Treat the Abuser, Reduce the Risk?

The scandal that has engulfed the Roman Catholic Church has thrown light on a form of sexual abuse that, perhaps more than any other, has always hidden in the shadows.

The sexual victimization of children by adults reaches far beyond the church to permeate society. Some experts say that as many as one in four girls and one out of six boys under the age of 18 will be molested at least once in their lives.

But as troubling as the extent and harm of the abuse may be, health care professionals working in the field say society must decide not just how to punish the abusers, but how to treat them.

Such decisions will not be easy. Reports that some priests accused of molesting children were dispatched to church-run programs only to subsequently molest again have ignited public outrage, sparking calls for harsher prison sentences for molestation and casting doubt on the effectiveness of all treatment programs.

The doubt is warranted, critics of such programs say. They contend that people who have abused children can never be fully trusted, that treatment can do little to curb desires so deeply ingrained.

“For those who’ve crossed the line and acted on their darkest fantasies, it’s very difficult, if not impossible, to go back,” says Ruben Rodriguez, director of the exploited-child unit at the National Center for Missing and Exploited Children in Alexandria, Va. “Unless treatment programs have a 100% success rate, the only way to safeguard children is to take these people out of the mainstream.”

While that view is shared by many victims and their families, some therapists and law enforcement professionals insist that simply locking up sex offenders doesn’t protect children. Every month, California releases 250 to 300 sex offenders from prison or jail, and more than 94,000 registered sex offenders are currently living in the state, roughly two-thirds of whom were convicted of crimes against children.

Only treatment, therapists say, in combination with incarceration, can stem what some say is a problem of epidemic proportions.

“We can’t beam these people to Mars--they’re going to be back on the streets eventually,” says Father Stephen J. Rossetti, a psychologist and president of St. Luke Institute, a church-run psychiatric hospital in Silver Spring, Md. “If they get treatment, it reduces the likelihood that they’ll re-offend.”

However, in figuring out which treatment strategy works bests, scientists are still grappling with many unknowns. Because child sexual abuse frequently isn’t reported, we don’t have a true picture of all perpetrators (although they’re usually a relative or close acquaintance of the victim), and we don’t fully understand what compels adults to be sexually intimate with adolescents or young children.

Complicating matters is the fact that sexual deviants are a diverse group, from one-time abusers to fixated pedophiles who may have committed hundreds of crimes against children as young as 2 and 3. And they come from every stratum of society, ranging from the homeless to corporate executives and elected officials.

What therapists and law enforcement officials do know, based on the nation’s hodgepodge of treatment programs, is that some abusers respond better to therapy than others. The so-called “situational” molesters who turn to children out of curiosity, stress or convenience, for example, usually require less stringent interventions than either classic serial pedophiles, who make up 5% to 10% of sexual deviants, or violent sexual predators. And some therapists believe the threat of lengthy prison sentences is the only leverage they have to get offenders to change.

“The hard-core sex offenders have a propensity for this, and no matter what you do, they will re-offend the first chance they get,” says Jerome Marsh, a parole official with the California Department of Corrections. “For the majority of offenders, though, treatment--along with tight controls and supervision--can work.”

For Abusers, Combining Therapy and Medication

Therapy for abusers has evolved in recent decades. In the past, treatment programs often relied on so-called talk therapy, in which those with sexual feelings for children were encouraged to explore the roots of their feelings. By understanding the source of their urges, it was believed, the abuser could triumph over them. Faith-based retreats, on the other hand, prescribed prayer, meditation and spiritual cleansing as a way to overcome such desires.

Most doctors and therapists no longer hold out hope of a “cure.” They do agree, however, that some sexual deviants can learn to curb their impulses, in much the same way that recovering alcoholics stay sober.

Most treatment programs now use cognitive behavioral therapy, in which abusers must acknowledge the wrongness of their actions and the harm they’ve caused. They subsequently learn various ways to control their behavior, such as avoiding playgrounds or being alone with children.

The therapy is often used in combination with drugs such as Depo-Provera, a testosterone-lowering medicine that decreases the male sex drive, and antidepressants such as Prozac, which dampens libido, aids in impulse control and alleviates depression. Polygraph tests, which are used to monitor behavior, and strict supervision by law enforcement usually round out the treatment. Some treatment programs also use physiological techniques to measure sexual arousal, as a way of testing whether offenders have learned to control their urges.

One treatment program, in Redding, is considered by many corrections officials and therapists to be a model for others. The Sexual Offender Rehabilitative Treatment Program, started in 1991 and funded by the California Department of Corrections, requires convicted offenders to attend therapy sessions for three to six hours a week, depending on the severity of their offenses, after their release from prison.

In addition, participants take polygraph exams two to three times a year to help ensure they’re not committing more crimes; their movements are limited--they can’t walk past schoolyards or playgrounds or be around children under 18, even if they’re relatives, for example; and they are monitored by police, who do random drug tests and pay surprise visits. About 20% of the program’s participants also take antidepressants.

Sexual offenders pay for the program themselves and attend for an average of four years. Flunking the polygraph exam (questions might include whether they walked past schoolyards or were around children for longer than 15 seconds, for instance) can send them back to prison. They also must admit to their crimes, stop rationalizing their offenses, and learn anger management techniques. Some offenders, who are immature or loners, are taught basic social skills so they’re better able to negotiate romantic relationships with adults.

The approach seems to work, says program director Gerry Blasingame. Out of about 120 offenders who’ve completed the program since 1991, only one or two were later arrested for sex crimes.

Many therapists, prosecutors and corrections officers acknowledge the usefulness of such programs and are trying to standardize treatment regimens, in keeping with the methods used in the SORT program. But even supporters of such programs acknowledge that success rates vary.

In a 2002 study of 121 priests who finished an intensive program at St. Luke Institute, for example, only three--or 2.5%--had relapsed five years later.

In contrast, Canadian researchers looked at the results of 43 studies from around the world that encompassed several types of therapeutic strategies. They found that treatment knocked the recidivism rate down from 17% to about 10%, though those numbers included all sex offenders, not just child molesters. Since abusers are rarely caught, however, recidivism rates --as in first-time charges--might be much higher than these numbers suggest.

But even a 10% recidivism rate is better than nothing, says Bill Marshall, an expert in sex offenders and professor emeritus of psychology at Queens University in Kingston, Canada. “That’s an additional eight fellows who don’t re-offend out of every 100 who are treated,” he says. “As a result, an average of 16 people are saved from suffering, and the taxpayers don’t have to spend $200,000 to investigate and prosecute each offender.”

Still, people like Rodriguez of the National Center for Missing and Exploited Children remain unconvinced. “None of these programs can guarantee that if an individual is released into society, he won’t harm a child,” he says.

Supporters of therapy for sex offenders acknowledge that some molesters may repeat their crimes, but contend that locking up all abusers for the rest of their lives--or sentencing repeat offenders to death, as Gov. Don Siegelman of Alabama advocates--isn’t a realistic option. Better, they say, to reduce the risk they’ll molest again.

California Prisons Lack System of Treatment

But treatment for all who want it isn’t a foregone conclusion.

The California Department of Corrections doesn’t have a systematic program within the prison system to treat sex offenders. Many of them have addictions or mental illness and, although they may receive treatment for those problems, the sex abuse itself often is not treated.

The treatment that does exist is usually granted as a condition of their parole, after offenders have re-entered society. Even then, it’s no guarantee that all offenders will receive therapy.

A 2000 survey by the Safer Society Foundation, a nonprofit sexual abuse prevention foundation in Brandon, Vt., found that throughout California there are 40 treatment programs for sex abusers of all kinds. Nationwide, the survey said, there are 787.

Therapy supporters say that is hardly enough; after all, California alone has thousands of convicted sex offenders, and people in rural areas often have no treatment options of any kind.

But as little help as there is for convicted offenders, it’s even less likely that offenders who have not yet been caught will get help: Therapists in all 50 states are now required to report sex crimes to the police, and failure to do so can result in criminal charges.

A 1991 Johns Hopkins University study revealed that after Maryland instituted a mandatory reporting law in 1989, the number of undetected abusers who sought treatment dropped from about seven per year to zero.

“This may cause some unidentified children to remain at risk,” says Dr. Fred S. Berlin, associate professor at the Johns Hopkins School of Medicine in Baltimore and founder of the National Institute for the Study, Prevention and Treatment of Sexual Trauma. He says he receives several calls a year from child abusers who want help but don’t want to incriminate themselves.

Most professionals, though they have mixed feelings about mandatory reporting, don’t advocate the elimination of these laws. Marshall Abrams, a sex offender treatment coordinator in Santa Barbara, says that if therapists didn’t have to report abuse to police, it would “put children in harm’s way.”

“In this one instance, we subvert our pledge of confidentiality for the greater good,” he says.

The Redding program sidesteps this legal Catch-22 by offering convicted sex offenders protection from similar crimes--as long as they occurred in the past and the abuse is not ongoing.

Its supporters say it creates the open communication necessary for effective therapy and helps authorities identify and treat victims they might not know about otherwise. “When these guys come in, we need to know just how deviant they are,” says Blasingame, the program director. “If they’re not honest with us, we can’t treat them properly, and the process is counterproductive.”

But this program and others like it deal with convicted offenders, who may represent only a small fraction of child molesters.

Studies suggest that the majority of molesters escape detection. For example, only 12% of rapes of girls under 18 are reported to authorities, according to a 1999 survey conducted by researchers at the Medical University of South Carolina in Charleston. And identifying people who commit incest is even more difficult because fewer than 5% of children will tell anyone.

Stop It Now!, a nonprofit group in Haydenville, Mass., attempts to get abusers into treatment. The organization has launched public awareness campaigns in Vermont, Minnesota and Philadelphia to encourage sexual offenders to seek help. In its first two years of operation in Vermont, 51 people called the hotline seeking treatment.

“One of the best ways to protect children is to make sure abusers have access to good treatment,” says Fran Henry, an incest survivor who founded Stop It Now! “Most sex offenders are unidentified and living in our midst,” she says. “We need to reach these folks when they’re young. If they get the right treatment, they won’t turn into chronic offenders.”

*

Where to Get Help

If you’re an adult who has inappropriate sexual feelings for minors, there are places to get help.

To find the nearest treatment facility, contact these nonprofit groups:

* Stop It Now! in Haydenville, Mass. (413) 268-3096, from 9 to 5 p.m. Eastern time.

* Safer Society Foundation in Brandon, Vt. (802) 247-3132 from 9 to 5 p.m. Eastern time.