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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.
If you have been following our blog series, you know that we are trying to use our years of experience to help you find the best counsel and treatment possible for the issues that brought you into the legal system. This post may be the only controversial one of the series.
Should you take a polygraph test?
When most people think of a polygraph, they think about something they saw on TV or a lie detector. The polygraph is not a lie detector but a device that measures physiological responses. It is often not admissible in criminal court (though it is in some places and can be used for probation violations). So why am I even talking about it?
Despite it’s issues, the polygraph is routinely used in the treatment of sexual offenders and is considered a standard of practice. So even if you don’t do a polygraph pre-trial, you will while you are on probation. While on probation it is used as a therapeutic “tool” to assess whether the person on probation is following rules and regulations of probation and/or keeping any secrets from treatment and probation. It is a measure used to gather information.
Again, why on earth am I talking about you possibly taking a polygraph examination before you go to court? Just like it is used as a tool after adjudication, we can use it as a tool prior to sentencing. In our geographic area, the FBI likes to ask people they are investigating (often within hours of knocking on your door in the wee hours of the morning) to voluntarily consent to a polygraph test. What are they looking for by doing this? They are seeking any evidence that you may be a mixed offender. A mixed offender is someone who is being investigated or arrested for a cybersex crime that ALSO has committed a hands-on sexual offense in their lifetime. It will come as no surprise that many people to take this polygraph test right away don’t do very well. There are many reasons for that, anxiety, fear and absolutely no preparation.
As someone being investigated for a sex crime, why might it be helpful to you to do a polygraph? Honestly, for the same reasons that the FBI does them. Research now tells us that the assumption that people who look at child pornography must also be contact offenders is false. However, it is hard for a court or an evaluator to just take someone’s word for it. Though it is not admissible in court, if you take and pass a sexual history polygraph and have no history of contact offending, this has a favorable effect on your risk of recidivism.
Guidelines for taking a polygraph before sentencing
- Make sure your attorney is on board with this decision. As with an evaluation, you can do this through your attorney so if you don’t have a favorable result from a polygraph it will be protected under attorney client privilege.
- Find a polygrapher who is trained, accredited and familiar with working with sexual offenders and giving sexual history polygraphs. You want to take a Sexual History Polygraph.
- Do your homework. This means that you and your therapist need to spend a great deal of time going through your sexual history with a fine-tooth comb. This takes time. People often have trouble on polygraph tests because they don’t really go through their history. Work through your sexual history from the first time you kissed someone through the moment you are ready to take the polygraph.
- BE HONEST. It is best to be honest and pass than to keep and hold your secrets and have a deception indicated. Also remember, that though this may be a tool to help you in sentence mitigation, it is ultimately about you getting honest with yourself to help your treatment and growth into a better human!
Shame lives in secrecy. If there are no more secrets you can start to work on shame reduction. This means that the value of the polygraph can be something more than just another measure your attorney or psychosexual evaluator can use in sentence mitigation.
Dr. Jennifer Weeks is the owner of Sexual Addiction Treatment Services. She specializes in the treatment of sexual offenders and cybersex offenders. Through her program she provides psychosexual evaluations, treatment and expert witness testimony. SATS also offers coaching services for those people who are being investigated but are not in Pennsylvania.
If you are reading this blog, either you or someone you care about has recently been visited by the police and are under investigation for a cybersex crime. You are likely in shock and are likely panicking. After many years of working with people in this situation, I have learned a thing or two of what to do next. Even though you might be panicked, immobilized, in shock or depressed, you must take action.
Here is what you need to do right away.
- Hire an attorney
If you have the money or can rustle up the money, you need to immediately hire an attorney. I will talk about what to look for in an attorney in a later post. What you need to know in these first moments is that you should not just hire the first attorney you talk to. Talk to several criminal defense attorneys. Find out how much experience they have working with cybersex cases. Make sure that the attorney has experience working with cybersex cases at your level. If the FBI is investigating you, you need an attorney who has experience in Federal Court. If you cannot afford to hire an attorney, you are going to have to be your own advocate during this process. A court appointed attorney won’t have the time to give you what a private attorney will. You will have to do some of the leg work yourself.
- Make sure you are safe
When I say make sure you are safe, I mean make sure you are emotionally safe. People who are investigated for cybersex crimes frequently feel immediately suicidal. The majority of cybersex offenders have never been in trouble with the law before and the entire process can cause a shame spiral. If you feel suicidal, go to the emergency room or find a hospital where you can go for a few days to ensure your emotional health and well-being. If you are the loved one of someone who is under investigation be aware that they may be experiencing suicidal thoughts.
- Find a therapist
Now is not the time to just go down the list of in-network treatment providers from your insurance. You don’t just need a therapist, you need a specialist. The therapist you see should have experience treating people in your exact situation. They should have experience treating sexual offenders and perhaps pornography addicts. While many therapists might be able to help you work through the anxiety and depression that will occur related to the investigation, if they don’t have experience working with the specific sexual behaviors or the court process, they will not be as effective as someone who specializes.
The criminal justice system works at a rather slow pace. You will have time to deal with all of what comes after the investigation. I will address many of these things in further posts.
If you are newly investigated please do things now and start to let experienced professionals help you through this process.
Dr. Jennifer Weeks is a Clinically Certified Sex Offender Treatment Specialist and an expert witness in the areas of sexual offending, cybersex offending and sexual addiction. For more information on her services please go to the Sexual Addiction Treatment Services website.