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.