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Longing to matter

 

End of the year. These are the shortest days as time tumbles towards the new year, and in that compressed space it seems time to add a parting note or two about my last novel, Venus Looks Down On A Prairie Vole. Written mostly in 2015, published in the shortest days of last year, I now feel it slipping from my mind, no longer living a constant, parallel life in my head. I imagine many writers, the successful and the (like me) unsuccessful, are like this. We are fickle. We skipped well upon rocks over water when kids, and are prone to moving on in certain areas of our lives, losing interest before others do, assuming that interest is there in the first place.

For myself, of the various intermingling themes in Venus, freedom and loneliness linger with the most purpose. From the outset of the novel, the freedom of therapist Daniel Pierce is not a happy one. Estranged from his son, and grieving over the death of his wife, he plods through a daily task which reflects a more mundane aspect of his isolation: he struggles to communicate with a representative of an insurance company, seeking to get paid for his services. Intended to satirize the managed care industry, this exchange is bookended at story’s end, and lives in light juxtaposition with the novel’s more serious plot. Yet it highlights an unpleasant side of Pierce’s outsider role, one in which complaints go unheard; acknowledgement, and sometimes reward, is delayed, or withheld indefinitely. The result is helplessness: a sense that he is alone, vulnerable, and—treated as dispensable by a governing machine—fated to lose.

The idea was to set him up (and the reader) for a winning comeback. Daniel Pierce, a stand-in for mental health professionals who are underpaid, who are poorly represented by their associations; for whom laws (like AB1775) are written without their proper consultation, gets to be difficult. He gets to show an arrogant if well-meaning interventionist that he won’t enact hers or mainstream society’s notions of heroism. He gets to show lawyers, even a judge, that he won’t be at their beckon call, and further, that he won’t betray the principles of his profession just because they think there is a greater cause. For anyone who might listen, he (like myself), will expose hypocrisy, tautologies, and—despite the will of a legal and professional system—fashion his own ending.

It’s a fantasy, of course. Side note: I enjoyed a documentary about Alfred Hitchcock recently in which Martin Scorsese enthused about Vertigo, one of my favorite films. He loved the way the film indulged fantasy, dodging that which is plausible for the sake of compelling drama. Amen, I say. And so, Venus is a statement of my fantasy: a longing to matter when isolated and (at least sometimes) unheard. The story is ironic for me in so far as I am largely happy in my relatively isolated, private practice. Yes, I have the occasional problem with managed care, but in Venus I put a little on it for the sake of compelling drama. And yes, I have been subpoenaed and otherwise called upon to break the confidentiality of clients by an importuning authority, but I have not grandstanded as Daniel Pierce does.

The story is ironic for Daniel Pierce in so far as he isn’t necessarily sympathetic to his wrongdoing client. His default advocacy for a man accused of molesting his child is a serendipitous event, and Pierce defends the privacy of their session (the professional one, plus those which symbolically take place away from the confines of an acceptable setting) not because he thinks the man innocent, but rather because he’s concerned with principle: preserving the confidentiality of the therapeutic space, for everyone. If you think that a precious or overreaching cause, especially in the context of child abuse, then consider what I’ve previously written in entries like “Why child abuse isn’t as important as you think”. Why are psychotherapists mandated reporters of child abuse while lawyers and clergy (in effect) are not? Is it because our service isn’t dovetailing with legal rights? Is it because we are secular in our mission?

To address a secondary theme, Pierce isn’t necessarily sympathetic to his misbehaving client base. Though not nearly as hateful as Lira, his women and children’s advocate antagonist, Pierce is often jaded by the sex offending or sexually addictive men that he sits with. Many of them are indeed entitled, or misogynistic, or plainly self-centered, while others are less offensively lost—underdogs of another kind. In some respects, Daniel is like most therapists: trying to be neutral, but nonetheless stumbling into an advocate’s role at times, holding different sides of individuals, including that which is objectionable. As weary with them as he is any oppressive system, Daniel weighs his dedication to those wayward men against a sometimes-I-wonder-why-I-bother-with-you attitude.

I have bothered considerably with the ideas contained with Venus Looks Down On A Prairie Vole. I have, I think, one more aspect, or pair of ideas, to explain. Then it will be time to move on to another story, and perhaps another cause. On to lengthier days.

Graeme Daniels, MFT

 

 

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The problem of listening

 

“Thanks,” said the man in the bad shirt to his group. He kept a peripheral eye upon me, picking up my distaste in the air, my discrepant air. The process moved on, with my journeyman skills keeping things in order, neutral—not taking sides, not standing up for anything yet; not saying much of anything, even though talking’s easier than listening. Talking’s way easier, believe me. Storytelling: now that’s a cinch. Neutral is how I am, professionally and, now that I’m alone, also personally. Wanna know what listening looks like? It’s a stifled yawn pinching oxygen; a blank stare held together with tautened facial muscles, and a soft, metronomic nod providing faint reinforcement, possibly a tease, because maybe it’s a nothing, this service I give. Some really want it, and I’ve been like this for years: a cipher into which people deposit their brokenness, and then leave. Not much of a story here, you might think. If you’re a film producer, you’d say, “I’m not touching this, it can’t be done”, thinking this dull: unwatchable, or unreadable. Pornified eyes wouldn’t like it. But in the unlikely event that it hits big, is binge-read and wins awards I’ll gladly take the stage, drunk, saying “For twenty years people tried to write this script but everyone said it couldn’t be done. So and so tried it and failed. So did whatsisname, that other really famous guy.” That’s when I’d punch stuffy air; thank doting mom and rival dad, the wife and kid for their support, God for doing whatever he does, and say goodnight.

In group I became restless, started saying some things I shouldn’t have said, slipping from the listening stance: fighting with men as well as women. It’s what happens when people stop listening.

— a passage from Venus Looks Down On A Prairie Vole

Part of a polemic that runs through the novel: I set up a binary between notions of listening versus doing. Therapists don’t do anything. That’s the sometimes comic refrain that Daniel Pierce expresses, at times to punctuate a dramatic event. It’s not a popular image, this one of therapist neutrality, this sense that we sit back in our cozy offices, smugly observing pathology, remarking on it but not acting as agents of change. Not really. See, the task is to render it invisible…the change…so you won’t notice.

Not good enough, of course. For the general public, I mean: this traditional stance of not doing is not good enough.”I’M A DOER”. Isn’t someone scoring political points with this currently? When parents bring oppositional teens into therapy (as in Working Through Rehab), when wives call up and make appointments for their depressed husbands, when a couple presents for therapy needing help with a ‘crisis of communication’, and when people get out of line with respect to drugs, violence, and especially sex, people from officialdom call, asking for therapists to do something.

And so I chat the other day with an amiable lawyer, a good guy looking to represent his client and mine, someone who did something he shouldn’t have done, with a girl who was younger than she should be if doing what she was doing. But it was his fault. No argument there.It’s just that this lawyer wanted to know…what I was going to do. He knows what therapists do. He knows that we listen; that we don’t judge. But could I give him something, anything, live or in a letter, that he could share with a court and sound, ya know, convincing. He even voiced his suppositions, as if he’d hacked my association’s list-serve and scrolled through the typical ways therapists market themselves. Would I offer coping skills, he asked tentatively?  Teach ‘tools’ for affect regulation (actually, he didn’t ask that).

Empathy. Victim empathy.That’s what I offered. That plus the hope that what my client did he would not do again.

 

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The bourgeois hypocrisy

Lira hissed through her teeth—a disappointing, face-contorting habit, I wanted to say but didn’t.  “That’s irrelevant. Men are the ones that buy porn. The consumer is the oppressor.”

I paused, studied her face for a credulous moment, and thought politics, the global order. “Do you own a cell phone?” I asked. I knew she did having watched her scroll through it several times, but she didn’t answer, instead giving me an I’m-thinking-of-your-next-move look. “Ever think about who assembles those things and what wages they make?”

She rolled her eyes, said, “Here we go,” as if knowing my path.

“What would you say if I said that all your electronics purchases are made on the back of unfair labor practices in the developing world; that your cosmetics are made possible because of animal cruelty?”

She gave me a lazy-eyed stare. “Apples and oranges,” she replied.

I paused. “Really? That’s your rebuttal, a tired fruit metaphor?”

“You’re changing the subject.”

“It’s not a subject. It’s called context.”

“Context my ass. It’s a specious argument, Dr. Pierce, You’re saying the average consumer has as much culpability as a sex offender. That’s bullshit. No one would buy that argument.”

“Not in this society, maybe, but only because people here are hypocrites. The consumer is the oppressor, you said.”

It’s a shame that talk moves quickly sometimes, because I wanted to patronize her saying ‘specious’, which sounded impressive, like something a law professor would say—maybe that guy from the bar, I considered. Actually, I didn’t want to patronize Lira. I just wanted to argue some more.

–passage from  Venus Looks Down On A Prairie Vole

Maybe it’s the rhetoric of certain politicians currently reminding me of the polity’s gullibility, but I can’t let this go: one of the reasons AB1775 passed so easily through the California legislature was the notion that users of child porn enable child pornographers. Assuming you haven’t read my twenty or so other blog essays on that subject, let me remind that AB1775 is a 2015 law that re-writes the California civil code relating to child abuse reporting, apparently for the first time in 35 years, after the original Child Abuse and Neglect Reporting Act overlooked the issue of child porn, I guess. The new law allows–no, compels–mental health professionals to report to police clients/patients who view child pornography. Specifically, it mandates reporting with respect to that which depicts the sexual conduct of a minor (as in anyone under the age 18) over an electronic or digital medium. Genius. Now we have to violate confidentiality when teens sext one another.

The other pretext for this law was/is the unsubstantiated claim that such a measure will “crack down on child porn”. In other words, it will crack down on child porn to report to police individuals who, in the context of a psychotherapy session, talk about their child porn use, or e-mail pictures of their junk to their partners. For some this law will lead to humiliating discussions with unctuous adults who will educate about how to respect self and others. Boys will be schooled on how to respect girls’ bodies. Girls will be schooled on how to respect girls’ bodies. Some might criticize the circular nature of decision-makers’ interventions. Decision-makers will blink in confusion because they won’t know what circular reasoning is.

For others (men, basically), the law will lead to their arrests, their job losses, their ostracism from society, the sudden loss of custodial rights with respect to their children; the convenient awarding of full custody to another likely informant, the other parent. In case you think these are good things (and you probably do), one other likely outcome is that such individuals, following the adjudication of their cases, will be mandated into mental health treatment (this is hilarious!) wherein–it is presumed–they will honestly disclose further their history of child porn affinity and commit themselves to healing, trusting fully the confidentiality of the psychotherapeutic space.

This law will have no effect on the sociopaths who produce and distribute child pornography, any more than a generation of arresting pot smokers has won the drug war. People like me won’t be reporting such people to police because…how should I say this…THEY DON’T GO INTO THERAPY, IDIOTS!

For all the politicians who voted for this bill; for the lawyers who wrote it having consulted with maybe two therapists in San Diego County who also believe in things like conversion therapy for gay people; for the right wing politician who fronted (“authored”) the bill, declaring it would “crack down on porn”, scoring cheap points with an illiterate constituency determined to scapegoat society’s sexual miscreants because it doesn’t understand real social issues; and for all of you who enable poverty and economic exploitation in developing economies everyday of your lives with your electronics hoarding, drooling consumerist habits, I have the following message:

YOU ARE ALL…

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Sexual Schizoid

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“They say in SAA that you get to define your own bottom line,” offered another man. He licked his chops, tilling the ground of groupspeak as he had an equally dubious claim involving a late teenager (so he said). A hyper-masculine, balding figure, he personified a certain faction of my group: conventionally unattractive, sired in conjugal visits, wired towards the visual; overflowing with discharge, living just this side of incontinence. These guys tend to not open up much: they speak in code, use phrases like “I crossed the line” to briefly reference why they’re in treatment. Then it’s back to the persecution litany: about their hearings, upcoming or past; about the unfairness of courts, probation officers, the unforgiving nature of wives. I think of women and what they think. What do they expect from these men if not porn addiction? Come to think of it, do those women even look at porn? Have they watched the films, studied scores of images? You see, in some respects they have it backwards. Objectification—that’s the right word, isn’t it? That’s what’s happening to women. But hold on. Do they realize how many porn clips don’t even show men’s faces? Often, all you see are these girthy, circumcised peters sticking out between splayed pairs of legs. Talk about objects. In porn, the penis is the star, make no mistake about it. It is center stage, in the camera’s face, and literally in women’s. But at least their participation makes use of eyes.

— A passage from <em>Venus Looks Down On A Prairie Vole

The above passage describes the population of sex offenders that Daniel Pierce treats in his weekly group therapy. They’re a motley (as opposed to diverse) crossection of underdogs, typically unsophisticated, unlike predators who don’t get caught. Initial contacts with these guys are not just haunting, they’re an all-around humiliation, plus descent into a dark cave. Gruff, terse like their fathers and grandfathers were, they answer questions from counselors like they’ve just come from their lawyers’ offices, and are therefore still following the dictum, say as little as possible, which echoes their characters. Besides their illegal behaviors, the non-violent or non-direct contact offenders are socially withdrawn figures more so than anti-social; diffident more so than brutal. They shy away from intimacy, though more so out of bewilderment than contempt. Their relationships are with machines, computers–that which seems less impinging. To the average observer, they might seem like they’re on the spectrum of autistic disorders, and they might seem as self-absorbed or un-empathetic as any Narcissist. But the accent of their fears is less upon rejection as it is upon safety, and to remain safe this need must remain invisible. Difficult patients, they do not crave understanding, but rather a calculated space between themselves and others. It might sound a bit like this:

Therapist: So, what happened? What’s led you to make an appointment?
Client: (staring at therapist with concealed hate, as if the question is stupid) Got arrested. Crossed the line. (shrugs, pauses. The statement is done)
Therapist: I see, what exactly did you do that led to the arrest? (no more open-ended questions for a while, looking to avoid stonewalling)
Client: (ever externalizing) The charge was lewd and lascivious…with a minor…while intoxicated…something like that
* To get an actual narrative one will need a police report. Imagine what the more blunt truisms might sound like…
Client: Got caught with my dick in a hole
Therapist: By hole, you mean a female?
Client: Yup, one of them…

Most of the men I’ve worked with don’t betray thoughts like these, not so much out of shame, rather because they have little incentive to be honest, or to understand their disordered selves. Their situations mirror their fears, resulting in a self fulfilling prophecy: they are under someone’s control. See, sex offender treatment isn’t looking for honesty in its subjects. It’s looking for compliance, and in no other area of mental health treatment is this misguided objective more pronounced. Therefore, if sex offender treatment doesn’t work (an ambiguous conclusion) it’s because the systems that govern the treatment are misinformed, under-educated, and catering to public opinion rather than the recommendations of research. I write as a former provider under the California Sex Offender Management Board (CASOMB), and now operating privately and sometimes working with men who seek treatment BEFORE they get caught…BEFORE they hurt someone.

Treatment with them is not about compliance. It is about understanding. Imagine that.

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Poking ideology, ladies first

 

 

Whenever I consider a critique of a social group, an organization, or an ideology, I try to pause and think about where I am vulnerable; about who or what my sacred cows are, and whether I can take needling comments from the lesser knowing on the sidelines. I’m not a religious or especially political person (I think), so I don’t get my feathers ruffled when viewing debates. I am only thinly amused by scoffing comic journalists, and I sigh at the familiar rhetoric, bemoan all I don’t know or can’t know. As for miscellaneous activism, well, the AB1775 thing was about the only cause I researched well enough and thus felt qualified to comment on.

In most matters I prefer the observer’s role, plus the ethos of the neutral, hence my affinity for psychoanalytic thought, my periodic disdain for reductionist thinking in psychotherapy, as expressed elsewhere in this blog. Activism is an adjunct of psychotherapy for some. With a particular cause in mind, many enter grad schools wanting to “work with ___” because their lives have been touched by whatever their bone of contention is. That wasn’t me and it still isn’t. Mine is an ideology influenced more and more by the unknown, so the stance of the neutral radiates through Venus Looks Down On A Prairie Vole, my mischief novel about a jaded psychologist/neutral (or neutered) male, Daniel Pierce, who is stalked by a former prostitute and thereafter challenged to assume the activist role. Lira is a law student who likely saved money from her night job to earn an education and a better life for herself. She is an empowered woman looking back, looking to help the less fortunate, the not-yet-survived sisters on the streets, plus the odd John or two who needs redemption, whether they want it or not. Her ideology, which is a broader, not goal-specific construct, is likely feminist, though she doesn’t indicate this in such specific terms.

It’s difficult tackling an ideology because ideologies are multi-faceted and evolving. They defy simplification, require and deserve considerable thought and reading, so I’m skeptical of labels from those who identify with an ideology without putting in study time; from those who oppose an ideology based upon a similarly stereotyping process. If you haven’t combed through The Feminine Mystique by Betty Friedan, or “Beyond The Pleasure Principle” by Freud, or read anything by either Cordelia Fine or Melanie Klein, then stop with the broad-brush dismissals. So when Kirkus remarks in their review that Daniel Pierce is anti-feminist, I have to take issue because I don’t satirize feminism in my novel, but rather some of its derivative rhetoric that is co-opted by common opportunists, and which informs a modern narrative. Besides, I have to wonder what ruffled the feathers of my reviewer because he or she didn’t get specific. It’s certainly true that my narrator issues a few sideways jibes aimed at popular trends: at women’s seeming double standards in the dating arena; at the goading of men that happens in advertising: the suggestion that men should take drugs to enhance sexual performance, whether to serve ego, the pleasure of a wanting partner, or both; the way media increasingly presents women as sexual aggressors, men as on the run, clutching fearfully at their pants, acting like fools; the way musical/lyrical clichés are deemed misogynist if depicting women in supplicant roles—romantic or millennially winning if men are.

Daniel Pierce is traditionalist in some ways, but is neither an anti-feminist nor a misogynist. He’s monogamist, partly because of love, otherwise by constitution. Sexually, he’s played it safe in life while keeping at arm’s length the influence of promiscuous men, so he’s wary of Rick, the would-be porn star who buddies up to Daniel, liking his quiet non-conformism. Rick is aware that Daniel is not a player, but scarcely registers the psychologist’s critique of reckless sex. Daniel could give or take guys like Rick, knowing them to be endangered, but he’s more concerned for his own psychological kind: the sexually diffident or undersexed; the workaholic, drab men who sacrifice decades to the man and then die of heart attacks. If pushed he’d point out that if women want the same pay or workplace opportunities as these men, they may need to do more of the work his masculine forebears did: the blue collar or dangerous jobs that still comprise well over ninety percent of workplace injuries. Let us not forget that the harbinger of feminism, the suffragette movement, more or less suspended itself to support men in their most dangerous traditional role, that of soldier. Subsequently, World War I slaughtered nearly half of the European male population of that era, which is not women’s fault, but what did they do? Time moved on: women organized and confronted the alcohol industry with temperance movements, industrialists about child labor; they rightly won voting rights, the right to own property, etcetera, while never having to register for the draft, and few women over the years complained about that.

When pushed by Lira to co-sign her assessment of Derek Metcalf as a child molester, Daniel pushes back, supposing that the child in question (Derek’s five year old son) may be a pawn in a protracted custody dispute, latterly mired in manufactured charges, coached and inconsistent reports from the son about alleged behaviors, the adjudication of which is meant to leverage a favorable custody outcome for the mother. While Daniel’s familial background is thinly sketched in Venus, I suggest towards the end that his father was not a Prairie Vole (a monogamist), and that Daniel’s mother, a figure on whom he once doted, left his father at some point in Daniel’s childhood. On the one hand, I accept Clarion’s critique that my title, Venus Looks Down On A Prairie, may be too obscure, or confused, for the average reader. I’d intended to give clues in the text, but otherwise leave room for you to wonder. Well, I guess I’ll supply an answer, whether you wonder or not. Daniel is looked down upon by women (or would be so), not because he’s a philanderer and therefore commonly misogynist (he’s not), and certainly not because he was a devoted husband, but rather because he isn’t a hero. He simply refuses to split in that traditional way. His refrain, I don’t do anything, is partly a complaint, partly a muted boast, and he defies a traditionalist male role that lingers in our society, whether feminists want this or not.

 

 

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Talkin’ about it

 

 

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Deviancy Today

The latest issue of Psychology Today features an article entitled “Sympathy for the deviant”, fronted by a teaser, “Do we misunderstand sex offenders?” It’s a leading question, suggesting, as such questions tend to, that misunderstanding constitutes prejudice. The thesis of writer Jennifer Bleyer is that sexual abuse stigma may prevent people from getting help before they commit harm. She follows accounts of men who slide from attraction to early adolescents, to grooming behaviors, skinny dipping, sleeping nude with underage partners, from embracing to sexual intercourse. The passage from intrigue to abuse is insidious, laden with denial, compulsion and horror. Partners share their trauma as they watch their husbands being hauled away to jail. The husbands, like the wives, are shaken, apologizing desperately, seeking forgiveness before anything’s been understood.

How can it be understood? the article asks. Given the legacy of silence and collusion, it won’t be easy, writes Bleyer. She points out that discussion of sexual abuse emerged from the cultural shadows in the 1980s, when a confessional culture lead survivors to speak out. “For the first time, its prevalence and its adverse effects became apparent. The pendulum of public concern swung hard in the direction of indignation, as sexual abuse went from being largely ignored to intensely condemned.” In psychoanalysis this is called reaction formation. In short: guilt. The guilt feelings are appropriate, but as many within our profession argue, guilt also gets in the way, by stirring its derivative, rage. It gets in the way by disregarding some facts: that recidivism rates for sex offenders, for example, are lower than for other major types of crime and much lower than is commonly believed. Take radio show host Bill Carroll, for instance. In July, he and politician Melissa Melendez clucked righteously that sex offenders can’t really be treated. “You can’t change a pedophile’, he said. The next day I went on his show and told him what’s what. In September, a board member for the California association of marriage and family therapists (CAMFT) opined that sex offender treatment was ineffective, offering in a public forum that over half of offenders continue to offend despite treatment. After the forum, I stepped up and with a polite smile told her she was wrong also.

No surprise that this side of the information divide makes it to public ears, coloring opinion. Given the hysteria that such opinions generate, few learn the truth as Jennifer Bleyer reports: that only 40% of convicted sex offenders meet criteria for pedophilia, or that pedophilia refers to an attraction, not necessarily a behavior or set of behaviors. It chills the skin of progressives to consider that pedophilia is likely an orientation, and likely because they don’t wish that sympathetic term co-opted by an unpopular segment of society. They may be assuaged to learn that pedophiles have been shown to be shorter on average and more likely to be left handed, as well as having lower IQs. One study has shown they are more likely to have suffered childhood head injuries. My own clinical experience (not based upon a large sample, I should note) bears out the impression that pedophiles are prone to childlike personas, presenting as sexually diffident, living on the margins.

In Germany, a prevention project begun in 2005 aims to prevent abuse by offering anonymous treatment to people who are sexually attracted to minors. In on TV ad, a masked man recites a script of self-loathing, followed by a pronouncement of what he had learned in therapy. In the ad’s climactic moment, the man removes his mask, exposing his shame, but also expressing his hope. “I don’t want to be an offender,” he says. According the Bleyer, over 5000 people have come forward seeking treatment as a result of the ad campaign, leading to the establishment of 11 clinics across Germany, with a specific sexual abuse prevention at the core of program mission statements. CBT and testosterone-reducing pharmaceuticals are the preferred interventions, not so much psychoanalysis. Oh well, progress not perfection, I say. With this article in hand, I approached my colleague at work, a man exhorting me to renew my credential for treating sex offenders with the state. We should be bypassing the state, I said. Long term, we should be trying a version of what they’re trying in Germany: reaching out, through our website, through social media, through CAMFT board meetings, meetings with the California Coalition on Sex Offending (CCOSO). We should be aiming at those individuals who are out there, seeking help, looking for therapists, programs, who will speak to their particular problem.

So far, no one in this neck of the woods is doing this. No one’s aiming a marketing strategy at sex offenders, or sex addicts who might transform into offenders. No one’s funding a public service announcement on a bus or billboard, outreaching with a message like the one suggested in Bleyer’s article: “If you’re concerned about your attraction to children, call this number.” My colleague claims–rightly, I think–that new reporting laws such as AB 1775 will make preventions efforts such as what’s happening in Germany virtually impossible. Maybe that’s true. Maybe someone with a problem can’t really talk to me. If they tell me they look at underage porn, I’d have to report that to authorities, who may choose to let therapy do its thing, or they may not. They may choose to break down my client’s door, confiscate electronica, make an arrest that will trigger a catastrophe in that person’s life. I guess they’d call that prevention too. But they couldn’t call it understanding.

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Voices of sex offender treatment meet

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.

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A Child Abuse Law That Won’t Work (Part One)

By now many readers will be familiar with the controversy surrounding actor Stephen Collins, whose divorcing wife surreptitiously taped a couples therapy session in which Collins confesses to the past molestation of an 11 year old girl. While some (mostly professionals) are disturbed by the violation of confidentiality issue, most of the trolling comments in social media seem biased towards the end that justifies the means: the outing of a child sexual abuser.

The cacophony of wrongness is so loud that I wonder if there’s room for a thoughtful, informed breakdown of the issues. As a psychotherapist, I’ve come across many situations wherein child abuse (sexual and not) is suspected, and I’ve further worked with sex offenders who are mandated through the legal system to seek counseling. There are misconceptions about the treatment of these cases, one of which surrounds the reporting requirements of the mental health professional. For example, in the case of Collins’ alleged victim, many have wondered why the therapist in question didn’t report Collins’ confession to either the police or a social services agency, as would have been his or her prerogative. But not necessarily an obligation. It’s unclear from the story if the 11 year old in question is still a minor, and in such cases where the alleged victim is an adult at the point of disclosure, the therapist actually has discretion under the law. He or she must actually determine if an ongoing risk to a child is present, and then make a report.

What happens next? Well, in ordinary abuse cases, an investigation happens, possibly followed by arrest or a suspension of custody or contact rights for the alleged abuser: a disruptive, frightening, if sometimes necessary experience for everyone involved, especially children and parents. The matter of the therapist’s report is generally private–meaning, a matter between therapist and client. If the person who is reported is disgruntled with the therapist for making the report, he or she can fire that person or work through the conflict and continue the therapy. This is not the case with respect to child sexual abuse, or with respect to sex offenses that do not involve children. As many are aware, those who are convicted of sexual offenses are placed upon a public registry, and their designation as sexual offenders is lifelong. (BTW: the list of what constitutes a sexual offense is long and varied, and if you think teens sending ‘selfies’ are exempt, think again). If directed to counseling in California, an individual must find a therapist credentialed by a government body called the California Sex Offender Management Board (CASOMB), which provides guidelines for the treatment of sex offenders–guidelines that compromise bedrock principles of psychotherapy, especially those pertaining to confidentiality.

So, if a therapist reports a client for child sexual abuse and has not chosen to credential (no small task, actually) with CASOMB, their work with the person they’ve reported will soon be over. This is not the case with respect to all other mandated report situations–a truism not understood by many therapists. CASOMB compels treatment guidelines involving regular reports to CASOMB-partnered officials, following a premise echoed on social media: that pedophiles are not treatable. This is the kind glib drivel that has been asserted about several diagnostic or assessment categories in the past, including addictions, borderline personality, and schizophrenia–assertions that have since been debunked. What the reader should understand is that research into “what is effective” mental health treatment is often shallow, unconvincing, and contaminated by the interests of the insurance and pharmaceutical industries, not to mention providers offering competing models of care. How do you know if a treatment approach for, say, ADHD, is demonstrably effective? Because a study by university X conducted 3-6 months after a treatment protocol is applied to sample of subjects indicates a significant “reduction” of problem behaviors, as defined by the study. Note the time frame and the word reduction. These criteria are central to research into conditions like depression, anxiety, ADHD, behaviors like substance abuse. Now consider child sexual abuse, so-called pedophilia: would you, the apparent consumer of mental health research, be satisfied with such short-term time frames of study? Would you satisfied to hear that a child abuser’s behavior has “reduced”.

My point is not to inflame the passions of those brandishing pitchforks and torches, ready of lynch sex offenders, or throw them in jail and throw away the key–yada, yada, yada. My point is to rebuke the casual invoking of research to sell an arbitrary standard of care. In part two of this article, I will further an argument for the importance of confidentiality in mental health treatment, and protest against those ignorant legislators and self-appointed advocates who are unknowingly working against their own cause.

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Sex Offender Treatment: Just Say No to the Dodo

 

Talk about reductionist thinking: try this corner of the mental health industry. It’s a dark little corner, where the journeymen and women of our profession go…because someone has to, supposedly. Not that therapists are wanted, necessarily. As in the treatment mileus depicted in my book, Working Through Rehab: An Inside Look at Adolescent Drug Treatment, administrators and directors of SO treatment programs, or the “supervising officers” (euphemism for correctional officers) that are actually in charge of the three-headed mon–sorry–treatment team, want straightforward instructors for implementing of program protocols. They want containment based upon a structured approach designed to elicit successful behavioral outcomes–a teleological perspective.
       Recidivism: the repetition of offending behavior. That’s the operative concept in sex offender treatment: the standard by which this entire arena of care is judged, or will be judged, if it is indeed on trial. And why not? you may ask. Surely the problem of sexual abuse needs to be addressed as aggressively as possible, with a behavioral lens front and center; with recidivism the criteria for assessing everyone in the process, participants and providers alike.
       The problem is with the research, and thereafter with the spinning upon said research for anxious listeners. At a recent presentation of sex offender treatment protocols at a CCOSO (California Coalition on Sex Offending) conference, I listened to program officials assert the need to implement a structured treatment program consisting of an RNR (Risk Needs Responsivity) model, in conjunction with Cognitive Behavioral Therapy (CBT), and that unstructured psychotherapy (unclear what that was referring to–perhaps the aforementioned “Freud stuff”) was contra-indicated (meaning, ill-advised), because its methods were not associated with a significant decrease in recidivism. By RNR model, presenters were alluding to the work of criminologists Don Andrews and James Bonta, who outlined what are termed dynamic risk factors central to treatment, alongside corresponding so-called criminogenic needs. The list of factors include some of the following: antisocial personality, antisocial cognitions, social support for crime (meaning, friends or family with criminal attitudes), impulsive behavior, family dysfunction–again, such as criminality, low education. Other factors of ancillary importance are early childhood negative experiences, family of origin stressors, age, gender, and ethnicity. Spot the issue yet? Well, the likes of Ward, Melser, and Yates (2007) did, opining that the RNR etiological theory was too general to explain criminal conduct, and as a result, was unfalsiable–meaning, not especially useful.
        As for recidivism, the research here is generally thin and unconvincing. According to Duwe and Goldman (2009), a reduction of 18% in sexual recidivism existed for one in-prison treatment program. But researcher Stephen Brake, who in 2010 published his examination of 37 studies of sex offender treatment outcomes conducted over a quarter century, found that only 41% of such studies indicated reductions in recidivism, with 37% not significantly reducing recidivism, and a remainder of studies indicating mixed, partial evidence based upon different factors (violent versus non-violent recidivism, for example). Overall, it’s been known since the early 90s (via federal reports) that sex offenders exhibit among the lowest recidivism rates (4-12%–tracked over 5 years), compared to other criminal profiles. But it’s unclear whether such findings can be attributed to specific treatment models. The authors of another meta-analysis study, Losel and Schumacker (2005), concluded that there is a significant effect of treatment on recidivism, but the studies they examined indicated treatment programs that featured not only CBT methods, but also surgical castration. Pardon me while I imagine the principals of each intervention strategy arguing over whose method worked best.
       Several critics point out basic problems with research into sex offender treatment: findings that indicate as much effect upon recidivism for no-treatment versus treatment; inadequate control groups; the fact that sex crimes are the least reported types of crimes (thus confounding statistics on recidivism). Add to this discrepancies in study designs, outcome measurement protocols, time-frames for follow-up, and what researchers have is a messy globule of information that strains against the community’s desire for straightforward action. Critics of the RNR model point out its limitations: the opinion that attention to criminogenic needs is insufficient, and that attention must be paid to individual needs, self-esteem issues, personal distress; that treatment alliance is an unassailable factor in positive treatment outcomes. Amen, I say. However, these are borderline heresies for those presenting on the topic of sex offender treatment, for sex offenders aren’t really allowed to talk about personal distress and low self esteem–at least, not until they’ve admitted to all of their crimes and then said they were sorry…like, really sorry. And so, with all this in mind, I wade into this dodgy realm of care, becoming a ‘certified’ provider of sex offender treatment. Why? because I have some clients who fit the profile, and because they are people about whom I care. I’ll nod my head at the pronouncements of those looking to codify practices and reign in the unconscious. I’ve got my eye on the Dodo.
* Stephen Brake (2010) The Effectiveness of Treatment for Adult Sex Offenders.

* Ward, Melser, and Yates (2007) Aggression and Violent Behavior, 12, 208-228.

* Losel and Schumacker (2005) The effectiveness of treatment for sexual offenders. Journal of Experimental Criminology, 1, 117-146.

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