of property and assault. Vandalism and destruction of property accounted for a significantly greater proportion of the crime around the Halloween time period.  Sex crimes accounted for a little more than 1% of all Halloween crime and sex crimes against children accounted for less than .2% of Halloween crime incidents. 

This data, and the fact that we know that the majority of sex crimes against children are committed by someone known to the child, call into question the efficacy of spending the valued time and resources of police and probation departments engaging in extra monitoring or policing of registered sex offenders on Halloween.  Perhaps resources could be better spent policing other crimes on Halloween such as vandalism.  The CDC has reported that children are four times more likely to be killed by a pedestrian/motor vehicle accident on Halloween than any other day of the year. 

Extra policing of sexual offenders on the registry during Halloween might make the public feel better or feel that their children are safer.  However, it appears that these efforts are more publicity than efficacy in reality. 


Chaffin, M., Levenson, J., Letourneau, E. & Stern, P. (2009). How safe are trick or treaters? An analysis of child sex crime rates on Halloween. Sexual Abuse: A Journal of Research and Treatment. (21) 3, 363-374.

Do Motivations for Sexual Offending Differ Depending on Race?

Research Review: Paraphilia and Antisociality Motivations for Sexual Offending May Differ for American Whites and Blacks. Lee, S.C., Hanson, R.K., Calkins, C & Jeglic, E. Sexual Abuse, 32(3), 2020 335-365.

There is a vast array of research pointing to the fact that sexual offenders are a heterogenous group and that it is difficult to generalize across offense types and populations.  Despite the vast amount of research on sexual offenders, there is a lack of scientific studies that look at potential differences in offender characteristics related to race or ethnicity.  This study sought to address this lack of knowledge by investigating any potential differences between white and black men who have committed sexual offenses.

It is well documented that people of color are over represented in the criminal justice system and also are over represented among those people convicted of sex crimes.  The limited research tells us that white men convicted of sexual offenses tend to be more paraphilic and have more sexually deviant arousal than their black counterparts.  White men are also less likely to commit sex crimes such as crimes involving adults or female victims.  Additionally, childhood sexual abuse is reported more frequently in the histories of white men who commit sex crimes than black men who commit sex crimes.

Another noted concern involves the actuarial risk assessment the STATIC-99R.  This instrument, that is widely used to predict risk in sexual offenders, was normed on predominantly white research samples. Black sexual offenders tend to score higher on the STATIC-99R despite having similar sexual recidivism rates. 

The current study sought to address whether white sexual offenders were different from black sexual offenders on risk relevant characteristics.  The second aim of the study was to determine whether the Static-99R predicted sexual recidivism differently for black and white offenders.

Study Details: 

The subjects for this study were 1585 males (788 black and 797 non-Hispanic white) in the New Jersey Department of Corrections system.  The case files of these offenders were reviewed, looking at the following measures:  Static-99R score, MnSOST-R score, Pervasive Anger Score, a general criminality scale, a sexual criminality scale, a paraphilia scale and sexual recidivism.  Recidivism was defined as any subsequent conviction for a sexual offense after release. 

Study Findings:

There were differences in Static-99R scores between black and white offenders with scores for black offenders being higher than for white offenders.  The black offenders were underrepresented in the lower risk categories (Levels I and II) and both racial groups were overrepresented in the higher risk categories of Level Iva and VIAB.  The higher scores for the black offenders resulted from them, on average, being younger and less likely to have been married.  Black offenders were also scored as having higher hostility scores than white offenders. 

Black sexual offenders in this study showed lower indicators of paraphilias, particularly, they were less likely to be diagnosed with pedophilia than their white counterparts.  Black offenders were also less likely to have minor victims or male minor victims.  They were also less likely to use pornography during a sexual contact offense and were less likely to be involved in offenses such as exhibitionism or voyeurism. 

In terms of actuarial risk assessment, the ability of the Static-99R to discriminate recidivism was not related to race. For both black and white offenders, the 5-year recidivism rate was lower than expected though this result only reached significance for white offenders. 

In general, black offenders in this study were found to have more criminogenic characteristics than whites and whites were found to be more paraphilic (pedophilic) than the black offenders. 

Implications for Sentence Mitigation or Aggravation:

For black American sexual offenders, the elevated levels of antisocial behavior may be attributed to many factors that stem from the systemic social oppression and discrimination experienced by Blacks in the United States. There is a large amount of research that shows that there is an association between systemic racism and experiencing unstable family environments and the likelihood of holding anti-social beliefs or engaging in antisocial behaviors.  These social factors may influence the development of anti-social beliefs and behaviors that then influence the commission of their crime. Sentence mitigation reports or psychosexual evaluations should include these factors to help counsel understand the influence of these factors on the clients psychological and behavioral development.

The results of this study also suggest that white offenders use sexual behavior as a dysfunctional coping mechanism for emotional distress which can lead to more engagement in illegal sexual behaviors such as prostitution, exhibitionism etc.  Any assessment conducted on the offender should look at previous history of mental health treatment and should also assess whether the person’s sexual behavior is a compulsive means to manage negative affect.

Though the Static-99R has not been normed on a racially diverse population, this study supports it’s use with black American sexual offenders.

Implications for Treatment Recommendations:

This study finds that the motivations to offend differ significantly based on race. All treatment recommendations should follow the Risk Needs Responsivity evidence-based model.  This study is of interest for the responsivity part of the model. Many white clients may need a greater treatment emphasis on both sexual arousal, i.e. pedophilia, exhibitionism, etc. as well as affect regulation skills.  Black clients might need more emphasis placed on criminogenic needs such as antisocial beliefs and behaviors. 

Book Review: Neglect The Silent Abuser: How to recognize and heal from childhood neglect

Neglect: The Silent Abuser is a recent publication by respected psychotherapist Enod Gray.  The book seeks to provide information about the concept of neglect as well as provide some cursory steps to try to heal from the consequences of childhood neglect experienced by the readers.

Most people who come to therapy can recognize overt abuse.  Overt abuse is abuse that is obvious to the person or a form of abuse that is easily recognizable.  For example, physical or sexual abuse, though frequently minimized, are often identified as abuse.  Verbal abuse is something that people can sometimes have a harder time recognizing, but again, this type of abuse tends to be more overt.  Think of a parent who also calls their child names or humiliates them consistently.

Neglect is something that most people do have a harder time identifying.  When most people think of neglect, they think of again, more overt neglect, such as someone growing up with not enough food, safe shelter, etc.  Neglect most often brings forth thoughts of physical neglect.  Most people do not immediately think of emotional neglect when they are asked about it.  This is because, frequently, this form of neglect is not overt or consciously done.  It is also a form of neglect that is easy to minimize or rationalize.  For example, if you grew up in a household with a parent with a mental illness, you may not have received the emotional care and nurturant that you needed as a child.  However, this neglect was not consciously or intentionally done.  It would have been a consequence of the parent’s mental illness and not necessarily consciously done.  As another example, if you grew up in a household with a sibling with a physical disability, this likely took up most of the time and energy of your parents.  Likely there was some neglect in this family system, but not intentionally. One family member just needed more time and energy and the child(ren) that don’t have more overt needs are assumed to be just fine.

Neglect can also come from growing up in a family where there is addiction present in one or both parents.  If a parent is struggling with addiction, they will not be able to be fully present for their children and meet their needs for nurturance.  Frequently, we also see neglect in families where one parent is a workaholic.  Again, this neglect is not something consciously done and often justified by creating the financial means to provide the children with all the material goods and experiences they could wish for.  Unfortunately, children more often wish for  time.

This book does a nice job of discussing neglect and the effect of growing up in a neglectful environment on our adult behavior.  This is done at a cursory but understandable level.  The factual information is nicely complemented by stories of clients of the author. Often, it is these client vignettes that are most relatable to readers. 

After addressing the process of neglect, Ms. Gray provides guidelines and thoughts on how to address the struggles of adults who grew up with neglect.  In this section of the book, I found myself wishing for more “meat.”  The thoughts and ideas are brief “reader’s digest” overviews of ways to help healing such as journaling, yoga, EMDR and other forms of therapy. 

Though I found myself wishing for a bit more from this book in regard to tools for healing, it is perfectly suited for a person who is new to the idea of neglect as something they experienced in their childhood.  It feels like a primer for someone just starting their journey into recovery from neglect.  The book also provides an excellent array of resources for further investigation.  This is a book I would recommend for a client who wants a quick and easy read to serve as an introduction to the concept of neglect and the road to healing. 

Dr. Jennifer Weeks is the owner and director of Sexual Addiction Treatment Services, author and educator.

ATSA Update: Are Denial and Minimization Always Bad?

Guest Blog by Patti Hoyt LPC CAADC CSAT

Have you ever minimized your actions or even denied all or part of them?

 Denial is like a small child saying “I didn’t do it” when a parent walks into a room filled with a mess. Maybe, you say you completed a task, but in reality, you haven’t started it. Minimization is like a small child saying “it isn’t that bad” when they get a poor grade or you saying “it isn’t that big of a deal” when you forget to bring something you said you would. These are examples of denial and minimization, which are both types of cognitive distortions. We all deny or minimize behaviors at some point in our lives to one degree or another.

Yet, in the forensic world, denial and minimization are viewed as a negative behaviors and cause for concern. They are often seen as barriers to people taking accountability for their actions, to a person’s response to treatment, and thought to be a predictor that the person will reoffend. Treatment often focuses on denial and minimization as a means to reduce risk of reoffending.  The research on denial and minimization has yielded inconsistent results over the years. Some studies have shown addressing denial for certain populations reduces risk of reoffending for a few, but not necessarily all. Multiple researchers have been exploring the question “what is the function of denial?” Why do people deny all or part of an event?

Current research by Gabrielle B. Lucente and Kevin L. Nunes of Carleton University explores the function of denial. They note that denial is an adaptive response to a person being charged with a crime. They propose that denial should be addressed as a barrier to treatment rather than a deficit to be addressed or focused upon. The researchers have indicated multiple possibilities for the use of these cognitive distortions by people who have been charged with a crime.  Through their research, they have identified what they call the Adaptational Model.

People deny or minimize their actions for some of the following reasons:

  • To continue offending behavior or continue to manipulate situations (psychopathy)
    • If I don’t tell, I can keep doing it, and no one will ever know.
  • Protect self-esteem
    • If I don’t tell, people will continue to like me. I will still have friends and family.
  • Avoid consequences of action
    • If I don’t tell, I will still have a job or people will continue to talk to me.
  • Distance self from negative label like sexual offender
    • If I don’t tell, I won’t have the shame of being labeled negatively.
  • Protect identity
    • This behavior is completely out of character and something I would never do it, thus I cannot tell.
  • Avoid negative evaluations from others
    • If I don’t tell, I won’t be judged.

The more a person has at stake, such as losing friends, family, employment, sense of self, or increasing self-loathing, the more likely it is that they will minimize or deny their actions. The role of shame often plays a huge part in denial and minimization.

This research does not give permission or recommend that a person deny or minimize any legal or illegal behavior. What it does do is give insight to why these thinking patterns can occur. 

Changing how we look at denial and minimization allows treatment providers to explore the barriers to a person’s responsiveness to treatment.  If a treatment provider starts to ask about the “Why” behind denial or minimization, they can help the client begin to work through the underlying mechanisms for the distorted thinking.

What’s a MAP and why it matters

There were many research presentations this year at the ATSA conference relating to MAPs.  This was a great thing to see as, from a scientific perspective, we just don’t know much about the MAP community, which means we don’t know about their needs and how best to help those individuals who seek help.  As my goal for this blog is to bring science to the non-research community, I am not going to spend time here discussing this research.  Instead, I am going to focus on education. 

To start with, what is a MAP?  Very few people are aware of the term.  MAP is the acronym for a Minor Attracted Person. 

Semantics recap –

Pedophilia –       the name for the attraction to pre-pubescent children.  We use this for diagnosis (DSM-V), and research purposes.

Hebephilia –   the name for the attraction to pubescent children (not pre or post pubescent).  Again, we tend to use this term for diagnosis (not in the DSM-V) and research purposes.

MAP –      Minor Attracted Person.  A non-diagnostic umbrella term for a person who is attracted to children.  There is no specific age nor pubertal status associated with this label.

The MAP debate:  There are some people who do not like the MAP moniker.  I have heard these arguments from people who often work in research and supervision.  The argument loosely goes like this.  The MAP label is not descriptive enough.  It lumps all minors together and does not distinguish between pre-pubescent, pubescent and post pubescent attraction.  I understand this argument when it comes to research.  There is not enough scientific research in the community looking at any type of attraction to minors.  To lump pedophilia and hebephilia together for research purposes assumes that there are no differences between people who have these attractions. While this may be the case, due to lack of research, we just don’t know.  It is better to look at these groups differently until we can say that they are, or are not, similar enough to put in the same subject category for research purposes. 

Arguments have also come from treatment providers or supervising entities.  I need to state that these are usually treatment providers for people who have sexually offended.  From a treatment perspective, for someone who has engaged in offending behavior, it is very helpful to understand a person’s arousal template so that we can help the person manage unwanted or illegal sexual behavior.  However, I can argue that once we have made the diagnosis, we have the information and perhaps no longer need to continue to use the pedophile language, particularly with our clients.

I am not a person who identifies as a MAP but am a treatment provider and not a researcher.  I am going to make an assumption based on my work with clients that the main reasons to use the MAP language have to due with shame and stigma. 

The general public (fueled by the media) equate pedophile with child molester.  There is an assumption made that someone who is attracted to children either has or will eventually sexually offend with a child.  We know that this is not true.  As I recently wrote, attraction is not a behavior.  While pedophilia and sexual offending are related, they are not synonymous.  The label of pedophile is stigmatizing.  There is no way around that truth.

So that brings me back, again, to shame.  I recently learned of the work of Braithwaite (1989) and how this researcher classified shame.  Braithwaite argued that there were two types of shame, reintegrative and disintegrative shame.  “Reintegrative shaming is temporary, used to communicate censure to an individual, but ultimately aimed at correcting a person’s behavior and, for offenders, reintegrating them back into the community.  Disintegrative shaming is a more permanent and reoccurring shame, resulting in a master status that encourages stigmatization and breaks the bond between the person and the community (Bailey & Klein, 2018)”  I learned of this work when researching the effects of the sex offender registry on the people who have to register. 

As the general pubic equates attraction to children with child molesting, those individuals who are attracted to children get put in this category (valid or not) and thus, if they come forward for treatment or talk about their attraction to family or friends they can face the disintegrative shame that encourages stigmatization. 

Levenson and Grady (2019) recently published work where they spoke to MAPs about their experiences.  Specifically, this study looked at people seeking help for their attraction.  The subjects of this study reported that they often felt isolated and alone with their feelings.  They also experienced feelings of shame, fear and expected to be misunderstood by people, including therapists.  Particularly distressing was the finding that the therapists tended to want to focus on the minor attraction as a treatment focus when the client wanted to work on concerns such as depression or loneliness and not specifically their minor attraction. 

Returning to the title question, why does the term MAP matter? From a person centered, trauma informed perspective, we should be using terms that the people with the attraction identify with and don’t function, by the stigma associated with the term, to increase shame and isolation.  From a public education standpoint, using a term that is not as value laden and stigmatizing might help to counter the popular narrative that all people who are attracted to children sexually offend against them. 

If you have read any of my blog posts, you know that the misuse of the term pedophile is one of my soap boxes.  Yes, I argue about semantics and how the word is used.  I also get frustrated with the media’s use of the word as equal to child sexual abuse. 

I challenge people to think about these issues for themselves.  Can you accept that some people are attracted to children and it is not a choice?  Can you decry the assumption that every person who is attracted to children is going to offend? 

To end, I will leave you with something heard more than frequently in graduate school.

Correlation is not causation.


Bailey, D.J.S. & Klein, J.L. (2018). Ashamed and Alone: Comparing offender and family member experiences with the sex offender registry. Criminal Justice Review, 43(4), 440-457.

Braithwaite, J. (1989).  Crime, Shame and Reintegration.  Cambridge, England, Cambridge University.

Levinson, J.S. & Grady, M.D. (2019).  Preventing sexual abuse:  Perspectives of Minor Attracted Persons About Seeking Help.  Sexual Abuse, 31(8), 991-1013.

Does treatment for sexual offending behavior increase or decrease the likelihood of reoffending?

In most jurisdictions in the United States, a person convicted of a sex crime is mandated to treatment.  This treatment tends to be group therapy with the primary modality being Cognitive Behavior Therapy, also known as CBT.  As a community of treatment provider0,s we are always striving to improve our practices, use evidenced based treatment modalities and use the interventions best suited to our clients to help decrease their risk of recidivism.  So the question of whether or not what we are doing is helpful or harmful comes up, we need to pay attention.

The keynote address Thursday morning at this year’s ATSA conference was by Dr. Teresa Gannon.  She presented her recently published meta-analysis of the effectiveness of sexual offender treatment.  This article was recently published in Clinical Psychology Review and is open access.  The study looked at all types of violent offending but Dr. Gannon spoke this morning specifically about treatment for sexual offending.

There have been some studies that have been published that have provided a grim picture of treatment.  Most specifically, Dr. Gannon points to a 2017 report from the UK Ministry of Justice that stated that people who had committed sexual crimes and had treatment had a 25% increase in their rates of recidivism.  To those of us who do this work, that is a shocking number.  No treatment provider wants to do more harm than good and none of us would ever knowingly do anything that would increase the risk of harm to anyone. 

Enter Dr. Gannon and her colleagues.  They embarked on a meta-analysis of 70 studies on offending behavior.  Specifically they also looked at variables that could influence treatment outcomes.  Their work asked three specific questions.  1). Does offense specific treatment influence recidivism risk?   2). Is a trained psychology professional needed?  And 3). What program variables are important for success.  Again, if you want to read the full journal, you can obtain it free from the journal Clinical Psychology Review. 

The results of the meta-analysis were both encouraging and enlightening.  The results indicated that over a 6 year follow up period, those individual who engaged in sex offender specific treatment reoffended at a rate of 9.5% and those individuals who did not attend sex offender specific treatment reoffended at a rate of 14.1%.  This means that those who attended treatment were 32.6% less likely to reoffend than those individuals who did not attend treatment.  This result is the encouraging part.

The next set of results elucidated what program variables were important for reductions in recidivism.  The first important question involved the presence of a licensed psychology professional.  Was there a licensed professional involved in provision of treatment?  This was broken down into unclear/none meaning that a psychology professional was not directly involved with providing treatment or it was unclear.  The other categories were inconsistent and consistent.  The results indicated that treatment is more effective when a psychology professional is consistently hands on in the treatment process. 

The last set of factors that were investigated involved actual variables in the treatment program.  It was found that offenders who attended group only had better outcomes than those who attended group and individual therapy.  Those programs where there was supervision by a licensed psychology professional had better outcomes.  Programs that used arousal conditioning had lower recidivism rates and those programs that did not use the polygraph had better outcomes than those programs that did use polygraph testing. 

This meta-analysis posits that when providing treatment for people who have sexually offended, we need to think about several key elements shown in this study to improve outcomes and reduce recidivism.  The most effective treatment programs had the following characteristics:  A licensed psychology professional with expertise in treating sexual offenders, who is hands on and consistent in the treatment.  Inappropriate sexual interest is addressed.  It is group based and supervision by a psychology professional is provided.  The polygraph is not used in treatment. 

On a side note, the study indicated that the countries with the best outcomes for treated offenders were Canada, New Zealand and Australia. 

This is the most up to date meta-analysis of sexual offender treatment efficacy published.  It is the first to provide some evidence for the efficacy of arousal conditioning.  It also indicates that it is not just treatment that is effective but treatment provided by individuals with expertise in the field and offer supervision to treatment providers. 

ATSA 2019 Updates: Understanding Sex Doll Ownership

As a clinician, I live at an intersection between three worlds.  Sex Addiction Therapy, Sexual Offender Therapy and Sex Therapy.  These are often conflicting worlds.  The sex addiction world can (used to) tend to think all non-normative sexual practices are an addiction.  The sex offender treatment world can tend to label out of the box practices “deviant” and the sex therapy world thinks that all consensual sex practices are pretty much just fine.  It is probably safe to say that these three different (but connected) worlds all likely have different thoughts about sex dolls. 

Sex doll use and sex doll ownership is something that is seriously stigmatized in most arenas.  People who own sex dolls can be labeled perverts.  Many people think that there is something really wrong with someone who might want to own a sex doll.  And many people think that if a minor attracted person has a sex doll it will increase his likelihood to sexually molest a child.  This can be attested to by countries or states enacting legislation about importation and/or ownership of sex dolls as well as a recent controversy in Texas about the opening of a sex doll brothel. The reality is that most of these statements are either stigmas or assumptions as it is a topic that is little researched.

That is why I was so excited to see a session at this year’s ATSA conference dedicated to research about sex doll ownership.  Dr. Craig Harper and Jeremy Malcolm presented preliminary research regarding sex doll ownership.  The first study that was presented was a qualitative study about the motivations for sex doll ownership.  The proviso here is that the sample size is still small (6) but is growing as the research is ongoing.

So why do the men in this study own sex dolls?  Two themes emerged.  First was that of the “perfect partner’ and the second was about sex.  The owners of the dolls identified deficits on real people or themselves that made relationships difficult.  The men in the study cited things such as a doll not always being critical as a reason to have a doll versus a real relationship.  Some men cited their own personal deficits as reasons for having a doll.  They suffered from great anxiety when interacting with others and found it easier to have a sex doll.  In these cases, the dolls took on emotional significance as well.  Another reason to have a sex doll is that you can create the perfect partner.  We all know that real people have flaws.  When creating a sex doll, it is totally customizable and can be created to perfectly match a person’s arousal template.

The second study was quantitative and looked at whether or not doll ownership predicted sexual aggression.  This is a topic of great importance as many people hold the belief that having a sex doll (particularly when you are talking about child sex dolls) will increase a person’s likelihood to offend against a real person (or child).  This study only looked at adults with adult sex dolls.  This study had both doll owners and a control group take a survey that looked at many variables.  Without digging into all the results, I will summarize.  Owning a sex doll did not increase the likelihood endorsing sexual aggression.  There were no differences between doll owners and non-doll owners on measures of sexual assault proclivity or paraphilic interest.  There were also no differences between doll owners and non-doll owners on the emotional factors studied nor in attachment style.

The study did find that doll owners scored higher in some of the implicit rape theories endorsements.  Particularly, doll owners scored higher on hostility toward women, seeing women as sexual objects, seeing women as dangerous and sexual entitlement.  It should be noted that the study did not look at causation.  Therefore, you cannot say whether owning a doll increased these scores or that people with these attitudes are more likely to get a doll.  We can just note a difference.

Again, as a reminder, this is preliminary data.  The second study has 70 doll owners and 90 controls at present.  However, the research is a step in the right direction as it is empirically looking at doll ownership.  The second study found preliminary evidence that owning a sex doll is not associated with an increase in sexual aggression. 

Some people might ask why this is important research.  Laws in states and countries are being enacted regarding sex doll ownership.  These laws are being proposed without research to back up whether or not bans would be effective.  It is easy to pass a law about sexual behavior on an emotional basis.  However, if the science ends up saying that the law is unhelpful or even harmful, it is nearly impossible to get these types of laws overturned.