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. 

Child Pornography Prevention

gavel and handcuffs on laptop

On Tuesday another one of my clients was sentenced in Federal Court on Possession of Child Pornography charges. That evening, the group talked about how to prevent people from possessing child pornography.

A Federal judge is mandated to look at four factors (according to US Code 3553) when imposing a sentence upon a defendant. Any sentence must reflect the seriousness of the crime; provide deterrence to criminal conduct; protect the public from further crime and provide rehabilitation.

The way I have heard judges, both federal and county, explain their thoughts on deterrence is that they need to impose a sentence that will send a message to other people in the community who are either engaging in the behavior or thinking about it. Their thinking is that if someone sees the sentence imposed upon another for a crime, they will either stop or won’t start engaging in an illegal behavior.

I and my clients both struggle with the concept of deterrence in these cases. My clients will tell you that they knew what they were doing was wrong and they wanted to stop. They also will tell you that they could not stop. Reading news stories in their local paper about individuals being arrested for possession of child pornography did not deter their behavior. They were aware of the illegality of their behavior but were caught up in the throes of addiction, they could not stop their behavior.

I also see this in my clients who are new to treatment after the police initiate an investigation into their illegal pornography use. In the near term time frame, clients can’t even imagine looking at pornography again. I call this “sobriety by police”. One would think that the appearance of the FBI in your home at 5 a.m. would be a great deterrent to addictive behavior. However, it is not a long term deterrent. When we are dealing with addiction, punitive deterrents do not last as long as the client would like or as long society would think.

If the use of legal deterrents is not very effective in stopping people from viewing child pornography, the question remains, what will work? I believe the lack of actual prevention work is problematic. There are prevention programs for teens regarding drugs, alcohol and even gambling. There are no real prevention programs for pornography for teens. There are some well meaning groups who are spear heading this movement and this week the cover story in Time Magazine is about pornography and young people. Still, no one is talking about child pornography. Even in talking about problematic pornography use child pornography is rarely addressed, yet there are a lot of people, both adults and teenagers, who are watching it online.

Many of the younger men who come to my practice started looking at pornography online when they were approximately 12 years old. This statistic is not uncommon. We know that the average age of first exposure to online pornography is around 11 years old. What is also very common for my younger clients is that they started watching child pornography at the age of 12 as well. Though it is biologically appropriate for a teenager to have sexual attraction to a teenager, to watch pornography involving 12 year olds is illegal. Also, the content of those videos is frequently the result of child sexual assault. Therefore, it is not truly the same as a 12 year old looking at another 12 year old in school and having sexual thoughts about them.

The news is bombarded with articles about teen sexting and some of those teens being charged with either production or possession of child pornography. This youth produced imagery is not normally what we see in child pornography possession cases. Exposure to stories about teen sexting helps spread awareness but not enough.

How do we prevent the possession of child pornography? By spreading educated awareness, meaning thoughtful, helpful awareness that is free of judgment and shame.

First, talk to your children about online pornography. When you are talking to your children about online pornography you MUST also talk to them about child pornography. An illegal image is only a Google search away. Talk to your children about what to do if they come across this imagery. Talk about the images your child might have seen.

Second, we need to acknowledge that pornography addiction in adolescents and adults is a real problem. The academic crowd might argue as to whether or not pornography addiction exists. Let them argue. What those of us in the trenches know is that pornography addiction is real. There is treatment available from specialists who are trained to specifically deal with this issue. If you know someone who is struggling with pornography addiction, talk to them. Let them know that they can get treatment. Treatment is always confidential so no one has to know if they don’t want them to know.

Third, know that incidental contact with child pornography is not that uncommon. Most people think that gaining access to child pornography is difficult. It is not. Anyone who is using a filesharing program to download pornography has likely seen child pornography. Anyone who has been looking at pornography online for a long time has likely seen child pornography. This does not mean that they are looking for it but they have likely come across it. Even if you are not seeking it out but have inadvertently opened a thumbnail file that is a pornographic image or video of a child, you can be arrested for it. Anyone who wishes to avoid incidental contact with child pornography should stay away from file sharing programs. You can download thousands of images quickly but likely some of that is illegal. Stop using filesharing programs.

A final thing to know is that even if you are addicted to viewing pornography that includes child pornography, you can get help. Each state has different rules, but in most states, any therapist you go to is NOT legally required to report the use of child pornography. Recent law changes (2015) in Pennsylvania and California have made child pornography viewing part of a therapists mandate to report. If you live in a state where there is a mandate to report, you can still get help for pornography addiction, you just won’t be able to say you are also looking at illegal pornography. This is obviously not ideal for the context of therapy, but is still better than nothing.

People possess child pornography for a multitude of reasons. Some started to look at it 15 years ago when they were a young teen and never stopped. Perhaps their pornography addiction progressed to the level that they needed more taboo material to get a “hit”. Some are reenacting a childhood trauma by watching images of child sexual assault. Some people intentionally look for the content because they are attracted to minors. Some people encounter child pornography by accident. No matter what route a person takes to get there, any possession of child pornography is illegal and the person can be prosecuted and placed on a sex offender registry.

The more we talk about the problem of child pornography in a rational manner that is not based in fear, the more we can enact prevention efforts. Talking to a 12 year old about the risks of looking at illegal pornography may be uncomfortable for a parent, but please trust that the conversation about pornography will be much less uncomfortable than sitting in a court room waiting for a judge to sentence your child for an internet sex crime.

Jennifer Weeks Ph.D. LPC CAADC CSAT-S is the founder and owner of Sexual Addiction Treatment Services (SATS). SATS is an out-patient treatment program located in Pennsylvania that specializes in the treatment of sexual addiction and in treating sexually addicted offenders. Dr. Weeks specializes in treating cybersex offenders. She has been an invited presenter on the topic, taught continuing education for attorneys and serves as an expert witness on the topic.

Sexual Abuse – Societal Double Standard

Last week there were two high profile cases in the area newspapers involving sexual abuse.  One was about a male psychiatrist who is accused of sexually assaulting several female clients, some of which were underage.  The second was about a female high school teacher who was accused of having an inappropriate sexual relationship with a student. I made the mistake of looking at the comments sections of the online versions of these stories.  Though I really should have known better than to do so, these comments brought to light a shocking difference in how these events were perceived.  Granted, this is the perception of those persons willing to put a comment on a newspaper web-page.  Nonetheless, they do represent a sample of our society.

What was glaringly evident, based on these comments, was the difference in how the sexual abuse was perceived based on the gender of the perpetrator and the victim.  Both of the alleged perpetrators were in a position of trust, one a teacher and one a psychiatrist.  Both of the alleged perpetrators had sexual contact with a minor.  What was very different was how the commentators viewed the issues.  In the case of the male psychiatrist accused of assaulting female victims, the comments were a relative consensus of negative feedback, some cruder than others.  The overall impression was that this was a horrible abuse of trust of his position as a doctor and that he was a sick or depraved man.

In the case of the female teacher accused of having sexual contact with her male, underage student, the comments were of a very different vein.  Many of the comments involved people commenting on how this was the quintessential adolescent male fantasy.  Many of the commentors stated that they would have had sex with her if they were in the teenager’s shoes.  What was missing was the plethora of comments about how horrible this event was or that it was, clearly, sexual assault.

This disparity in societal feedback was made even more pronounced in my brain as that same day I received an announcement for the Creative Changes Conference promoting its 6th Annual “It Happens to Boys” conference in February of this year.  (www.creativechangeconferences.com). This minimization of the impact of sexual abuse on boys is damaging in so many ways.  As a clinician, I work with many men who were sexually abused as boys.  This abuse is, in fact, very impactful for them and a source of deep shame and trauma.  The fact that it is often perpetrated by men can add to the shame of the event and decrease a boy’s likelihood of coming forward to report the abuse.

The organization Male Survivor (www.malesurvivor.org) discusses many of the myths of male sexual abuse.  When I think about the event recently in the news here, Male Survivor’s Myth #7 comes to mind (http://malesurvivor.org/myths.html), “If the perpetrator is female, the boy or adolescent should consider himself fortunate to have been introduced to heterosexual activity.”  The comments in the news article overwhelmingly supported this myth.  Not confronting this myth does a disservice to those boys that are sexually abused.  Any sexual abuse of any kind is dangerous and damaging.

In no way do I want this post to infer that I am minimizing the impact of sexual assault on female victims.  This post is simply the result of my experience both in reading the comments of these news articles and my work with many men who were sexually abused as boys.  I challenge all of us to confront our own judgments and myths about sexual assault. It is imperative that we all realize that sexual assault is damaging and traumatic to the victims, no matter what the gender of either the perpetrator or the victim.