|
As with most areas in psychology, the assessment
phase is much easier than the treatment phase. It is easy for us
to assess and diagnose. Treatment is much more difficult. This has
never been so true as with sex offenders.
Confrontational one-on-one therapy is effective only after there
is some development of a trusting relationship. Those forced by
the legal system to seek treatment, and required by law to attend
a particular amount of sessions, usually have a better outcome in
terms of disclosure. The Plethysmograph has been widely used and
very effective. The Plethysmograph is a small blood pressure cuff
that is placed around the shaft of the penis. Visual stimuli are
then presented to the alleged perpetrator, and it measures arousal
levels. The visual stimuli can be children that are clothed of various
ages, and a variety of visual stimuli are presented. At that time,
the alleged perpetrator is usually given a urine drop before the
Plethysmograph is administered. This is to check for substances
that the perpetrator will often take to minimize the results. They
will take Benzodiazepines and Beta-blockers to try to decrease their
arousal state. This also discloses the extent to which a perpetrator
will go to fake the test.
Perpetrators in treatment must always be responsible for the fee.
This author has had individuals who have literally had to sell their
boats to pay for treatment, sell certain luxury items to pay for
treatment, especially when they are mandated by the courts.
Public awareness of who the offender is has been very controversial,
but effective. In 1992, this author presented this viewpoint to
a group of 300, at a time when this issue was just reaching the
forefront, and met with a lot of resistance among fellow professionals.
It has since proven to be a very effective method. Issues of embarrassment,
and legal issues in terms of HIPPA rules, have made this a thin
ice issue. When mandated by the courts in 1992-93, this author saw
many perpetrators who were required to send letters to their places
of employment to let their bosses know they were perpetrators, and
were not fired. Letters were also sent to principals of schools,
and other places the perpetrators were affiliated with. They had
to write these letters, sign and submit them. Although difficult
to do, this author had approximately 5-10% success rate with perpetrators
who would write these letters and bring them to those in the community
who were in contact with them, including neighbors, to let them
know they were perpetrators and currently undergoing treatment.
Group therapy:
Group therapy can be powerful, and effective. Part of the reason
for this is that you usually have individuals at different levels
of treatment, very similar to AA groups. There is usually nothing
more effective than having a perpetrator in a group tell another
perpetrator that he is “full of shit” and that he is
not coming clean or coming true with some of his issues in group
work. As per Salter, there will be a list of assignments that offenders
will work on while not in the group. The following are a list of
assignments that were developed and utilized by the Northwest Treatment
Associates. These are fairly standard and they have also been used
in the Midwest at many treatment facilities. Sexual autobiography
is key. Sexual autobiography is usually always added upon because
more and more issues come out in sessions. This is a timeline, if
you will, and details certain sexual offenses. For the sake of brevity,
I will not mention all the assignments, but I will mention a few
to give individuals an idea of some of the treatment modalities.
- An addition list. This list is developed by the offender, which
is not only the addiction of some of the sexual issues that he
has, but other addictions, whether they are alcohol, drugs, or
gambling.
- Victim reminders. They usually have to come up with 25 victim
reminders. These reminders are triggers that the offender usually
needs or sees that may trigger arousal. It could be a certain
dress that the victim was wearing. It could be a certain soap
or shampoo that is triggering the offender. It actually could
be a cartoon, favorite T.V. program, or a Disney movie that the
child watches. A variety of victim reminders.
- An empathy paper. This is helpful to question sincerity. It
is not uncommon for this empathy paper to be written 3-4 times,
in terms of an apology, what he would like to state to the victim
and the family, in terms of being sorry.
- 40 adults. The offender should come up with 40 adults that
he will acknowledge and to whom he will write and sign this letter,
to let them know that he is an offender and he is under treatment.
This is a controversial area, but is very helpful in decreasing
recidivism. To make sure that these letters are actually received,
there is usually another letter that must be signed back by the
recipient, so the therapy knows they did receive it.
Many of the above are brought up in group therapy. There are many
more on this list, but again, for the sake of brevity, we will keep
this at a minimum.
Some examples to minimize the possibility of re-offense, or to
minimize the possibility of recidivism, a jogger, for example, who
is involved in exhibitionism, may be obligated to put his name and
address on the shirt of his jogging outfit to help decreases the
changes of him re-offending, and as previously stated, this is most
helpful.
Treatment of sex offenders is obviously far more involved that
has been mentioned here. It is a complicated issue with a high recidivism
rate, and is subsequently very frustrating for the therapist, in
terms of lack of success. More will be added at a later time.
References
Treating Child Sex Offenders and Victims - A Practical Guide, Salter,
Anna C.
|
