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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.
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
- 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.
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.
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.
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.
It is often easy to tell when some bit of science regarding pedophilia is brought out to the general public. There is usually a rash of social media memes that are negative and frequently suggest that by agreeing with the emerging science, the writers or researchers are condoning the sexual abuse of children.
Recently, Dr. James Cantor, a highly respected and published researcher who focuses on the study of pedophilia, appeared on an Australian news show to discuss his findings. He shared his research, which involves brain scans and neuroscience, which shows that people have differences in their brain structures. His research suggests that people with pedophilia are born with this attraction and it is not something they can change.
Enter the memes………. And where I get on my soapbox and continue to spout science and education.
I have written about this topic before because it is something that I feel strongly about. I feel very strongly about it being accurately portrayed in the lay community. So, let’s recap.
Pedophilia (without giving you the entire DSM-V diagnosis) is a sexual arousal to a person who is prepubescent. The age here is not the important thing (i.e. 10 vs. 11. vs. 12 etc.). The important thing is that the attraction is to a child’s body that has NOT started the physiological changes associated with puberty. If a person is attracted to pubescent or post pubescent children, that is considered hebephilia.
Pedophilia is NOT a behavior. I believe that this is one of the most common myths in the non-scientific community. Pedophilia is an attraction. Actions are behavior. The frequently cited concern is that every person who has a pedophilic arousal template is a child molester. Not true.
Some people sexually abuse children because they are attracted to them. Some people sexually abuse children for reasons that don’t have much to do with sexual attraction. For example: issues of power and control, distorted thinking, emotionally connecting with children in an inappropriate manner that becomes sexualized. Some people who are attracted to children never engage in any sexual contact with them, nor do they view images of child sexual abuse (child pornography).
Many people have questioned why I get so revved up about this topic. Why do I think it is important? When you get it wrong, when the press gets it wrong, it damages prevention efforts. Every person who is attracted to children, whether they have offended or not, knows how society feels about them. Most carry an immense amount of toxic shame. This shame keeps them from coming forward to seek help from trained professionals (the stigma against this population by treatment professionals is a topic for another day).
Every time a person who is attracted to children feels that he or she cannot come forward to seek treatment, we do a disservice to the protection of children. What better way to engage in primary prevention than to make treatment accessible and not shame based for people who are attracted to prepubescent children, have not offended and want to keep it that way?
The United States does a good job of secondary prevention. Once we know you have offended and found guilty, you are mandated to treatment to prevent another offense. We try really hard to make sure you don’t offend AGAIN. While decreasing recidivism is a great thing, it misses the mark. I would much prefer to live in a world where there are no more first victims, not just no more subsequent victims.
Pedophilia ≠ Child Molestation
Pedophilia is an attraction.
Child molestation is a behavior.
They are not synonymous.
It seems as though there is another story in the news every day about the discovery of some type of sexual abuse in a church or school. This is both a good and a bad thing. It is good because it means that more victims are starting to come forward, speak their truth and hold their abuser accountable. This is obviously a bad thing because people continue to be abused by those whom they trust and are in positions of power or authority.
The more media coverage these incidents gain, the larger the public outcry. As with any type of sexual abuse, the question becomes, how do we prevent institutional abuse? We all want to believe that there is some way to screen out those individuals who might be prone to sexually abusing others and not allow them to be priests, clergy, boy scout leaders, teachers, etc. Despite the prevalence of this form of abuse, there is not a lot of research on institutional sexual abuse as a specific form of abuse.
To try to combat this lack of research and work toward decreasing sexual abuse in institutions, ATSA’s most recent edition of their scientific journal, Sexual Abuse, was dedicated to the problem of sexual abuse in institutions.
I believe that it would be easier for the public to believe that there is something particular about people who abuse others in institutional settings than people who commit sex crimes outside of these settings. In reviewing the literature on the subject, Harris and Terry (2019) indicate that CSA perpetrators who are in institutional settings possess similar characteristics to those who offend in other settings. Additionally, the factors that make children vulnerable to abuse are not unique to these settings either. This makes it difficult to identify those who might abuse and keep them out of situations where they have easy access to victims.
Amrom, Calkins & Fargo (2019), researchers from John Jay College of Criminal Justice in New York, looked at personality characteristics of sexual abusers in the hope of finding a way to identify sexually abusive clergy. They used the MMPI-2 and MCMI0-III in the study, which are widely accepted personality measures. What is known from studies of pre-employment MMPI-2s is that clergy applicants tend to present as defensive, extroverted, compulsive, self-confident, uncomfortable with expressions of anger and in possession of a strong need for approval. Additionally, past research shows us that Episcopal and Presbyterian clergy applicants tend to present as generally well adjusted but do display elevations of narcissistic, compulsive and histrionic traits.
Amrom et. al.’s study looked at the MMPI-2 and MCMI-III of three categories of people. The first category was clergy who were sent to treatment for child sexual abuse. The second category was clergy that were referred to treatment for noncriminal sexual behavior with adults and the third category was clergy that were referred to treatment for non-sexual reasons such as depression or drug or alcohol problems. The control group was a group of clergy that took the test for pre-employment and had no history of clinical or sexual issues.
The results of this study indicated that there were no differences between the sexual abuse group and the sexual misconduct group. There was a difference between the sexual abuse group and the clinical group in that the clinical group showed more signs of psychopathology than the sexual abuse group. One elevation was found on the Sexual Abuse group MCMI-III scores and that was for the trait of Aggressive/Sadistic subscale. Ultimately, the authors opined that the MCMI-III and MMPI-2 were not able to distinguish between the Sexual Abuse group and the other three groups suggesting that these personality measures are not very helpful when it comes to screening out possible future sexual abusers from the clergy applicants.
Another study in the special edition by Spraitz and Bowen (2019) looked at the grooming techniques used by priests who have sexually abused. Some studies into the topic have shown that, in addition to traditional grooming techniques, clergy will use their role as priests or as an extension of God as grooming technique when abusing parishioners. The researchers analyzed records from several Archdioceses and unsealed records that all involved priests or monks in sexual abuse cases. From these files they created a taxonomy of grooming techniques in the priest sexual abuse cases.
Grooming is the term used for the process that a person uses (normally an adult with a child victim) to create a “special” relationship with a victim and create opportunities to abuse. In this study, priests used the following techniques: 1) giving alcohol, cigarettes or drugs to the victim, 2) giving gifts to the victim, 3) taking the victim on overnight trips, 4) physical contact, 5) using mentorship or friendship, 6) playing favorites, 7) creating a relationship with the family and 8) abusing the position of respect and reverence.
Like other studies in this special journal edition, the researchers found that the abusive clergy in their sample were no different from non-clergy who use grooming to sexually abuse . The technique of abusing the position as a person of God was not an overt form of grooming. They found that the use of this technique may not be “purposeful, overt, or done consciously in all instances.” There were clergy who did use this technique overtly but not many in this study.
In short, the studies in this special issue of Sexual Abuse confirm that (for the studies published) the individuals who perpetrate sexual abuse in institutions are not significantly different from those who abuse outside of institutions. These results are frustrating as it would be a boon to the prevention of sexual abuse if there was a way to predict who might abuse versus who might not.
The research will continue and hopefully, in the future, more work will be published that can help prevention efforts.
A recent posting about our intensive program for sexual offenders on a professional social network greatly upset a person on the network. This person felt that it was disgusting that we offer a treatment program that can aide sentence mitigation for people accused of sexual crimes, or to paraphrase, that we help sex offenders get lighter sentences for financial gain. This upset me greatly as I take our work with people who have committed sex crimes very seriously and consider it prevention of sexual abuse. As I consider part of my work as an expert to counter emotion with science, I thought to put my own emotions on the back burner and write something educational about sentence mitigation.
What is Sentence Mitigation?
When someone is being sentenced for a crime a judge is obligated to take into consideration all of the information about that person. It is the job of the prosecution to present evidence of all of the aggravating factors in the case. These are the things that help them make an argument for stronger and harsher sentences. Aggravating factors can include prior offenses, vulnerable victims, hate crimes, violence, etc.
It is the job of a defense attorney to present the facts about the person that would support a less harsh sentence. Any facts presented for sentence mitigation are not related to the guilt of the person, they have acknowledged what they have done (pled guilty). Mitigating factors can be those that were in place prior to the offending such as lack of criminal record, mental illness, addiction, physical illness, history of being abused. Other mitigating factors are those the occur after the offense has happened. These can be acceptance of responsibility, rehabilitation post offense (treatment), cooperation with law enforcement, addiction, mental illness, etc. Mitigating factors do NOT excuse a crime but help provide an explanation.
Therapy as a Sentence Mitigation Tool
Do defense attorneys suggest clients go to therapy so they have some fuel for sentence mitigation? In a word, Yes. Many of our clients are referred to us by their attorneys after they have had a visit from the police or the FBI. This happens basically no matter the type of offense. DUI? Get a drug and alcohol assessment. Domestic Violence charge? Do some classes. Assault charge? Complete an anger management program.
What most people might not know, but all of us in the treatment community do know, is that very few people self-refer for treatment relating to addictions of any kind or offending. In over 10 years of practice ownership, I can count on one hand the number of clients who came to treatment with no outside pressure because they felt like they had a problem. Many clients are pressured into treatment. This pressure may come from a partner, spouse, employer or the police. People don’t self-refer for many reasons, shame, fear, stigma and wait until they are caught in some way shape or form be that watching pornography at work, getting a DUI, getting caught in an affair, running up the credit cards with gambling debt, etc.
The act of going to therapy itself does not help the defense attorney make a mitigation argument. It is what happens in therapy that can help a defense attorney make a mitigation argument. If a client is referred by an attorney for treatment, the initial thought might be something like “ok this will look good to the judge.” Any good therapist will know whether or not a client is taking the therapy work seriously. If the client is just biding time, trying to look good for a judge, that is reflected in the treatment reports that go to the attorney. Trust me that bad treatment reports never make it to court. Same thing for evaluations that deem a client high risk to re-offend. They hardly ever see the light of day in a court room.
What gets a person in the door of a therapy office is not necessarily what keeps them there. The goal with pre-sentence treatment is to help the person move from the “oh shit I’m caught” stage into really deeply and truly looking at their actions and the motivations for the actions. Though it is popular to believe that people who commit sexual crimes are deviant monsters who deserve to die, most (not all) people who are committing these crimes know they have a problem, feel a good deal of remorse and want to do what they can to help themselves. Thus, an attorney referral to help with sentence mitigation can turn into a person who really wants to do a lot of work on themselves to get better and make sure they never offend again.
Sitting at the end of a day filled with many emotions, I reflect on the work I do. I am proud of the work that I and my staff do working with people who have committed sexual offenses. I realize that I work with a population of people that the world would rather forget about and many people think don’t deserve treatment. Though it would be great if more people self-referred, I ultimately don’t care if it is an attorney referral that gets them through the door. Those of us who work with sexual offenders are doing prevention work.
My final words are not mine but those of one of my wonderful colleagues: Everyone deserves treatment. Period. Full Stop.
The second gem of a book I found while planning for my graduate human sexuality course last fall is Assisted Loving: The Journey through Sexuality and Aging by Ginger Manley. It is really easy to find books on most sexuality topics, such as sex addiction, sex therapy, general sex education, teens, pornography, etc. What does not exist is a lot of good quality resources for sexuality of seniors. Our world seems to forget that seniors have sex too!
Ginger Manley is a nurse practitioner and a certified sex therapist. She has been doing this work since the 1980’s. She also wrote a column in Mature Lifestyles magazine where people could write in to ask advice about sex, sexuality and aging. She has also taught sex education classes at Vanderbilt University specifically for those over 60 years of age. This book is a compilation of her columns that cover everything from relationships to medical issues.
So, what makes this book special? It specifically addresses the issues that most other sex therapy or sex advice books do not. When discussing relationships, most books do not tackle topics such as dating after the death of a spouse, how to date online when you are in your late 60’s or how to talk to your adult children about your new love interest. The fact that these are real questions from real people make the book very relatable. Ginger Manley’s frank and humorous style make the book fun.
I will relate a short story related to this book. I am the type of person who just reads my books related to work wherever I am, be that on an airplane, etc. If people ask me what I am reading I will show them. I was in a tire shop, waiting on my new tires, reading this book. A lovely older gentleman sat down next to me. He got a flat on the way to his church’s men’s group that needed to be fixed. He asked me what I was reading. I replied with a “do you really want to know?” And off we went. Turns out he was 83 years old and happily married for well over 50 years. We had a wonderful, long conversation about sexuality in older people, his own relationship with his wife and a million other things related to sex. Never in a million years did I think I would be having such an open and honest conversation about senior sex in a tire store with a man I never met! I relate this story because I think it shows that people want and need to talk about relationships and sexuality no matter the age.
So what are some of the issues that this book addresses? It is divided into four sections. The first focuses on relationship issues. Many of the issues that seniors face in their relationships are the same as the issues faced by younger couples. There are issues of communication, lack of sexual interest, and dissatisfaction in the bedroom. Other issues that are more frequent in older couples involve starting new relationships after the death of a spouse and how to navigate online dating when you are older.
The second section focuses on male issues. Not surprisingly, many of these focus on erectile issues or lack of sexual interest. Using both her sex therapy background and nursing background the author delves into issues of ED, low T, sexual functioning after prostate surgery and TURP (Transeurethral resection of the prostate). Section three turns to women’s issues. Again, the author’s role as a nurse is helpful in working through issues that come with aging including hormonal changes and incontinence issues.
The final section is devoted to other medical issues. The issues in this section are those that are not most commonly brought to the clinical office and I assume are not frequently brought to the medical doctor as well. She covers topics such as resuming sex after joint replacement surgeries, dealing with added weight or things such as blood pressure medications. Additionally, and much less talked about in general, are topics of Parkinson’s symptoms and sexuality as well as how to manage sexual activity when one spouse has early stage dementia.
If you work with sexuality issues in your practice, or if you are a senior who wants to get questions about your health and/or sex life answered, this little book is for you. It is a fun but serious look at how aging affects our sexuality and offers great advice to help us to enjoy a healthy sense of sexuality no matter our age!
Dr. Weeks is the founder and director of Sexual Addiction Treatment Services. For more information on her practice, check out the website at www.sexualaddictiontreatmentservices.com