Sex Offender Treatment Program on Personal Experience

Abstract

Sex crimes continue to be prevalent within the US population, so much so that they dedicated a whole spinoff of Law and Order to it. There is fascination with these crimes; “how could someone do that?” but also a firm desire to punish these offenders. Counseling within this population is specialized and continues to become more divided due to circumstances (different venues for treatment; prison programs, private practice, mental institutions). This population presents a challenge as well since most of the obtainable data about the sex offender population comes from incarceration. Those incarcerated have very little desire to participate in treatment and resistance can be a hurdle for even the most seasoned of therapists. On top of that, other factors such as co-occurring disorders (addictions, mental disorders), shame, guilt, and negative self-talk add to the difficulty of working with sex offenders. The most difficult part of obtaining research in order to write this paper was wading through the amount of negative journal articles in regards to the offender population. Most articles were centered on punishment, accountability, chemical castration, and recidivism. It is no question that the safety of our society is important (most importantly, our children) however, debilitating an individual who is already incarcerated and full of shame and guilt serves very little purpose and may in fact result in increased recidivism rates. Most disappointingly, these journal articles gathered for research were written by those in the counseling field…which leaves me to conclude that there is not enough being done in counseling the sex offender population. In Irvin Yalom’s novel, Love’s Executioner, he bravely details the mistakes he has made within group therapy, the most important being bias error: “Translation error is compounded by bias error. We distort others by forcing into them our preferred ideas and gestalts, a process Proust beautifully describes: We pack the physical outline of the creature we see with all the ideas we already formed about him, and in the complete picture of him which we compose in our minds, these ideas have certainly the principal place. In the end, they come to fill out so completely the curve of his cheeks, to follow so exactly the line of his nose, they blend so harmoniously in the sound of his voice that these seem to be no more than a transparent envelope so that each time we see the fact or hear the voice it is our own ideas of him which we recognize and to which we listen (Yalom, pg. 59).” This concept is not only important to the academic/therapist/college graduate…it is equally important to the patient, the mother, the friend, the human. How often do we do this? Create an ideal of someone, so that they become a culmination of our beliefs and biases that we have mashed together. For example, many sex offenders in group therapy come from very difficult backgrounds…full of anger, abuse, and unspoken rules. These unspoken rules could be as simple as not putting elbows on the table during dinner, or as emotionally complex as not being able to display emotion for fear of weakness. When dissecting unspoken rules within our relationship packet, most patients had no idea that these rules were unhealthy, and that they perpetuated this negative environment by teaching their children the same rules they grew up with. This bias has become so normal to the individual and so ingrained in his/her life that they pass it on without a second thought. This is a part of life for them, so when obligated to sit down and dissect the negative aspects of their past…they are faced with the realization that what was originally thought of as “normal,” isn’t, and their “reality” isn't as it should be. When a therapist, or intern student like myself, can identify how this happens in their/my life…empathy and understanding can take place. After all, a different situation may take place but the concept remains the same. He sums up the concept of unity and humanity in The Gift of Therapy: “I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between “them” (the afflicted) and “us” (the healers) (Yalom, 8).” This bias provides the foundation for what will be discussed in this paper; how Yalom’s therapeutic techniques apply to this population, treatment options available today, and my limited experience as it applies to incarcerated sexual offenders.

Contrary to the societal belief that places punishment before treatment, correctional professionals understand that group psychotherapy and treatment is more beneficial than any prison sentence (Andrews et al., 1990). The primary benefit of group psychotherapy is to develop healthy and functional relationships; this becomes increasingly important within incarcerated populations as the only peer support offered is with those who are in a similar situation (Mathias & Sindberg, 1986). Yalom places emphasis on interpersonal process-orientated groups which refers to a style of group therapy that focuses on the here-and-now (Yalom, 1995) yet not much research has been done on this approach. While group psychotherapy is beneficial to offender populations, it is important to note that it is not a cure-all (it is not intended to cure recidivism). The aim of group psychotherapy is to help offenders gain insight into their behavioral patterns (mainly those that encourage illegal behavior) while also increasing their awareness of how they interact with others, and how others view them. Yalom (1995) has identified 11 therapeutic factors that can institute therapeutic change; in regards to the offender, population emphasis will be placed on instillation of hope, universality, and interpersonal learning.

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Instilling Hope

Hope is an important theme within therapy, especially when working with populations in the prison environment (Toch, 1992). Inmates need to maintain that hope is possible, because the maintenance of hope corresponds with the constitution of change. According to Yalom, “faith in a treatment mode can in itself be therapeutically effective (Yalom, 1995, p.4).” Since much of the incarcerated population falls prey to resistance, the group therapist must be able to properly communicate why this process is important and effective. For example, the therapist must reinforce a client’s ability and expectation to change and may need to educate the benefits to more resistant clients. Most people know the myth of Pandora, a woman who was molded by Greek god Hephaestus to punish men on earth. Pandora was given a jar by the Gods that was full of gifts and was instructed by Zeus to never open it. Her own curiosity encouraged her to open it one day and resulted in the release of all the evils of mankind. Sickness, poverty, jealousy, and revenge were enacted upon the world, and Pandora seeing what unfolded, quickly sealed the jar again. Everything except hope was released, and it is thought that hope was the only gift left in an effort to comfort the humans in the face of all evil on earth (Hawthorne & Galdone, 1967). The absence of hope among individuals seeking change can lead to a series of consequences from stuck-ness in the therapeutic process or successful suicide. Hope can be difficult to maintain in prison, yet that responsibility falls upon the shoulders of the therapist leading the group. By instilling hope, a therapist only strengthens the relationship of the clients and group involved.

Universality

Even more so than any other population, it is important to mention that shame prevents convicted sex offenders from creating meaningful relationships. This stems from a series of other issues, yet the foundation is the negative belief that no one could understand not only what I have done, but who I am and what my desires are. It is not uncommon for inmates to enter therapy and feel alone in the way that they feel or the difficulties they face. Disconfirming this belief can be a powerful instrument for change and group therapy provides the opportunity for this. A therapist’s job in facilitating this development is to identify commonalities between members in regards to history, behavior, thoughts and feelings, and treatment goals. Sexual offenders present with a high a level of shame due to the criminality behind their behavior and the way that the US legal system is acted out. By learning that others feel the same shame, members will feel less inhibited in sharing their experiences and feelings.

Interpersonal Learning

Interpersonal relationships are instrumental because it enables a client to understand who they are and how they appear based on the reflections of others (Yalom, 1995). For example, the inmate code dictates how those incarcerated live their lives and can be a source of great pride. Morgan et al found that this was especially true with male inmates as the code reinforces the machismo culture typically encountered in the prison system (Morgan, Van Haveren, & Pearson, 2002). A sense of self may be developed due to this code that can come with the respect and admiration of peers.

Interpersonal process groups can rekindle previous emotional experiences resulting in a “corrective emotional experience” (Yalom, 1995). Simply feeling these emotions is not enough, a cognitive layer must be implemented in which the client reflects and makes sense of the emotional turmoil that has occurred in their life. This presents a problem with sexual offenders as awareness of their own emotional experiences and the experiences of others can be difficult to attain. The responsibility falls on the therapist to make sense of emotions that are displayed during group sessions, which can include anger and hostility. In any setting, anger is viewed as progress, yet in incarceration, anger can be dangerous and detrimental. The expression of anger must be released in a therapeutic way as to avoid a violent encounter (Hassine, 1996).

The biggest benefit of interpersonal learning is the creation of a “social microcosm” (Yalom, 1995). In the basest of terms, clients will “keep it real” with each other, displaying true emotions including strengths and weaknesses. The first step of the therapist is to identify individual maladaptive patterns and then prep clients to receive feedback from others within the group. For example, a common issue within the prison population is sleeping during session. In an effort to address this, the therapist may ask group members what they think the impact of this behavior is on the group and how a client may change that behavior. Typically, hearing the disapproval from peers is enough for a client to quit engaging in disrespectful behavior.

Treatment Options

There are a myriad of sex offender treatment options, but for the benefit of this population, the focus will be on the aspects that they find the most helpful and instrumental. The Sex Offender Treatment and Evaluation Project, an inpatient programs for offenders in California, utilized an exit interview to understand what treatment options were the most helpful (Marques, Day, Nelson, Miner, & West, 1991). The results indicated that clients found relapse prevention, individual therapy, and stress and anger management as the most important in recovery. The least important area was sex education. These clients indicated that therapy was overall satisfactory, as staff attitudes tended to be judgmental. Levenson and Prescott (2009) surveyed 44 incarcerated sex offenders in Wisconsin who displayed positive outcomes with therapy, yet divulged that the lack of confidentiality and therapists who seemed judgmental led to a slow progression (Levenson & Prescott, 2009). Beech and Hamilton-Giachritsis (2005) found that group cohesion and a supportive stance from therapists were associated with reductions in offending behavior. These reductions were summed up by an inverse correlation of engagement in therapy and denial, and that those actively engaged in treatment has greater levels of accountability and displayed more progress toward their treatment goals (Beech & Hamilton-Giachritsis, 2005).

In regards to treating sexual offenders, therapists understand that mitigating risk is a primary concern; society demands protection and we should share a common goal in ensuring that there will be no more victims. This section is in no way meant to dull the horror and tragedy of sex crimes or to take preference of an offender over a victim. However, it would be foolish of us to assume that society does not play a part in perpetuating these crimes. It is our society after all that erects the barriers that stand in the way of the recovery of sexual offenders. The fact is that limited jobs, housing restrictions, and sex offender registration raise risk factors for recidivism. Our restrictive policies feed hopelessness; they fuel the false idea that treatment and recovery are impossible and that relapse is likely. Politicians and law enforcement respond to the public’s demand for justice with stricter regulations and laws for offenders which in turn send a message of “You are not welcome here, and you will never change.” There is also the gray area in which constitutes a sexual offender; I once worked on a case of a 19-year-old male engaging in consensual sex with a 16-year-old female. Many of the people I have shared this story with do not believe this makes a sexual offense, yet that 19-year-old will remain on the sex offender registry for life. The Romeo and Juliet law now prohibits this from being a sex crime as long as there is no more than three years between offender and victim. Too little, too late for my client, yet this is a step forward in the right direction.

Experience

My undergraduate internship at the Community Assistance Center in Honolulu, Hawaii enabled me to work with incarcerated sex offenders in state prison, federal prison, and those on parole or probation in both arenas. This internship turned into a job that I enjoyed for four years before moving to Austin, Texas to complete my master’s program in clinical counseling. Prior to the start of my practicum, I held the same beliefs that many in society do; that those who commit sexual crimes are among the lowest of human beings and that the punishment for that crime should be life in prison. My fear and trepidation towards working with this population proved unfounded, and my clients' and society’s perception of my role in therapy gave me more insight into my world than any measure of individual therapy ever has. The biggest critic of my population choice was my sister, who expressed frequently her worry about my safety and her general disgust with the offenders that I had grown to empathize with. Even when confronted with the research, that child sex offenders have a recidivism rate of 10% after prison time and treatment (Bench, 2013), she still refused to come to terms with it. Her point of view is the perspective that much of society shares and one that, as a mother of two, I can understand. The treatment of sex offenders is a relatively new concept and although it has worked for many years outside of the US, Americans have an “eye for eye” mentality when it comes to sex crimes. Yet, time brings about changes and if child sex crimes are still as prevalent as ever, then it follows that somewhere/somehow we are failing at prevention. So why not try treatment? Especially when multiple research experiments have shown that treatment can and does work. Barry Maletzky and Kevin McGovern of The Sexual Abuse Clinic located in Portland, Oregon followed 5000 offenders treated in their clinic between 1973 and 1990 using behavior-oriented methods. Some men were analyzed for as long as 17 years post-treatment, and success was achieved with 94.7% of the sample size. Success in this research design was determined by recidivism, which should be broadened with an updated study including other areas of success like treatment/post-treatment outcomes, management of behavior, and interpersonal relationships (McGovern, 1991).

When I entered my practicum, I was under the impression that a pedophile and a sex offender were synonymous. This is not the case; pedophilia is a psychiatric disorder in which an adult or older adolescent experiences a primary or exclusive sexual attraction to prepubescent children, generally age 11 years or younger. Therefore, not all sex offenders are pedophiles (some desire those older than 11 years) and not all pedophiles are sex offenders (most go their whole lives without giving in to their urges). Differentiating these two terms is important when it comes to societal bias. It is also important to note that there are biological influences that can encourage this behavior. James Cantor is the head of research in the Sexual Behaviors Clinic at the Center for Addiction and Mental Health, Canada’s largest mental health and teaching hospital. He has been working on better understanding sexual offending and through brain scans found differences in the white matter of a sexual offender's brain in comparison to a normal functioning brain. White matter is a shorthand term for groupings of axons and glial cells that transmit signals through the gray matter that makes up the cerebrum (think of gray matter like houses on a specific electric grid and white matter as the cables connecting those houses to the grid). Cantor states: “There doesn't seem to be a ‘pedophilia’ center in the brain. Instead, there is either not enough of this cabling, not the correct kind of cabling, or it is wiring the wrong areas together; so instead of the brain evoking protective or parental instincts when these people see children, it’s instead evoking sexual instincts. There’s almost literally a crossed wiring (Cantor, 2005).” Not so long ago homosexuality was listed in the DSM as a mental disorder and the biological aspects are still a topic of controversy today. The study by James Cantor is eye-opening and may sway much of public opinion that sexual offenders or pedophiles are “sick.” If biology is taken into account, then treatment does not seem like such a far-fetched idea.

In my experience, there is no assumption more dangerous than to believe that a person’s actions make up the entirety of who they are. One case in particular involved James (name changed), a Micronesian young adult who moved to Hawaii to provide for his family. He was on Oahu for two weeks before engaging in consensual sex with a minor. He knew and understood that she was a minor at the time, however, he did not comprehend that there were legal consequences that came with the choice he made. In Micronesia there is no age of consent and the legal system in place is minimal (practically non-existent). Prison is difficult for even the hardened criminal, yet James struggled more so due to his inability to speak English. Every treatment packet he read in group had to be translated and then comprehended. It took many months for him to understand that what he had done was illegal and carried a sentence of ten years in incarceration; to say he was hopeless is putting it lightly…I often wondered when I would show up to group and find out that he had committed suicide. After seven months of the same group, I saw the beginnings of universality and how this concept changed James. He felt less alone, he shared more willingly, and he persevered in learning English with the assistance of his group members. These interpersonal relationships allowed him to believe that he was more than the sum of his actions and that his original intention to provide for his family was still attainable. Upon the death of my clinical supervisor, Jerry, I flew back home to attend his funeral and was blessed to see more than three hundred of his former clients lined up to bid him farewell. James stood there, tears in his eyes, clutching his newborn daughter with his wife by his side. Upon completion of the sex offender treatment program, Jerry wrote James a recommendation for early release, and five years after entering the system, he walked out a ‘free’ man. While he has many years of probation ahead of him and his name on a registry, he told me how blessed and thankful he was to be given the opportunity to change and fulfill his dream; with a job in construction he saved up enough money to bring his entire family to Hawaii (mom, dad, and seven siblings!) While not every case study ends with a warm fuzzy feeling, this one is a profound reminder that change is possible.

References

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1. Yalom, I. D. (2009). The gift of therapy. (1st ed.). Harper Perennial.
2. Yalom, I. D. (2012). Love's executioner. (2nd ed.). Basic Books.