The monthly meeting of CCOSO, the California coalition on sex offending, takes place at 150th street in San Leandro, in the basement of a building that doubles (triples?) as a courthouse and juvenile hall. Indeed, the lobby resembles an airport terminal, complete with airport security. I was a guest speaker, there because my colleague was “lacking energy”, so he said. I wasn’t, I guess, though I would be by the end of the day. It was the end of August–hadn’t taken a vacation yet. Labor day’s around the corner, and then it’s on. It’s too late, isn’t it…to rest?
Well, I won’t be a sex offender treatment provider much longer, so maybe I can rest soon. Not that I mentioned this. As I looked about the room, at the one or two familiar, sympathetic faces, I felt the late summer languor, but also the resilient push of the twenty-deep audience. Some of these people–psychologists, mostly, plus a few probation officers– had been working this ugly corner of the business for quite some time. They had things to say, a backlog of knowledge and experience. But they were curious and open-minded, having heard my voice before, in previous meetings. The last time had been in January, when my colleagues and I from Impulse Treatment Center and Foundry showed up to scourge AB 1775, the execrable new law supposedly cracking down on child porn. Now I was back, all by my lonesome. My topic: “Assessment, modality, and course of treatment.” Sounds innocuous, doesn’t it? It wasn’t.
The assessment part was dry enough. Referring to the so-called Risk-Needs-Responsivity model, I outlined the differences between so-called static needs (criminal hx.) of cases, versus the dynamic risk factors (far more numerous) which are of increasing interest. It used to be different. Back in the day (meaning, like, the 80s) static factors were all that counted. A criminal was a criminal; they had anti-social personality disorder, and that was that. Treatment, or psychotherapy, was understood as a glorified act of babysitting, entailing regular discussions with offenders, reminding them to not do the things that get them in trouble–attending to the risk, their ‘criminogenic” needs. I shouldn’t be so flippant. I wasn’t a therapist in the 80s, so I don’t really know that it was this flat and uninspired. Still, what’s true is that sex offender treatment has long been predicated on the paradoxical notion that offenders aren’t treatable.
Latter day research is altering the methods, ethos of providers, even if public opinion about this population remains–excuse me–static. In particular, the work of researchers like Michael Seto and Karl Hanson has loosened the thinking somewhat. Their studies reveal profile differences between online child porn users and direct contact offenders: pointing out that online users only possess greater victim empathy capacity, lower scores on anti-social personality test assessments, lower recidivism rates with respect to sex offending behavior. With a nod to the POs, I kept using the word “recidivism” at the CCOSO meeting, knowing this construct held more currency with them. Not without reason, actually: another researcher, Stephen Brake, cast doubt upon SO research in 2012, by pointing out in his meta-analysis that only two studies out of 37 in the last decade have managed to correlate victim empathy with lowered recidivism. On the other hand, methodology of research on the whole is suspect. I note his skepticism about cognitive behavioral therapy as the treatment style of choice, and about the reliability of other factors. Inadequate control groups is one problem: standards of intervention are poorly defined; the lack of long-term outcomes. He points out that the positive results of some programs (low recidivism rates) are attributed to psychotherapeutic method when many of these same SO programs concurrently use pharmacological, or hormonal treatments–the so-called chemical castration treatment–which are at least as likely to be the agents of change. I just crossed my legs, by the way.
Anyway, my pitch to my audience was for more flexibility in our approaches; more openness to alternative treatment methods: EFT, EMDR, narrative therapies that might address the trauma histories of offenders (example of a dynamic risk factor); even a psychoanalytically-derived approach that treated patients as if they were capable of achieving transference with a provider, or even a group of peers. My audience seemed to agree, noting that they, too, had been straying from the CBT workbook script from time to time. A great example of an intervention designed to induce victim empathy was volunteered: “Remember how it felt when you saw your name, and more importantly, your picture, on that public registry. I think that must be similar for someone in porn–particularly a minor: to know they’re being looked at”. One psychologist perhaps disliked my broader implications, my criticism of standards. She made cryptic appeals for retaining the bathwater. “I think it’s a matter of integration”, she said. However, most agreed that the internet phenomenon had done more than simply proliferate child porn; it had also diversified the offender population. Hanson, for example, points out that online offenders are likely to present more characteristics in common with compulsive sex addicts versus conventional offenders, hence the rationale for what I term “hybrid” therapy groups, mixing lower risk sex offenders with sex addicts who do not necessarily engage in illegal behaviors.
For my coup de grace, I turned further to the matter of group therapy, for which there are few standards, much less reliable research, largely because it’s so hard to isolate factors for success. Nonetheless, I turned my head to the stolid POs present, observed a few things that had bothered me in recent years about the model that places them in charge: the arbitrary transfer of probationers from one county to the next, which inevitably extricates clients from programs; the unnecessarily punitive incarcerations for trivial matters, token probation violations. If we are to think of SOs as those who merit care, then we can’t do therapy by half measures, I say. They must have some confidentiality. They must be allowed to make proper use of the therapeutic space, the chance to form a rapport and an alliance with professionals and peers. They must have continuity of care. I know that POs don’t have much more power than me, but they have a voice.
Unbeknownst to them, it was a parting comment, this criticism of the so-called Containment model. In December, my credential for treating this population will expire, and I’ve chosen not to renew. My bad if things indeed get better.