Victim Issues Key to Effective Sex Offender Treatment
Name: Mary Jane (Jay) Adams, Ph.D.
Affiliation: California Department of Corrections, Staff Psychologist, retired
Address: 26 Hillcrest Drive, Paso Robles, CA. 93446
Phone and Fax: (805) 238-4454
E-Mail: jayklaus@msn.com
Abstract:
The recent passage of Sexually Violent Predator laws in several states has
increased interest in identifying those sex offenders most likely to re-offend
and changeable or “dynamic” factors that can be most effectively
addressed in treatment in order to reduce sex offender recidivism. Hanson and
his colleagues have identified the following as promising stable dynamic factors:
intimacy deficits, negative peer influences, attitudes tolerant of sexual offending,
problems with emotional/sexual self-regulation, and general self-regulation.
On the basis of 25 years’ experience treating sex offenders, the author
explores the relationships between these factors and the long-term effects of
child abuse as well as the growing literature on the effects of early trauma
on the development of the brain.
Bio:
Dr. Jay Adams has been involved in the practice of forensic psychology for
25 years, in a state forensic hospital, a medium security state prison, and
private practice. She specializes in the treatment of sex offenders and adults
who are survivors of childhood abuse. She has given numerous presentations at
professional conferences on the treatment of abuse survivors in forensic settings.
Victim Issues Key To Effective Sex Offender Treatment
by Jay Adams, Ph.D.
This article was originally published in the journal,
Sexual Addiction and Compulsivity, Vol. 10, Number 1, 2003.
The expanding literature on the long-term sequelae of childhood abuse can help
us to treat sex offenders more effectively. Clinicians who treat sex offenders
often experience strong counter-transference reactions when their clients present
themselves as victims. This usually takes the form of blaming “the system”
for treating them unfairly and/or blaming their victims for causing them to
have sex. However inappropriate such blame may be, the feeling of being a victim
is real and stems from early childhood experiences. Virtually all the sex offenders
I have worked with in the past 25 years have had some history of sexual and/or
physical abuse. Hanson (1999) reports that “in file reviews of 409 sexual
offenders, we found that 75% had been victims of some form of child abuse, physical,
sexual, or neglect.” These findings are not incongruent with other researchers.
For example, Graham (1996) found, in a sample of 286 sex offenders in treatment,
that 70% reported having been sexually abused as children and 50% reported a
history of physical abuse. Lisak et al. (1996) found that more than 80% of a
group of men who sexually abused children had themselves been abused.
Moreover, there is ample evidence in the literature on adult survivors of child
abuse to suggest that these may actually be under-estimates. Courtois (1988)
estimates that 50% of female incest victims in therapy do not initially reveal
their abuse history, and both she and Sgroi (1989) have explicated a variety
of reasons why clients do not report a history of sexual abuse. In addition,
it is probable that men in our society are even less likely than women to report
a history of sexual abuse, for a variety of reasons, including shame and sexual
identity confusion (Vasington, 1989). The persistent evidence in the abuse survivor
literature of client denial or omission of abuse history raises serious question
regarding the accuracy of Hanson and Bussiere’s (1998) findings that a
history of childhood sexual abuse was unrelated to sexual re-offense risk. In
contrast, another study (Hanson and Harris, 1998), used official records of
physical, sexual or emotional abuse and whether the offender had ever been taken
into the care of child protective services, rather than self-report. This study
found that the early backgrounds of sexual recidivists were significantly worse
that those of non-recidivists in terms of abuse, neglect, and placement.
In a recent article, Hanson (1999) puts forth some suggestions for improving
sex offender treatment that “start with the assumption that the same basic
rules that govern the behavior of you and I also govern the behavior of sexual
offenders” (p.83). Indeed, it is the thesis of this paper that sex offenders
can best be understood as a sub-group of individuals who have been abused as
children, and who have reacted in a manner not unlike other child abuse survivors.
Hanson (1999) suggests that a history of abuse may result in a schema or “core
belief“ among sex offenders that “given all his hard luck, the world
owes him something” (p.83). While possibly true in part, this is only
one aspect of the complex relationship between childhood victimization and later
sex offender behavior. Hanson and Harris (1998) have identified a number of
stable dynamic factors which appear to offer promise to therapists interested
in changing sex offender behavior. These factors include intimacy deficits,
negative peer influences, attitudes tolerant of sexual offending, problems with
emotional/sexual self-regulation, and general self-regulation. It is no coincidence
that many of these factors have been well documented in the literature as long-term
effects of child abuse.
Difficulty in forming and maintaining intimate relationships is perhaps the
hallmark symptom of a history of child abuse. Briere (1992) has described adult
abuse survivors as displaying ambivalence and fear regarding attachment and
vulnerability, impaired ability to trust, increased anxiety as closeness increases,
expectations of re-victimization, and a need to push others away and sabotage
relationships. Virtually every writer in the field cites adult intimacy problems
as common among adults abused as children (see, for example, Courtois, 1988;
Jehu, 1989; Gil, 1988; Lew, 1988; et al.). Closely related is the need for control
cited by numerous writers (McCann et al., 1988; Sgroi, 1989; Evans and Sullivan,
1995; Briere, 1996) as a pre-occupation of many survivors of child abuse. The
control dynamics of both rape and child abuse have been widely explored in the
sex offender literature. Hanson (1999) notes, “For some sexual offenders,
the act of forcing, controlling and degrading the victim is perceived as more
rewarding than any of the sexual elements of the offense” (p.86). For
some offenders, fear of adults and fear of loss of control may be as prominent
in their offending behavior as deviant arousal. These factors need to be assessed
carefully and their origins processed at an emotional level in sex offender
treatment.
Societal attitudes tolerant of rape have been well researched by Malamuth (1981,
1986). In addition to societal attitudes, most of the rapists I have encountered
in my forensic clinical practice have been sexually abused by women, which may
also contribute significantly to their later attitudes regarding women. But
society is generally far less tolerant of the sexual abuse of children. So where
do child molesters acquire attitudes that support their deviant behavior? The
answer may be that their own histories of sexual abuse also lay the groundwork
for attitudes tolerant of molesting children. At the heart of this is the common
victim conviction that he or she is to blame for the abuse, or somehow deserved
it (Courtois, 1988). Individuals of both genders whose childhood sexual violation
has gone untreated often express self-damning sentiments such as “I must
have been seductive and provocative when I was young” and “I did
not physically resist, so I must have wanted to have sex” (Jehu, 1989).
Self-blame may involve belief in what Lerner (1980) called the “just world”
hypothesis. As Briere (1996) puts it, “The victim may choose to believe
that ‘I got what I deserved’ as opposed to the potentially more
frightening notion that violence is random and unjust, and that one cannot do
things to avoid being victimized” (p.15).
Elsewhere, Briere (1992) has used the term “abuse dichotomy” to
describe how a young child with primitive, concrete cognitive processes tries
to understand the behavior of a parent who is hurting him. The child is forced
to choose between the conclusion that either he is bad or his parent is bad.
He has been taught that adults are always right, that they do things “for
your own good,” and that they should be obeyed. It is far too threatening
for a child victim to believe that his parent is wrong or bad, and his childish
ego-centric way of thinking also mitigates against such a conclusion. It is
not uncommon, moreover, for victims to be given direct, overt messages by perpetrators
that they are responsible for their own abuse. Therefore, the child who is being
sexually abused by someone close to him concludes, “I am as bad as whatever
is done to me. I am bad because I am being punished; I am being punished because
I am bad” (Briere, 1992). Sgroi (1989) has noted that many sexual abuse
survivors in treatment go through a secondary phase of denial which is designed
to reduce their feeling that they are “damaged goods”: “Having
acknowledged the reality of the abuse in the first stage of recovery, the survivor
now attempts to minimize the significance of the abuse in order to shield herself
or himself from experiencing the emotional pain ...” (p.120). This is
perfectly consistent with the view often expressed by child molesters that having
sex with children “doesn‘t really hurt them.” It is the offender’s
own self-blame, self-loathing, and denial of harm, stemming from his own unresolved
sexual victimization history, which both allows and drives him to create more
sexual victims. Again, this is a connection that must be made conscious in treatment
and extensively worked through. Hanson and Harris (1998) further cite “problems
with emotional/sexual self-regulation and general self-regulation” as
important stable dynamic risk factors. Van der Kolk et al. (1996) have contended
that the intrusive and numbing symptoms which define PTSD in DSM-IV are really
only a part of the clinical picture of the lasting effects of trauma.
Their research has found that “the occurrence of pure PTSD is the exception
rather than the rule: the majority of people who respond to a trauma with persistent
intrusive and avoidant symptoms also develop a complex set of other, interrelated
problems”(p.89), which often persist for many years after the person no
longer meets the criteria for PTSD. “The combination of chronic dissociation,
physical problems for which no medical cause can be found, and a lack of adequate
self-regulatory processes is likely to have a profound impact on personality
development” (p.86). These effects were more pronounced in subjects who
had experienced trauma before the age of 14. Van der Kolk et al. conclude: “This
study supports and amplifies the existing body of research that has demonstrated
an intimate association between the diagnoses of PTSD, dissociation, somatization,
and a variety of problems with affect regulation, including difficulties with
modulating anger and sexual involvement, as well as aggression against the self
and others” (p.89).
Hanson (1999) notes that “Deviant sexual schema gain their power from
their sense of urgency” (p.86). Evidence is now accumulating that this
sense of urgency may, in the cases of those who were sexually abused early and
severely, be based in neurobiology, as a result of how the young child’s
brain processes, and is affected by, trauma (Schore, 1997; Siegal, 1999). This
rapidly growing body of literature has important implications for sex offender
treatment. An offender who suffers from extreme emotional liability, whose emotions
are experienced more intensely, or who interprets emotional arousal in terms
of past rather than current events is very likely to become overwhelmed when
in the throes of strong negative emotions. Such a person will certainly have
difficulty applying a set of complex cognitive strategies, no matter how well
he may have learned Relapse Prevention or how motivated he may be to change
his behavior. For some sex offenders, specifically those who have suffered significant
early abuse, more treatment time may be required in which to correct affect
dysregulation, possibly by using some of the techniques which Linehan (1993)
has applied so successfully to borderline personality disorders.
Finally, what are we to make of Hanson and Bussiere’s (1998) finding
that “A negative clinical presentation (e.g., low remorse, denial, low
victim empathy) was unrelated to sexual recidivism” (p.357)? Victim empathy
has long been considered an important dynamic variable in sex offender treatment,
and consequently, most treatment programs have modules designed to increase
victim empathy. Shall we now conclude that it is completely irrelevant to sexual
re-offending? The answer is very likely “No.” Most “victim
empathy” treatment modules are primarily cognitive and therefore result
in offenders learning “appropriate” verbal responses that have little
to do with change at an emotional level. This may explain the finding that “empathy”
as it is currently taught is unrelated to sexual re-offending. It does not,
however, rule out true empathy as a critical variable in change. Lisak (1997)
examined the relationship between empathy for the self and empathy for others
and reached some conclusions that have potential significance for sex offender
treatment. He notes, “A number of studies lend support to the link between
people’s capacity to tolerate their own distressful emotions and their
capacity to empathize with distress in others...These findings suggest that
there is a relationship between a person’s capacity to experience and
express their own painful emotions and the capacity to respond sympathetically
to the emotional pain of another person” (p.166-167). He then goes on
to explore the hypothesis that masculine socialization in our society may be
a kind of “mediator variable” that increases the likelihood that
males, more than females, will be unable to process their abuse and therefore
become perpetrators (pp.167-171). This line of reasoning has an interesting
parallel in the field of attachment research. Main (1997, 2000) and others,
using the Adult Attachment Interview (George, Kaplan, and Main, 1984,1985, 1996),
have found that parents with histories of childhood trauma could nevertheless
form secure attachment bonds with their infants IF, AND ONLY IF, they could
discuss their own traumas in a realistic, coherent, and emotionally connected
manner. In order to form such a bond, a caretaker must be exquisitely attuned
to the infant’s feelings and responses, i.e., capable of enormous empathy.
It has not been my clinical experience that sex offenders in treatment try
to use their own victimization as an excuse for their deviant behavior. On the
contrary, one of the most difficult parts of therapy is breaking down their
denial that they were abused or that the abuse damaged them in any way. Studies
of abused former delinquents “suggest, if anything, a tendency to minimize,
forgive, and forget previously documented abuse” (Swica, Lewis and Lewis,
1996, p.431) . Sex offenders are often deeply affected by processing their own
abuse and then seeing the connections with their offenses. I have also had clients
report that the compulsivity of their deviant fantasies was greatly reduced
by such processing. At this point, however, this is purely anecdotal. With few
exceptions (Lisak, 1997; Friedrich (1995), there appears to be little interest
in the field of sex offender research and treatment in applying knowledge gained
from trauma theory, despite ample evidence that most sex offenders are in fact
trauma survivors. It is my strong belief, based on 25 years of sex offender
treatment, that the vast majority of what Hanson (1999) refers to as “deviant
schema” grow out of childhood abuse experiences. Hanson concludes his
paper with a discussion of compassion. The most compassionate thing we could
do for sex offenders and for their potential future victims is to compel them
to address their own childhood trauma histories as a major part of sex offender
therapy. More than anything else, the field of sex offender treatment needs
more research on the relationships between early victimization and later sexual
offending.
References:
Briere, John (1992). CHILD ABUSE TRAUMA: THEORY AND TREATMENT OF THE LASTING
EFFECTS. Newbury Park, CA.: Sage Publications.
Briere, John (1996). THERAPY FOR ADULTS MOLESTED AS CHILDREN: BEYOND SURVIVAL.
New York: Springer Publishing Co.
Courtois, Christine (1988). HEALING THE INCEST WOUND. New York: W.W. Norton.
Evans, Katie and Sullivan, J. Michael (1995). TREATING ADDICTED SURVIVORS OF
TRAUMA. New York: Guilford Press.
Friedrich, William (1995). PSYCHOTHERAPY WITH SEXUALLY ABUSED BOYS. Thousand
Oaks, CA.: Sage Publications.
George,C., Kaplan, N., and Main, M. (1984, 1985, 1996). ADULT ATTACHMENT INTERVIEW.
Unpublished protocol (3rd ed.) Department of Psychology, University of California,
Berkeley.
Gil,Eliana (1988). TREATMENT OF ADULT SURVIVORS OF CHILDHOOD ABUSE. Walnut
Creek, CA.: Launch Press.
Graham, Kevin (1996). “The Childhood Victimization of Sex Offenders:
An Under- estimated Issue.” International Journal of Offender Therapy
and Comparative Criminology, Vol 40, No. 3, pp.192-203.
Hanson, R. Karl (1999). “Working with Sex Offenders: A Personal View.”
The Journal of Sexual Aggression, Vol. 4, No.2, pp.81-93.
Hanson, R. Karl and Bussiere, Monique T. (1998). “Predicting Relapse:
A Meta-Analysis of Sexual Offender Recidivism Studies.” Journal of Consulting
and Clinical Psychology, Vol. 66, No.2, pp.348-362.
Hanson, R. Karl and Harris, A.J.R (1998). DYNAMIC PREDICTORS OF SEXUAL RECIDIVISM.
(User Report 1998-01). Ottawa: Solicitor General of Canada.
Hesse, Erik and Main, Mary (2000). “Disorganized Infant, Child, and Adult
Attachment: Collapse in Behvioral and Attentional Strategies.” Journal
of the American Psychoanalytic Association, Vol. 48, No.4, pp.1100-1127.
Jehu, D. (1989). BEYOND SEXUAL ABUSE: THERAPY WITH WOMEN WHO WERE CHILDHOOD
VICTIMS. New York: Wiley & Sons.
Lerner, M.J. (1980). THE BELIEF IN A JUST WORLD: A FUNDAMENTAL DELUSION. New
York: Plenum Press.
Lew, Michael (1988). VICTIMS NO LONGER. New York: Nevraumont Publishing Co.
Linehan, M.M. (1993). COGNITIVE-BEHAVIORAL TREATMENT OF BORDER-LINE PERSONALITY
DISORDER. New York: Guilford Press.
Lisak, David (1997). “Male Gender Socialization and the Perpetration
of Sexual Abuse.” In R. Levant and G. Brooks (Ed.), MEN AND SEX: NEW PSYCHOLOGICAL
PERSPECTIVES. New York: John Wiley & Sons.
Lisak, D., Hopper, J., & Song, P. (1996) “Factors in the Cycle of
Violence: Gender Rigidity and Emotional Constriction.” Journal of Traumatic
Stress, Vol. 7, pp.525-548.
Main, Mary (1997). “The Organized Categories of Infant, Child, and Adult
Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress.”
Presented at the panel on attachment, Fall Meeting of the American Psychoanalytic
Association New York, December 20, 1997.
Malamuth, N.M. (1981). “Rape Proclivity Among Males.” Journal of
Social Issues, Vol. 37, pp.138-157.
McCann, L., Pearlman, L.A., Sackheim, D.K., & Abramson, D.K. (1985). Assessment
and treatment of the adult survivor of childhood sexual abuse within a schema
framework. In S.M.Sgroi (Ed.), VULNERABLE POPULATIONS (Vol. I). Lexington, MA:
Lexington Books.
Schore, Allen N.(1997). “Early organization of the nonlinear right brain
and development of a predisposition to psychiatric disorders.” Development
and Psychopathology, Vol. 9, pp.595-631.
Sgroi, Suzanne M. (1989). Stages of Recovery for Adult Survivors of Child Sexual
Abuse. In S.M. Sgroi (Ed.), VULNERABLE POPULATIONS (Vol. II). Lexington, MA:
Lexington Books.
Siegal, Daniel (1997). THE DEVELOPING MIND: TOWARD A NEUROBIOLOGY OF INTERPERSONAL
EXPERIENCE. New York: Guilford Press.
Swica, Y., Lewis, Dorothy, & Lewis, Melvin (1996). “Child Abuse and
Dissociative Identity Disorder/Multiple Personality Disorder.” Child and
Adolescent Psychiatric Clinics of North America, Vol. 5, No. 2, pp.431-447.
van der Kolk, Bessel (1994). “The Body Keeps the Score: Memory and the
Evolving Psychobiology of Posttraumatic Stress.” Harvard Review of Psychiatry,
Vol. 1, No.5, pp.253-265.
van der Kolk, Bessel, Pelcovitz, D., Roth, S., Mandel, F.S., Mc Farlane, A,
and Herman, J. (1996). “Dissociation, Somatization, and Affect Dysregulation:
The Complexity of Adaptation to Trauma.” American Journal of Psychiatry,
Vol. 153, No.7, July 1996, Festschrift Supplement, pp.83-93.
